Problems with Balance/Vertigo, Dizziness

Vestibular rehabilitation is an exercise-based treatment that facilitates central nervous system compensation to help patients manage/eliminate balance deficits and fall risks, while improving postural stability. Therapy can be used to help a variety of vestibular problems including benign paroxysmal positional vertigo (BPPV), inner ear issues with Meniere’s disease, viral infections of the vestibular nerve, bacterial infections of the middle ear, and recent onset of balance deficits due to trauma or after surgery.

Balance is maintained by the use of three systems:

  1. Vision- the use of sight to determine body positioning and adjustment strategies by looking at the walking surface
  2. Proprioception- the use of muscles and joint position to determine body position and uneven walking surfaces
  3. Vestibular- inner ear fluids and middle ear pressure used to determine head positioning and equilibrium

When one of these systems is damaged by disease or injury, the brain receives inaccurate information about movement and equilibrium resulting in dizziness, balance deficits, and vertigo. This causes the person to develop new movement patterns to avoid motions that make them dizzy; over time loss of range-of-motion and strength occur, which makes the problem worse.

Treatment and Rehabilitation

Physical therapists have received training in how these systems operate as a unit to maintain balance with changing environments and body positioning. Your therapist will perform an evaluation to assess balance/compensations, walking strategies, posture, and past medical history to determine the cause of the impairment. Your therapist will then design a treatment plan and home exercise program that is patient-specific to decrease symptoms and improve balance. The purpose of these exercises is to retrain the brain to effectively process sensory information from the vestibular system and coordinate them with signals from the visual and proprioceptive systems to improve balance. Some treatment options that your therapist may use included gait training, vestibulo-ocular reflex retraining, and canalith repositioning; these strategies help improve stability while walking to minimize fall risks. Initially treatment may cause an increase in symptoms as the brain adjusts to these new movement patterns; however, this improves with continued treatment and symptoms will decrease over time. This allows the patient to return to optimal level of function and regular everyday activities with improved balance.