Definition and Overview
Vestibular rehabilitation is an exercise-based treatment that induces adaptation, habituation, and sensory replacement of the vestibulo-ocular reflex. It is performed to improve dizziness, oscillopsia, and balance disorders caused by vestibular disorders.
Unlike the approach of suppressing symptoms with drugs, the key principle is to encourage the central nervous system to adapt to changed vestibular signals by repeating prescribed exercises.
Mechanism
Vestibular rehabilitation treatment utilizes three neural adaptation mechanisms.
- vestibulo-ocular reflex adaptation: Training to fixate during head movements restores vestibulo-ocular reflex gains.
- Habituation: Repeated exposure to movements that cause dizziness gradually weakens the response.
- Sensory substitution: Uses vision and proprioception to compensate for impaired vestibular function
composition exercise
Gaze stabilization exercises
It is an exercise that moves the head left, right, up and down while gazing at one point, and induces vestibulo-ocular reflex adaptation. As your gaze fixation ability improves, increase the difficulty by moving the background or target.
habituation exercise
Reduce sensitivity to symptoms by repeatedly performing certain head and body movements that cause dizziness.
Balance/gait training
Training to maintain balance in standing posture, walking, and postural fluctuations reduces the risk of falls and restores daily functions.
Indications
- Unilateral peripheral vestibular hypofunction: the most established evidence of effectiveness.
- Vestibular neuritis recovery phase: Promotes vestibular compensation after the acute phase
- Bilateral vestibular dysfunction: Compensating function through sensory substitution strategies
- Persistent postural-perceptual dizziness (PPPD): Used as adjunctive treatment
Evidence and effectiveness
The American Neurophysical Therapy Association clinical practice guidelines strongly recommend vestibular rehabilitation treatment for patients with unilateral peripheral vestibular dysfunction. The recommendation was maintained in the 2022 revised guidelines.
A Cochrane systematic review presented moderate to high-quality evidence that vestibular rehabilitation treatment is effective in improving symptoms and function in patients with unilateral peripheral vestibular dysfunction. However, in the case of bilateral vestibular dysfunction, the level of evidence is relatively low and additional research is needed.