Vestibular and Balance Rehabilitative Therapy (VBRT)

• Why Therapy is Needed: If the brain cannot rely on the information it receives from the vestibular system, a person's ability to maintain posture and coordinate balance can become overly dependent on vision or on the information received from the muscles and joints (proprioception). This can lead to developing new patterns of movement to compensate for the change and to avoid head movements that are apt to create symptoms of dizziness and nausea. For example, a person might adopt an exaggerated hip sway as a method of balancing, might swivel the entire body rather than just the head in turning to look at something, or might always look down at the floor to avoid what appears as a confusing swirl of activity. Unfortunately, these types of adaptation can result in headache, neckache, muscle stiffness, general fatigue, and a decrease in the ability to retrain the brain to adjust to the vestibular problem, hence making the symptoms much worse.
   
• The Goal of VBRT: to retrain the brain to recognize and process signals from the vestibular system in coordination with information from vision and proprioception. This often involves desensitizing the balance system to movements that provoke symptoms.
   
• What happens during VBRT: A qualified therapist will first perform a thorough evaluation. This includes observing posture, balance, movement, and compensatory strategies. Using the result of this evaluation, the therapist will develop an individualized treatment plan that will include exercises to be performed both in the therapy department and at home and that combine specific head and body movements with eye exercises. Many times, treatment may also include increasing activities and exercise in order to strengthen muscles and increase tolerance for certain stimuli. Some of the exercise and activities may at first cause an increase in symptoms, as the body and brain attempt to sort out the new pattern of movements. But with time and consistent work, the coordination signals from the eyes, proprioception, and vestibular system will occur.
   
• How Does Therapy Help: In most cases, balance improves if the exercises are correctly and faithfully performed. Muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease or disappear. Many times, VBRT is so successful that no other treatment is required.

Canal Repositioning Procedure for Benign Paraoxysmal Positional Vertigo (BPPV)

• In BPPV, true vertigo and other symptoms with certain head movements is due to debris (small crystals of calcium carbonate) which has detached from the utricle of the inner ear and has collected within another part of the inner ear (semi-circular canals). The goal of canal repositioning procedure (CRP) is to move the displaced debris out of one of the semicircular canals back into the utricle so they do not send false signals of movement to the brain.
   
• Through a series of head position changes, the CRP moves the crystals from the canal to the utricle. Once in the utricle, the crystals may re-adhere to the otolithic membrane, dissolve, be broken up, or move some place where they can't cause symptoms
   
• CRP is very effective, with an approximate cure rate of 80% after the initial treatment. The recurrence rate for BPPV after these maneuvers is low. However, in some instances additional treatment(s) may be necessary.
   
• These maneuvers must only be performed by a professional who is trained in the maneuvers and safeguard against possible neck or back injury, and who can determine whether certain health conditions excludes a person from being a candidate for this procedure. Potential complications from this procedure include the possibility of neck/back injury or debris moving into another canal.