Vestibular, Balance and Dizziness Rehabilitation

Introduction

Vertigo, balance and dizziness problems affect people of all ages and occupations. Vertigo is a sensation that the room is spinning and makes mobility difficult.  Nausea, lightheadedness, ear ringing, fear of falling, double vision, ear pain and motion sickness may accompany dizziness.  These symptoms occur when the brain receives conflicting messages from the three primary pathways that influence our sense of balance and equilibrium:  the eyes, the inner ear (vestibular system) and our joint and muscle receptors.  It may be especially difficult to turn over in bed, or come up to a sitting position.  Moving a certain direction or looking at still objects while you are moving can also provoke symptoms.  Symptoms can come on suddenly, or be more chronic.  Dizziness and balance impairments can be severely limiting to functional activities and independence, and is of significant concern for walking safety and risk of falls, especially in the elderly.  Inner ear disorders cause approximately 85% of all dizziness and vertigo problems.  Other causes may be aging, exposure to unusual motion or altered gravitational forces with flying or cruises, multiple sclerosis, neck problems or injuries and decreased endurance after surgery.

Balance is a very complex activity.  It requires multiple systems in the body to communicate and work in coordination.
Balance involves:
(1) the vestibular system in the inner ear, to provide input to the brain about the body’s motion and spatial orientation,
(2) the visual system, to provide input to the brain about spatial orientation,
(3) proprioceptive input from sensors in the muscles, tendons and joints, again, to provide input about the body’s position in space (for example, these sensors allow us to know that our arm is bent even when our eyes are closed),
(4) the brain, spinal cord and nerves, in order to receive and process all of the incoming information and then communicate changes in order to maintain balance,
(5) the musculature system, in order to appropriately position and stabilize the eyes and body.

To learn more about dizziness, refer to our Neurology Library’s Dizziness article.

Minneapolis Clinic of Neurology Balance and Vestibular Rehabilitation

The physical therapists at the Minneapolis Clinic of Neurology are well trained and highly experienced in Vestibular Rehabilitation Therapy (VRT) and balance retraining.  Each patient is thoroughly evaluated to determine the origin of their symptoms and appropriate treatment is provided accordingly.  Vestibular Rehabilitation primarily focuses on exercises to retrain the brain to adapt and re-organize input from the vestibular mechanisms and to eliminate the conflicting signals that cause dizziness.  In simple terms, the brain is taught to ignore the input from the dysfunctional system and pay attention more to the other signals. Balance retraining exercises are prescribed depending on the system that has been compromised.  Typically balance rehabilitation strives to improve coordination and stability, by increasing strength, flexibility and/or endurance.  Rehab also includes recommendations for environmental adaptations and/or adaptive devices in order to minimize the risk of falls.  Our goal is to help patients minimize their dizziness symptoms and improve their balance, thereby improving their function, independence and safety.