A vestibular therapist is a specialized physical therapist who evaluates and treats disorders of the vestibular system. These professionals aim to alleviate symptoms such as vertigo, lightheadedness, and unsteadiness. Their goal is to help patients regain stability, reduce the risk of falls, and improve daily activities and quality of life.
Understanding the Vestibular System
The vestibular system, located within the inner ear, maintains balance and spatial orientation. It works by detecting head movements and changes in position, sending this information to the brain. It consists of the semicircular canals, which sense rotational movements, and the otolith organs (utricle and saccule), which detect linear acceleration and the head’s position relative to gravity.
This system collaborates with other sensory inputs, like vision and proprioception (the sense of body position), to provide the brain with a comprehensive understanding of body position. When the vestibular system functions correctly, it allows for stable vision during head movements through the vestibulo-ocular reflex and helps maintain an upright posture. If disrupted, it can lead to dizziness, vertigo, and imbalance.
Conditions They Treat
Vestibular therapists address a range of conditions affecting balance and causing dizziness. Benign Paroxysmal Positional Vertigo (BPPV) is a common disorder they treat, characterized by brief, intense episodes of vertigo triggered by specific head movements. It occurs when tiny calcium carbonate crystals (otoconia) dislodge from their normal inner ear location and move into the semicircular canals.
Vestibular neuritis and labyrinthitis involve inflammation of the inner ear or vestibular nerve, leading to sudden severe vertigo, nausea, and imbalance. Meniere’s disease is another chronic inner ear disorder they manage, causing recurring episodes of vertigo, ringing in the ears (tinnitus), hearing loss, and fullness in the affected ear. These symptoms result from a disruption in fluid balance within the inner ear.
Vestibular therapy also treats post-concussion syndrome, where dizziness, balance problems, and visual disturbances persist after a head injury. Persistent postural-perceptual dizziness (PPPD) is a chronic condition characterized by non-spinning dizziness and unsteadiness that worsens with upright posture, movement, or exposure to complex visual stimuli. Vestibular therapists also help older adults with age-related balance decline and assist with balance issues stemming from neurological conditions like stroke or traumatic brain injury.
What Vestibular Therapy Involves
Vestibular therapy begins with an initial assessment by the physical therapist. This comprehensive evaluation includes tests to assess balance, eye movements (oculomotor function), gait analysis (how a person walks), and head movements to identify dysfunction. The therapist may use specialized equipment, such as infrared goggles, to observe and record eye movements, aiding diagnosis.
Based on assessment findings, a customized treatment plan is developed, incorporating Vestibular Rehabilitation Exercises (VRT). Gaze stabilization exercises train the brain to use vestibular information more effectively to maintain clear vision during head movements. These exercises involve fixating on an object while moving the head back and forth or up and down to improve the vestibulo-ocular reflex.
Habituation exercises reduce dizziness symptoms by repeatedly exposing the patient to movements or situations that provoke their symptoms, decreasing sensitivity. Balance training exercises are another component, aiming to improve stability and reduce fall risk, often progressing from stable to unstable surfaces. These exercises help individuals improve their ability to sit, stand, walk, turn, and navigate various environments. For conditions like BPPV, canalith repositioning maneuvers, such as the Epley maneuver, physically reposition displaced inner ear crystals, resolving vertigo. The goal of these interventions is to help the brain compensate for vestibular deficits or resolve specific inner ear issues, improving functional abilities.