VESTIBULAR REHABILITATION
WHAT IS VESTIBULAR REHABILITATION?
The vestibular system is your neurological foundation. The primary function of the brain is to localize the body in space so it can respond to the environment. It does this using a series of maps, created by inputs from the eyes, feedback from muscles and joints, and signals from the inner ear receptors of the vestibular system.
The vestibular map is the only one that gives your brain the series of three-dimensional coordinates it needs to create your concept of space. It creates the primary unconscious self-concept upon which all of your other maps are superimposed. Without proper vestibular input, your neurological foundation crumbles. Vestibular dysfunction can be found lurking within virtually any neurological condition.
HOW DOES VESTIBULAR REHABILITATION HELP ME?
People in the fitness industry spend a great deal of time inaccurately describing your “core,” as your abdominal muscles. Your true neurological core is your vestibular system, consisting of your inner ear receptors, your vestibular nerves, and the brainstem, cerebellar and brain structures they stimulate, as well as the pathways they fire. Your vestibular inner ear receptors are constantly sensing your head position in relation to gravity and how your head is moving. They constantly fire down through your vestibulospinal pathway, which is the fastest conducting system in your entire neuraxis. This pathway fires down to your ankles and back up through your spine at a speed measured in milliseconds. It contracts all of your stabilizing muscles to resist any shift in your center of mass, in order to prevent injuries and falls.
Your vestibular system also fires up at the same instant through the medial longitudinal fasciculus pathway to reflexively move your eyes in the opposite direction of head movement, so you can keep your eyes fixated on the visual world as you move. Without proper function of these reflexes, every time you move your head you would have no idea where you are in space, and no ability to stabilize yourself from falling. Impairment of these reflexes is thus seen in just about every condition that involves balance, dizziness, vertigo, and disorientation. Vestibular problems are also often seen in chronic pain states and conditions that involve repetitive reinjury.
The vestibular receptors from the inner ear fire through the vestibular nerves into the brainstem, and directly integrate with areas involved in control of the autonomic nervous system. This involves regulation of heart rate, blood flow, digestion, and stress responses. Impaired vestibular function can potentially be involved any condition involving the autonomic system, ranging from dysautonomia to digestive problems, and anxiety disorders to arrhythmias. Many neurodegenerative disorders can lead to problems with vestibular function. As this is the first sensory system to develop in utero, vestibular impairment is seen in many neurodevelopmental disorders. It provides the foundational awareness necessary for all forms of motor function, and vestibular impairment is found in movement disorders, coordination problems, and sports injuries. We almost always see some level of vestibular impairment in post-concussion syndrome and traumatic brain injuries. We are also regularly seeing vestibular problems in our post-COVID-19 syndrome patients.
WHAT TO EXPECT:
Vestibular rehabilitation can take many different forms depending on your condition and your unique set of circumstances. It generally involves directly stimulating a specific set of vestibular reflexes that have been shown by your diagnostic testing to be problematic. The exercises can include things like repositioning maneuvers designed to float inner ear crystals back where they belong, by holding your head in specific positions until your symptoms subside, while you wear infrared goggles that track your eye movements.
They can involve gaze stabilization techniques where you perform specific patterns of head movement while you keep your eyes still on targets, or exercises where specific head movements are performed immediately before you engage in an eye exercise. You may stand on specialized force plates that track your center of mass while you perform exercises that have you hit targets on a screen by shifting your balance. You may wear a head-mounted laser and be asked to move your eyes and head to track a moving target…
You may perform Gyrostim or Omniax exercises, which involve securing you in one of our robotic rotational devices that perform whole body stimulations in specific vestibular planes. Every case we work with is different, and so is every vestibular rehabilitation protocol.
FAQs
Is Vestibular Rehabilitation Safe?
Yes. Our vestibular therapy exercises are performed in many different positions, ranging from lying down to standing on unstable surfaces. In conditions where your balance may be impaired, a staff member will always be by your side to ensure that you do not fall and are safe at all times.
What Are the Exercises Like?
Many of our vestibular rehabilitation exercises are unique, and all of them are specifically tailored to your findings from your examination and neurodiagnostic testing. They usually involve some form of movement involving the eyes, body and head while you look at stationary or moving targets. These can be performed in positions ranging from lying down to standing on unstable surfaces or vibration plates that move in prescribed directions at specific speeds. They can involve body rotation or body translation in prescribed vectors. They may involve vestibular repositioning or integration maneuvers, during which you wear a set of infrared goggles while a doctor or therapist lies you on a table and moves your head in different positions while they observe reflex movements of your eyes. They may involve Gyrostim therapy, in which you are seated and secured in a motorized gyroscopic chair that rotates your entire body in specific planes of movement. The exercises may be designed to help you stabilize your gaze, to repair specific reflexes, to reposition crystals within inner ear receptors, or to help your motor and postural systems adapt to specific vestibular inputs.
As you progress through your NeuroRescue Program, we will incorporate vestibular stimulation with other forms of therapies. We may add targeted electrical stimulation or some form of light therapy to your vestibular exercises, or we may add a vestibular challenge to one of your cognitive or NeuroSensorimotor Integrator exercises. Our goal with your NeuroRescue Program is always to integrate every aspect of your nervous system at the highest levels, so we try to integrate vestibular stimulation with other multimodal therapies as soon as possible.
How is the NeuroRescue Program Different from Other Vestibular Therapy?
Our program differs from traditional Vestibular Therapy in a number of important respects. We strive to promote correction rather than habituation, and functional restoration rather than compensation wherever possible.
Conventional vestibular treatment usually relies on habituation therapy, in order to promote neurological compensation. It seeks to create conditions for the patient that provoke symptoms, and can be a very uncomfortable and provocative process. By repeatedly exposing the brain to challenging stimuli, the brain learns to compensate for the impaired reflexes and build strategies that help it cope in such situations. This also means pushing the patient to the point where symptoms are provoked and beyond during therapy. In essence, habituation therapy is neurological “tough love.” It can be a very challenging and uncomfortable process, and we see many patients that have dropped out of therapy as a result.
Depending on the level of damage, habituation strategies to build compensations may be necessary to some degree. However, it is important to distinguish between an impairment in capacity, and the reflexes that impair the capacity. If a neurological reflex is damaged, and this leads to an impaired functional capacity, habituation therapy involves repetitively performing the challenging task. Habituation forces and trains the cerebellum and brain to engage other pathways to perform the task, until they learn to compensate for the input with a more appropriate output. This may make the easier to perform over time and decrease some of the associated symptoms, but this will not usually repair the damaged reflex that created the problem in the first place. Compensation strategies also come with a cost, as the cerebellum and brain are forced to divert resources towards the compensation and away from other functions.
Our therapies instead seek to identify the problem reflexes and rebuild them, rather than to simply train strategies to compensate for the problem. We find this to be a much more efficient and effective approach in virtually all cases.
For example, if the vestibular reflex that is fired by moving the head back and to the right does not integrate well with the reflex that is fired when rolling the right ear toward the right shoulder, no amount of balance therapy will correct that specific impairment. You may see your general balance improve with therapy, but your diagnostic testing will still show an impairment of these specific reflexes. You will still likely develop some level of dizziness, vertigo, nausea, light-headedness, and imbalance when looking over your right shoulder. Worse, if these vestibular reflexes do not integrate well with visual systems, your symptoms may increase when visual stimulus is involved, such as when shoulder checking when driving, or when moving through grocery stores. Habituation therapy that forces you to repeat similar tasks over and over may help reduce the symptoms to an extent, but the reflexes will remain damaged, and at some future point in time the compensation will usually fail.
If NeuroRescue strategies are employed first, in order to repair and reintegrate the reflexes that are creating the problem, most if not all symptoms usually resolve, and habituation therapies often become unnecessary. And in cases where we cannot completely get rid of symptoms, the amount of time and effort necessary to train compensations is generally much smaller.
Does Vestibular Rehabilitation Hurt?
No.
LET’S GET YOU BACK TO LIVING YOUR BEST LIFE
“Dr. Z and his team have been just blessings in my life. I have nothing but amazing things to say about this facility, and I genuinely believe that this is the future of medicine.”
Outpatient Treatment Plan
We use advanced neurodiagnostic technologies and cutting edge neurorehabilitation strategies that are unique to your brain and condition.
NeuroRescue Intensive Program
We use high frequency treatment over 5-10 days, to bring you maximum results in the shortest time possible.