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Vestibular Rehabilitation Therapy: Role of Physical Therapy in Management of Vertigo

Preeti Madaan

Vestibular Rehabilitation Therapy (VRT) is the therapy used for rehabilitation of patients with vestibular lesion who have not compensated fully. Basically Vestibular Rehabilitation Therapy is customized exercise program designed according to the need of patient by physiotherapist.

Three clear indications for vestibular rehabilitation

1. Specific interventions for benign paroxysmal positional vertigo (BPPV)

2. General interventions for vestibular loss

2.1 Unilateral vestibular loss e.g. in case of vestibular neuritis or acoustic neuroma

2.2 Bilateral vestibular loss e.g. in case of gentamycin toxicity and related conditions

2.3 Central vestibular lesions - brainstem infarct, cerebellar infarct, MS etc.

3. Empirical treatment for common situations where the diagnosis is unclear

3.1 Post-traumatic vertigo

3.2 Multifactorial disequilibrium of the elderly

Persons without a vestibular problem e.g. the patients who will not benefit from vestibular rehabilitation therapy are - as a sentence...

• Low blood pressure

• Medication reactions (other than ototoxicity)

• Anxiety, malingerers, depression (although T’ai Chi may be helpful for anxiety)

• Migraine associated vertigo (although it has been reported to be helpful nonetheless)

• Transient ischemic attacks (TIA) Persons with fluctuating vestibular problems.

• Meniere’s disease

• Perilymph fistula

Functional Goals of VRT-

• Decrease disequilibrium – Improve functional static & dynamic balance.

• Improve postural and gait stability.

• To reduce motion related dizziness.

• Decrease oscillopsia-visual blurring during head movement – increase gaze stability i.e. DVA during both static and dynamic activities