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Why is therapy needed?
If the brain cannot rely on the information it receives from the vestibular system, a person’s ability to maintain posture and coordinate balance can become overly dependent on vision or on the information received from the muscles and joints (proprioception).

This can lead to developing new patterns of movement to compensate for the change and to avoid head movements that are apt to create symptoms of dizziness and nausea. For example, a person might adopt an exaggerated hip sway as a method of balancing, might swivel the entire body rather than just the head in turning to look at something, or might always look down at the floor to avoid what appears as a confusing swirl of activity.

Unfortunately, these types of adaptation can result in headache, neck ache, muscle stiffness, general fatigue, and a decrease in the ability to retrain the brain to adjust to the vestibular problem, hence making the symptoms much worse.

The goal of VRT is to retrain the brain to recognize and process signals from the vestibular system in coordination with information from vision and proprioception. This often involves desensitizing the balance system to movements that provoke symptoms.

What happens during vestibular therapy?
We will first perform a thorough evaluation. This includes observing posture, balance, movement, and compensatory strategies. Using the result of this evaluation, the therapist will develop an individualized treatment plan that will include exercises to be performed both in the therapy department and at home and that combine specific head and body movements with eye exercises. Many times, treatment may also include increasing activities and exercise in order to strengthen muscles and increase tolerance for certain stimuli.

Some of the exercise and activities may at first cause an increase in symptoms, as the body and brain attempt to sort out the new pattern of movements. But with time and consistent work, the coordination signals from the eyes, proprioception, and vestibular system will occur.

How does therapy help?
In most cases, balance improves if the exercises are correctly and faithfully performed. Muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease or disappear. Many times, vestibular VRT is so successful that no other treatment is required.
If surgery is required to correct an inner ear problem, therapy will also be an important part of treatment. A therapist may perform a vestibular evaluation before surgery, make daily visits during the hospital stay to help with the temporary increase in balance problems that often accompanies surgery, and may provide a series of simple exercises to do for home care after discharge from the hospital. Often, therapists provide further therapy after a person has recovered from the surgery.

BPPV (Benign Paroxysmal Positional Vertigo)
(Benign Paroxysmal Positional Vertigo) of the inner ear is a common cause of dizziness. About 20% of all dizziness is due to BPPV. The older you are, the more likely it is that your dizziness is due to BPPV, as about 50% of all dizziness in older people is due to BPPV. In a recent study, 9% of a group of urban dwelling elders were found to have undiagnosed BPPV (Oghalai, J. S., et al., 2000).

The symptoms of BPPV include dizziness or vertigo, lightheadedness, imbalance, and nausea. Activities which bring on symptoms will vary among persons, but symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common “problem” motions. Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, sometimes BPPV is called “top shelf vertigo.” Women with BPPV may find that the use of shampoo bowls in beauty parlors brings on symptoms. An intermittent pattern is common. BPPV may be present for a few weeks, then stop, then come back again.

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