Ft. Célia Serrão

Physiotherapist
Vestibular Rehabilitation Specialist

Vestibular Rehabilitation

How to “Tackle” Dizziness and Imbalance

HPA Magazine 10

Vestibular rehabilitation is a method that is being used more and more in physiotherapy for the rehabilitation of patients with vestibular disorders and equilibrium deficiency, and is in fact considered the best therapy in these cases. It aims to improve not only the equilibrium and symptoms of vertigo/dizziness, but also improve the patient’s self-confidence, and therefore their quality of life.
In the application of these techniques, a concise, objective assessment is important in order to reach a correct diagnosis and chart a protocol for a personalised intervention, in accordance with the lesion and the patient’s complaints.

Alterations of the peripheral and/or central vestibular system provoke signs of spontaneous nystagmus (repeated, involuntary movements of the eyes) and postural deviations, as well as symptoms such as vertigo, pathological nystagmus, imbalance, changes in vision, nausea, vomiting, stiff neck, vestibular ataxia and changes of consciousness, with significant functional limitations in the day-to-life of the patient.
Rehabilitation vestibular basically acts on the mechanisms of neuroplasticity that seek a more efficient central compensation in the recuperation of functions. Furthermore, the evidence also concludes that early vestibular rehabilitation, in the stage of vertiginous crisis, can improve the symptoms of dizziness and prevent future complications such as anxiety, reduced functional capacity and risk of falls.
Generally speaking, the objective of this method is the adaption to visual-vestibular interaction (eye-movement stabilisation) using repetitive movements of the head and/or eyes, which contribute towards reducing the error and the recovery of the vestibulo-ocular reflex.
Intervention techniques for peripheral vestibular lesions (especially unilateral peripheral vestibular dysfunction, such as vestibular neuritis and the labyrinthitis), bilateral vestibular dysfunction, multi-sensory impairment in the elderly, central vestibular syndromes, psychogenic vertigo, positional vertigo (benign positional paroxysmal vertigo and central positional vertigo) and visual vertigo can be used.
Basically, exercises for postural control, prevention of falls and functional re-education are used, based on principles of motor relearning that foster behavioural change and the development of motor skills.
There are specific repositioning manoeuvres in vestibular rehabilitation for patients with specific dysfunctional diagnoses, such as benign positional paroxysmal vertigo. This is the case of the canalith repositioning procedure or Epley, Semont and Liberatory manoeuvres, done by the therapist with the goal of repositioning the crystals, and can later be complemented with eye motricity, vestibulo-ocular, vestibular medulla and proprioceptive exercises.
Two or three sessions per week are usually given, depending on the stage of intervention and encompass manual therapies as well as vestibular repositioning manoeuvres. There can also be visual integration, ocular stabilisation and proprioceptive exercises, in accordance with the pathology.
It is equally important to teach patients exercises and strategies for balance control and coordination, aimed at improving their everyday lives.