Vestibular Rehabilitation
Vestibular Rehabilitation .... How and Why it Works
Vestibular Rehabilitation has emerged over the past several years as an exciting and successful alternative treatment for patients with chronic non-resolved motion intolerance and imbalance problems. This management strategy is being utilized by some of the leading medical and university facilities in the country. Patients are getting better and returning to normal lives because of this treatment. The history and how of vestibular rehabilitation are important keys to knowing why therapy works and what therapy type will be most successful.
HISTORY ...
Although Vestibular Rehabilitation has only recently gained world wide acceptance, the concept of head, body and coordinated eye exercises as a treatment for vestibular disorders is actually over 50 years old. As far back as the mid 1940's, an English otolaryngologist, Cawthorne, observed that some dizzy patients did better or recovered sooner when performing rapid head movements. In cooperation with a physiotherapist, Cooksey, they developed a regimen of exercises which are still used today, with some modification.
Since the resurgence of interest and research in vestibular rehabilitation in the mid 1980's, hundreds of articles have been published in otolaryngology, neurology, and physical therapy journals. The overwhelming conclusion of these research studies has documented the benefits of this management strategy for patients with vestibular dysfunction.
HOW and WHY Vestibular Rehabilitation Works .
HOW...
In order to understand how Vestibular Rehabilitation works and the underlying corrective mechanisms, it is important to remember that the primary role of the vestibular system is to tell the brain where the head is. Quite simply, the vestibular system is our internal reference telling the brain how our head is orientated in space. The visual and somatosensory systems, on the other hand, are external references, providing our brain with information about the movement and stability of the world around us. Working together in agreement, it is the harmonious integration of these sensory modalities that provides us with normal equilibrium.
When there is a conflict between internal and external references, the result is the brain's inaccurate perception or hallucination of motion. An example of this occurring in everyday life is the feeling of moving forward when stopped at a traffic light, when a larger vehicle in your peripheral vision has rolled backward. Another example of conflict occurs when you are parked in a car wash as the brushes pass by your car. The natural reaction is to hit your brakes to stop your car from rolling forward, but you hadn't moved at all. There was simply a conflict between the three sensory modalities. The input from the motion detector aspect of the visual system override the input from the vestibular and somatosensory systems creating the hallucination or perception of motion.
WHY ... There are three generally accepted models to explain why therapy works:
Adaptation: The central vestibular system and brain learns to adapt to the imbalanced signal coming in from the impaired peripheral vestibular sensory receptors. The role of the vestibulo-ocular reflex is to keep the eyes focused on a target during head movement. If the incoming signal from the two internal head movement sensors is not in synchrony, the result is a sense of "after-motion" with head movement. A primary component of the equilibrium system adversely effected by the imbalance from the two peripheral vestibular mechanisms is the vestibulo-ocular reflex. Gaze stabilization exercises work to "return" the vestibulo-ocular refle |
