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How and Why Vestibular Rehabilitation Can Help You

Vestibular Rehabilitation, which is a form of Balance Retraining Therapy, has emerged over the past several years as an alternative treatment for patients with chronic non-resolved motion intolerance, visual sensitivity, and imbalance problems. Patients get better and return to normal lives because of this treatment.

In order to understand how Vestibular Rehabilitation works and the underlying corrective mechanisms, it is important to remember that the primary role of the vestibular system is to tell the brain where the head is in space. Quite simply, the vestibular system is our internal reference telling the brain how our head is orientated - up, down, tilt, etc. The visual and somatosensory (touch, pressure, pain) systems, on the other hand, are external references, providing our brain with information about the movement and stability of the world around us. Working together and when the systems agree, it is the integration of these sensory modalities that provides us with normal equilibrium.

When there is a conflict between internal and external references, the result is the brain's inaccurate perception or hallucination of motion, or vertigo (dizziness). An example of this occurring in everyday life is the feeling of moving forward when stopped at a traffic light, when a larger vehicle in your peripheral vision has rolled backward. There was simply a conflict between the three sensory modalities. The input from the motion detector aspect of the visual system overrode the input from the vestibular and somatosensory systems creating the hallucination or perception of motion.

Another way to look at a conflict in the balance system is to think of yourself as a car with a front-end alignment problem. If you take your hands off the wheel, if you are distracted, or if the environment is challenging, you can find yourself drifting into another lane. In a sense, this is the "dizziness" you may experience with a balance disorder. Hitting the burm or getting a horn from someone next to you is the signal you are going off-kilter. It is the symptoms of dizziness - the possible nausea, visual sensitivity, motion intolerance, and/or feeling of unsteadiness that you may feel with a balance disorder. It can last for seconds, minutes, hours, days, or daily. The first thing you will want to do is avoid the sensation - I would think the same. If something makes you feel sick, you're first inclination is to stop the movement. You may also be given vestibular suppressants to reduce the symptoms - over 70% of all patients going to the PCP for dizziness are given Meclizine. The problem with both these issues is that in most cases (not all), this is the exact opposite of what you should do. Have you ever wondered how a figureskater spins or a combat pilot flies a jet - they challenge to the point of "dizziness" or "disorientation" and then recover. They do it in a dose-like manner - just like taking a pill for arthritis pain. Through repetition, practice, and mental training most are able to reduce the symptoms and even eliminate the problem. This is what needs to be done with most balance disorders but frankly is not done.

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