Overview, Vestibular Rehabilitation Therapy, Vestibular Rehabilitation Therapy Program. Vestibular rehabilitation exercises focus on gaze stability and gait stability. Gait stability includes both static and dynamic balance exercises. VOR stimulation exercises. The VOR maintains stable gaze and visual focus during active and passive head motion. This first set of exercises is designed to improve the gain and accuracy of the VOR.
The first activity involves moving the head while focusing on a stationary target while attempting to maintain stabilizing gaze on the card. For head movements in phase with a target (X1 viewing), hold a card with lettering at arm's length with eyes focused on the letters. Move the head from side to side, increasing speed with each progression. Repeat the entire cycle 2. The head can also be moved vertically and diagonally. Progress from sitting to standing with the feet shoulder width apart to standing with the feet together to standing partially pointed (one foot half way ahead of the other) to standing pointed (one foot completely in front of the other). The patient should progress from standing on a firm surface to standing on a compliant surface.
What is a Home VRT program?During vestibular rehabilitation therapy (VRT), home exercises are a vital part of treatment. Vestibular Rehabilitation Exercises – Level 1, page 3 6. Visuo-vestibular: Head/eyes moving in opposite direction Holding a single target, keep eyes fixed on target. Vestibular Rehabilitation Therapy (VRT) The American Academy of Otolaryngology has issued a position statement on the treatment of balance related disorders.
Post the card on the wall with a plain background and progress to posting on a wall with a busy patterned background. As function improves, the exercise can be advanced to moving the card opposite to head movement. The patient moves the head to the right and the card to the left while keeping the eyes focused on the letters. Then, the patient moves the head to the left and the card to the right keeping the eyes focused on the letters. The patient begins slowly and increases speed as the test progresses but keeps the letters in focus.
Information on rehabilitation therapy that can lessen the impact of a vestibular disorder on the sufferer. Vestibular rehabilitation is an exercise-based therapy that maximizes the body's natural ability to maintain balance. The Vestibular Rehabilitation Program at NYU. Vestibular Rehabilitation. Vestibular rehabilitation is an exercise-based therapy program used to treat problems associated with balance, vertigo and dizziness.
This is repeated the entire cycle 2. This test can also be performed in a vertical direction. The patient can progress from sitting to standing to a sharpened stance as described above. Ocular motor exercises. To increase pursuit gain, the patient holds a card with lettering at arm's length.
Then the patient moves the card left and right across the visual field, tracking with eye movement and keeping the head still. The full cycle is repeated 2. The test can be performed in the vertical and diagonal directions with increasing speed but being certain to keep the letters in focus. After this the patient can progress from sitting to standing to a sharpened stance as described above (see VOR stimulation exercises above). To improve saccade latency, velocity, and accuracy, the patient can hold a card with lettering in each hand approximately 1. While keeping the head still, the eyes are moved back and forth from card to card with 1 second per card.
This is repeated 2. This test also can be performed in the vertical and diagonal planes.
The patient can progress from sitting to standing to a sharpened stance as described above (see VOR stimulation exercises above). Habituation exercises. Habituation exercises are the focus of vestibular rehabilitation with respect to benign paroxysmal positional vertigo. Although 2. 00. 7 guidelines for management of benign paroxysmal positional vertigo recommend initial treatment of the condition with particle repositioning maneuvers (PRMs) such as the Epley, Liberty, or Semont, more recent studies have shown that combining PRM with vestibular rehabilitation improves outcomes. In a rapid systematic review, Epley was found at 1- week follow- up to be more effective than VRT in the treatment of posterior benign paroxysmal positional vertigo.
At 1- month follow- up, however, VRT and the Epley maneuver appeared to equally effective, although the evidence was inconsistent. Habituation exercises have also been shown to aid in the recovery of patients with vestibular neuritis. Balance exercises. The patient stands with the feet together. The patient may maintain balance by reaching out and touching the wall in front of them. The patient begins to take the hands off the wall for progressively longer periods. First the patient begins by taking 1 hand at a time off the wall and alternates hands.
Second, the patient sharpens the stance and stands with the feet shoulder- width apart looking at a target on the wall. The patient narrows the base of support by sharpening the stance. This is performed first with arms outstretched, then close to the body, and then folded across the chest. The patient can sit and then stand with the head bent forward 3.
The patient reaches up as though for an object over the head and then bends over as though picking up an object from the floor. The patient can then progress from sitting to standing to a sharpened stance. Exercises are performed in dim lighting and then with eyes closed. The difficulty level is raised by standing on foam or a pillow and then standing to one leg. Another exercise is making a circle with a ball. The eyes focus on the ball and then the patient moves it in a circular fashion in both directions with increasing speed.
The head and body moves with the ball. Difficulty level is raised as the patient progresses from sitting to standing to a narrowed stance. Tai chi is an effective adjunct to balance exercises, especially for those with imbalance when standing.
The evidence supporting the effectiveness of vestibular rehabilitation is. Rehabilitation in vestibular injuries.
These slow and deliberate routines may train balance mechanisms in a different and complementary way to more conventional standing, walking, and head- movement exercises. Gait exercises. In walking exercise 1, the patient begins by walking next to a wall with the hand out for support. Then, the patient gradually increases the number of steps without support. The stance is narrowed and the patient can also move the head in the vertical plane. The patient practices turning when walking, first with large circles, then with gradually smaller turns, in both directions.
In walking exercise 3 (sit to stand), the patient walks from one chair to another chair position 1. Upon reaching the first chair, the patient sits without using the hands, waits for 5 seconds, and rises without using the hands.
The patient goes to the second chair, touches it, and, with support, practices standing on 1 leg for 5 seconds. The entire cycle is repeated 1. The patient can add head movements as the exercise progresses, increase walking speeds, and decrease the width of gait. Combined category exercises. For an obstacle course, the patient can step over objects and around furniture.
Difficulty is increased by bending over, picking up objects, throwing and catching objects, bouncing them off walls, and walking on differing compliance surfaces. The patient can also practice at the grocery store by pushing a cart. First the patient pushes with minimal support and then no support from the cart. The patient can begin with slow, small head movements, increasing speed and degrees of motion. Also the crowd can play a factor in the rehabilitation. The patient should go when few patients are shopping and then progress to a crowded time of the day. The patient should make an effort to look at items that are on the top and bottom shelves.
The patient can also walk at the mall by beginning with slow walks close to the wall and by going with the flow of the crowd. Then the patient can increase speed, move away from the walls, and go against traffic. Window shopping with purposeful head movements is helpful. Computer- aided rehabilitation.
Recent advances in the ongoing research of vestibular dysfunction and rehabilitation have incorporated technology in the treatment sessions. One group incorporated virtual reality VRT into the traditional VRT sessions and documented improved posturography, vertigo, and mental health scores. At the time of its publication, the 2. Cochrane review claimed that this study had been the only study which reached statistical significance in comparing different forms of vestibular rehabilitation.
The review deemed that evidence was sufficient to support the addition of a simulator based activities to vestibular rehabilitation programs. NASA has used this virtual reality technology and taken it one step further.
The use of this technology is definitely exciting. Electrotactile stimulation. Vestibular rehabilitation has also been incorporated with electrotactile vestibular substitution system (EVSS) for the treatment of bilateral vestibular loss in patients with aminoglycoside- induced ototoxicity.
Aquatic physiotherapy. Gabilan et al studied the use of aquatic physiotherapy as part of vestibular rehabilitation in patients presenting with chronic dizziness with unilateral vestibular hypofunction. All rehabilitation exercises took place in a pool and included tasks such as rotational control of the trunk, gait with thrust, sitting position on a float, upright buoyancy, and balance control during turbulence. The study found that the participants had lower DHI scores, reduction in variation of body displacement by posturography, and significantly lower self- perception of dizziness intensity. For example, a study by Sparrer et al indicated that early rehabilitation using the Nintendo Wii Balance Board can benefit elderly patients with acute vestibular neuritis. It was found that patients whose therapy included use of the device had shorter inpatient stays than did other patients in the study. Patients who used the Wii Balance Board also showed faster resolution of nystagmus, as well as greater improvement on the Sensory Organization Test, the DHI, the Vertigo Symptom Scale, and the Tinetti questionnaire.