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Vestibular rehabilitation therapy is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are
1) to enhance gaze stability
2) to enhance postural stability
3) to improve vertigo
4) to improve activities of daily living.
VRT facilitates vestibular recovery mechanisms: vestibular adaptation, substitution by the other eye-movement systems, substitution by vision, somatosensory cues, other postural strategies, and habituation. The key exercises for VRT are head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks, repeating the movements provoking vertigo, and exposing patients gradually to various sensory and motor environments. VRT is indicated for any stable but poorly compensated vestibular lesion, regardless of the patient's age, the cause, and symptom duration and intensity. Vestibular suppressants, visual and somatosensory deprivation, immobilization, old age, concurrent central lesions, and long recovery from symptoms, but there is no difference in the final outcome. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery.
VRT is indicated for the following conditions
Stable vestibular lesion
VRT is indicated for any condition characterized by a stable vestibular deficit, in which evaluation reveals no evidence of a progressive process and the patient's natural compensation process appears to be incomplete.2
Central lesions or mixed central and peripheral lesions
Patients with stable CNS lesions or mixed central and peripheral lesions should not be excluded from treatment, although their prognoses are likely to be more limited than the average patient with a stable peripheral injury.2 A trend for the overall performance to be worse for mixed central-peripheral disease than for pure unilateral peripheral disease was seen, but no significant differences have been identified.
Head injury
Patients with head injuries suffer from significant disability due to vestibular symptoms. Their conditions often include cognitive and central vestibular involvement along with a peripheral component. VRT techniques are therefore used as a supplement to a comprehensive, multidisciplinary head-injury program.
Psychogenic vertigo
Patients with panic disorderand other anxiety disorders often seek treatment for ill-defined vestibularsymptoms. After appropriate evaluation is performed, VRT may be recommended asan adjunctive measure for their condition. If the anxiety is mild, VRTfunctions as a behavioral intervention similar to exposure therapy for thetreatment of phobias. If the anxiety component is significant, and particularlyif panic attacks are frequent, psychiatric intervention will also be required
Elderly with dizziness
In older adults withsymptoms of dizziness and no documented vestibular deficits, the addition ofvestibular-specific gaze stability exercises to standard balance rehabilitationresults in a greater reduction in fall risk.
Vertigo with uncertain etiology
It is not always possiblefor the physician to determine whether the patient's complaints are due tostable vestibular disease with inadequate central compensation or to unstablelabyrinthine function. For the patients in whom the cause of vertigo is notclarified despite extensive diagnostic efforts, an empirical trial ofvestibular physical therapy may be a helpful option. Identifying patients forwhom the symptoms are not the direct result of a vestibular lesion does notprevent the use of vestibular rehabilitation as an adjunct treatment.
BPPV
One study found thatresidual dizziness after successful repositioning was observed in two-thirds ofpatients with BPPV, and disappeared within 3 months without specific treatmentin all cases. Nevertheless, balance training may be necessary after treatingBPPV.