Vestibular Rehabilitation for Vertigo, Dizziness, and Imbalance

Balance is a multifactorial process involving, on a basic level, what we see, feel, and how our inner ear responds to head movements.  

Vestibular rehabilitation is a form of therapy that harnesses the amazing ability of the brain to compensate for and adapt to difficulty processing information from the inner ears.  When the ability to process this information is impaired, whether through injury, age related changes, or hypersensitivity, dizziness, vertigo, and disequilibrium can occur.  

Vestibular rehabilitation involves maneuvers to improve the health of the inner ear balance organs, exercises to improve gaze stability and functional vision, activities to improve head-eye coordination, habituation exercises to reduce dizziness severity, and activities to help organize the sensory systems involved in equilibrium and balance.

Jessica Malouf PT, DPT has received competency in vestibular rehabilitation for children and adults from the American Physical Therapy Association, Emory University, and Speciality Therapy Source. She has been evaluating and treating dizziness and balance dysfunction since 2008 and is a member of the Vestibular Disorders Association (VEDA).  

Causes of dizziness treated at mainstay include:

Benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, unilateral and bilateral vestibular hypofunction/loss, migraine associated vertigo, visual vertigo, persistent postural-perceptual dizziness (chronic subjective dizziness), cervicogenic dizziness, Miniere's disease, dizziness related to anxiety, and vertigo/dizziness after TBI or stroke.

Infrared Video Googles

I use infrared video infrared goggles to help accurately diagnose and treat many kinds of dizziness including BPPV and vestibular loss/hypofunction.  These googles allow for eye movements to be viewed via video while the patient's vision is blocked.  One a patient's eyes cannot fixate on something in their visual environment, abnormal eye movements indicative of vestibular dysfunction can be seen much more easily.  The ability to see the specific direction and quality of these abnormal eye movements, called nystagmus, is paramount in the accurate diagnosis of specific types of vestibular dysfunction, such as BPPV.



Virtual Reality

I also use virtual reality (VR) and video exposure to simulate experiences that may trigger symptoms and sensitivities in a safe and controlled environment.  VR allows for slow and controlled progressive exposure to triggering stimuli to encourage the normalization of the central nervous system (CNS) response to these stimuli.  Over time, this desensitization process diminishes CNS reactions to triggering stimuli such as busy, moving backgrounds, resulting in reduced feelings of dizziness.