Vestibular Rehabilitation for Vertigo in Atlanta, GA
Vestibular rehabilitation therapy aims to alleviate problems caused by vestibular disorders, the primary being vertigo (dizziness). At our Alpharetta, GA clinic we develop customized exercise programs coupled with expert guidance based on the findings of objective testing, a clinical assessment of the patient, and listening to the patient's concerns and goals - to treat vertigo.
What is Vestibular Rehabilitation for Vertigo?
Vertigo is a symptom, as opposed to a condition itself, of sensing motion when there is none. People with vertigo feel that they, or the world around them, are spinning - resulting in their feeling dizzy. Vertigo’s sensation of movement can range from subtle to so severe it’s difficult to maintain balance and complete daily tasks. Vertigo stems from a problem in the inner ear’s vestibular system, which controls balance and is also involved in:
- stabilizing our visual gaze, which is the eye's ability to focus on a stable point when the head is moving in space and;
- maintaining posture which is the ability to remain upright and stable when moving
Research has shown vestibular rehabilitation therapy is effective in treating vertigo by using a problem-oriented approach to promote compensation, and that’s what we do here at Fyzical Therapy & Balance Center. A "problem-oriented approach to promote compensation" is a clinical way of saying:
- We identify your underlying issues that contribute to your vertigo and;
- Correct any deficits (shortcomings, lacking or loss of functioning) by vigorous therapeutic development (exercise & skills training) of what’s neighboring and healthy - in effort to fulfill the function of what’s injured.
Correcting deficits is the foundation of vestibular rehabilitation therapy as vertigo is an indication the neural connection of the vestibular system to and from the brain is disrupted. In other words, the brain's ability to understand the position of the head in context to the rest of the body, gravity and the surroundings is ‘off’, thus the dizziness. Visit our page on Vestibular Rehabilitation for Concussions for a comprehensive discussion on the critical nature of this neural connection and balance.
Correcting the deficit of a damaged neural connection between the vestibular system and brain is achieved through adopting ‘neuroplasticity’ in your therapy. Neuroplasticity describes the brain’s ability to assess function and target regions and/or build new neural pathways to achieve what’s being trained. In sum, the brain can adjust, adapt, and be “retrained” to control balance and spatial awareness.
Vestibular Rehabilitation Exercises for Vertigo
Vestibular rehabilitation therapy for vertigo is an exercise-based program aimed to encourage vestibular (inner ear balance) adaptation and substitution:
- Adaptation exercises are mostly based on vestibulo-ocular reflex (eye movement that stabilizes gaze by countering head movement) and habituation (becoming less sensitive to something after repeated exposure).
- Substitution exercises are mostly based on vestibulo-spinal reflex (using the vestibular system and the skeletal muscles) to keep balance, stability and posture.
Vestibular rehabilitation therapy for vertigo aligns individualized exercises and skills training to the circumstances of the patient. Therefore before your vertigo recovery program can be designed, a comprehensive clinical examination is required to identify the scope and scale of your vestibular dysfunction. Generally speaking, these results form the foundation of 3 principal methods of exercise that are prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.
Habituation Exercises
Habituation exercises treat symptoms of dizziness produced from self-motion and/or exposure to visual stimuli. This means patients who report increased dizziness or feeling unbalanced when they move around, make quick head movements, or with the changing of positions like when bending over or looking and reaching up above their head. Also, habituation exercise is effective for patients reporting dizziness from being overwhelmed visually. This could arise from being in high density and activity environments like when shopping, at airports, and/or when walking over shiny floors or patterned carpets and/or when watching action on video screens. Habituation exercises aim to reduce dizziness through repeated exposure to visual stimuli or specific movements that mildly, or at the most, moderately provoke the patient’s symptoms. Over the course of some weeks and with regular visits, the intensity of the dizziness subsides due to the brain having been retrained to ignore the abnormal signal or former triggering action.
Gaze Stabilization
Gaze Stabilization exercises aim to improve eye movement control so vision can be clear and stable during head movement. These exercises are for patients reporting their vision seems to bounce, jump, jiggle, or vibrate, such as when reading or walking outside and looking at an object such as a street light.
Balance Training Exercises
Balance training aims to improve steadiness so daily activities such as work, self-care, and enjoyment of life can be fully resumed both safely and successfully. Exercises will be safe but moderately challenging, something required to realize growth and development. Also, balance exercises are designed to overcome any risk areas or environmental barriers in the patient’s daily life. For example, people have homes with stairs, property with sloped landscape, uneven ground, narrow passageways to backyards and dimly lit spaces. As we all know, the traffic in Atlanta can be a stressful experience. It’s commonplace to have feelings of vertigo triggered while driving by objects passing by you much faster than normal. This leads to vertigo experiences because your visual processing speed increases. Whatever the patient’s unique circumstances may be, balance exercises will help the patient resume their full lifestyle, safely and with confidence.
While exercises are straight forward and not hard to learn, that doesn’t mean they are easy. You will be challenged and committing to a regular schedule is essential to helping you achieve success. Initially exercises may seem to make symptoms worse, but overtime and with consistency symptoms steadily decline and you’ll soon be resuming your daily activities and lifestyle. An important part of the vestibular rehabilitation exercise program is to ensure some of the maneuvers can be performed regularly at home.
What to Expect From Vestibular Rehabilitation for Vertigo
Vestibular rehabilitation starts with a comprehensive clinical assessment that covers a detailed medical history (medications, vision or hearing issues, injuries) and listening to the patient describe their symptoms, how their living situation and daily activities are affected. Our therapist will build a profile of the symptoms including type and intensity along with the preceding circumstances triggering vertigo.
Our therapist will also build an objective profile by a series of tests that screen the patient’s visual and vestibular systems to learn how well eye movement is being controlled, for example. We’ll learn about the patient’s muscle strength, extremity and spine range of motion, posture, balance, coordination, and walking ability.
An individualized exercise program is structured from the findings of the clinical assessment, the results from any needed lab testing and/or imaging, and listening to the concerns and goals of the patient. For instance, a person coping with BPPV may be prescribed canalith repositioning* exercises in response to the dizziness and spinning they’re experiencing. However someone with gaze instability while walking due to vestibular neuritis (an inner ear disorder) may be prescribed habituation and gaze stability exercises, and possibly balance exercises if necessary.
Education is also an integral part of vestibular rehabilitation for vertigo as it’s helpful for patients to understand the basic science behind their unique issues and the fundamentals of their treatment program. Education also takes away much of the mystery of what’s transpiring, which in turn helps reduce any anxiety or stress that may accompany the vertigo recovery journey.
* Canalith repositioning exercises: Vertigo is frequently the result of displaced tiny calcium carbonate crystals (or canaliths), misplaced in the semi-circular canals of the inner ear. The Epley maneuver is a canalith repositioning exercise and procedure to remove these trapped crystals, click here to learn more about the Epley maneuver.
Vestibular Rehabilitation Therapy: 3 Types of Vertigo
There are 3 types of vertigo: peripheral, central, and psychogenic.
Peripheral Vertigo
Peripheral vertigo is the most common, often accompanied by nausea and vomiting, usually caused by vestibular system dysfunction and triggered by head movements.
Examples are:
-Benign paroxysmal positional vertigo (BPPV): BPPV is the most common cause of vertigo, accounting for half of all cases. We speak to BPPV at length including our treatment here.
-Labyrinthitis & vestibular neuritis: Inflammation in your inner ear (vestibular nerve) is often caused by a bacterial infection.
-Meniere’s disease: Results from a buildup of fluid in the inner ear and treated with diuretics.
-Migraines: Migraines trigger vertigo due to their impact on the central nervous system. We speak to Migraines at length including our treatment here.
-Perilymph fistula: A condition caused by a tear in the membrane that separates the inner & middle ear.
-Acoustic neuroma: A condition caused by a tumor on the nerve connecting the brain to the inner ear.
-Vestibular paralysis: Paralysis of the muscles controlling eye movement and treated with physical therapy to return full function and coordination.
Central Vertigo
Usually the result of a central nervous system problem involving the brain or spinal cord. The most common is stroke, but tumors, inflammation due to infections, or migraines can also cause it. Along with dizziness, sufferers usually are coping with neurological symptoms such as trouble speaking, weakness, or changes in vision.
Psychogenic Vertigo
It is caused by psychological issues, such as depression, panic disorder, stress or anxiety. It can also be triggered by vestibular migraine.
Our goal in vestibular rehabilitation physical therapy is to reduce if not eliminate symptoms of vertigo or dizziness, strengthen gaze stability, improve balance and mobility, and lower the risk of falls and accidents. Beyond the physical benefits, vestibular rehabilitation can also improve emotional and mental health, increasing your confidence in maintaining balance, and decreasing any stress and anxiety. At FYZICAL Therapy & Balance Centers - Alpharetta, our team of experienced therapists is dedicated to helping our patients diagnose and alleviate the causes of vertigo to achieve optimal health and wellness.