Although vestibular rehabilitation is often associated with dizziness after concussion, the method is also used for, among other things, persistent symptoms after BPPV, vestibular neuritis and persistent postural-perceptual dizziness (PPPD).
The brain can be trained
The balance system depends on an interplay between the inner ear, vision and the body's proprioceptive system. When this interplay is disrupted, the brain can have trouble interpreting the information it receives.
Vestibular rehabilitation builds on the brain's ability to adapt, often referred to as neuroplasticity. By exposing the system to gradually greater challenges, the brain learns to handle these signals better, and you will often experience an improvement in symptoms.
It is not unusual for the exercises to provoke symptoms along the way. This is often an expected and necessary part of the rehabilitation process.
How does vestibular rehabilitation work?
The treatment is adapted to the individual patient and based on which functions are affected. After a thorough examination, an individual exercise programme is drawn up.
Common elements in vestibular rehabilitation include:
● Gaze stabilisation exercises ● Head and body movements with gradually increasing challenges ● Balance training ● Habituation ● Graded exposure to activities that trigger symptoms
The aim is not to avoid the symptoms, but to increase tolerance for movement and activity over time. This is best done together with qualified healthcare professionals, and should feel safe for you as the person doing the exercises.
Active rehabilitation rather than passive treatment
In recent years research has moved away from the idea that prolonged rest alone is the best solution for vestibular problems. Today we know that many patients achieve better results through targeted and gradual exposure to movement.
Vestibular rehabilitation is therefore not about fixing something in the nervous system, but about training the brain's ability to handle information from several systems at the same time.
For many, this can be an important part of the way back to normal activity, work, exercise and an everyday life with less dizziness.
This article was written by Carl Johan Ween, chiropractor at Behandlerverket Oslo sentrum. He has further education in concussion and dizziness, and works in particular with assessment and treatment of patients with post-concussion syndrome, vestibular problems and other causes of dizziness.
References
Hall CD, Herdman SJ et al. Vestibular Rehabilitation Clinical Practice Guideline. Journal of Neurologic Physical Therapy, 2022.
McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews, 2015.
Galeno E, Kleffelgaard I, Soberg HL et al. Effectiveness of Vestibular Rehabilitation after Concussion: A Systematic Review of Randomised Controlled Trials. Healthcare, 2023.