Academy of Otolaryngology Position Statement on Vestibular Rehabilitation

Vestibular Rehabilitation recommended as a beneficial treatment for dizziness and balance disorders

Vestibular Rehab Recognized as a Valid and Beneficial Intervention for Individuals with Dizziness and Disequilibrium

We wanted to let our readers know that leaders in the field of inner ear disorders have reaffirmed their recommendation of Vestibular Rehabilitation as a beneficial treatment for dizziness and balance disorders. BPPV is the cause of approximately 50% of dizziness in older adults ^[1].

Recently at the Academy of Otolaryngology – Head and Neck Surgery’s 2013 Annual Meeting, the American Academy of Otolaryngology revised a position statement regarding Vestibular Rehabilitation. Their position now states that:

 “Vestibular Rehabilitation, or Balance Retraining Therapy, is a scientifically based and clinically valid therapeutic modality for the treatment of persistent dizziness and postural instability due to incomplete compensation after peripheral vestibular or central nervous system injury.”

“Vestibular Rehabilitation is a valid form of therapy for dizziness and imbalance resulting from the medical or surgical treatment of vertigo disorders and for acute vertigo or persistent imbalance that may result from a variety of peripheral vestibular disorders.”

“Balance Retraining Therapy is also of significant benefit for fall prevention in the elderly patient who may suffer from multiple sensory and motor impairments or for those who have sensory disruption with moving visual information.”

Many sufferers of dizziness, vertigo and imbalance have benefitted from Vestibular Rehabilitation, and we know how important this treatment is to them. It is also a very positive sign when the work of Vestibular Rehabilitation professionals is declared clinically valid by the Ear, Nose and Throat medical community.

^[1] Fife TD et al. Practice parameter: therapies for BPPV (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurol. 2008;70:2067-2074.

What to Expect During Vestibular Assessment and Treatment

Dizziness or Balance Disorders Can Be Caused By a Number of Different Conditions

At LifeMark we give clients different tests to narrow down what may be contributing to their dizziness

There are many, many different conditions that can contribute to dizziness or balance disorders. To help narrow down a clinical diagnosis, at LifeMark we give clients a number of different tests and evaluations. One of the first steps of the assessment process is the Dizziness Inventory that we ask clients to download from the website and fill in before your first appointment. This questionnaire allows us to identify difficulties that you may be experiencing because of your dizziness or unsteadiness, and gives us some valuable clues about what conditions you might be dealing with.

Vestibular Assessment Includes Infrared Video-Analysis of Eye Movements

LifeMark's vestibular assessment is extensive and includes infrared video-analysis of eye movements, which provides information about the inner ear and its connections in the brain. Many of these eye movement clues cannot be detected in room light. Treatment can involve a combination of stationary and moving balance retraining, gaze stabilization to help you focus during head movement, training for motion sensitivity, and canalith resposition manoeuvres for BPPV; the results are often dramatic.

The balance retraining component is also effective for clients who don't necessarily have a vestibular problem, but have muscle and joint problems, brain-related disorders, sensation problems, or vision changes affecting their equilibrium. LifeMark is actively involved in collecting outcome measures to make sure what we do is making people better, and is committed to utilizing the most current, evidence-based tests and techniques in its training and treatment programs.

Vestibular Assessment Also Includes Motion Sensitivity Testing, Static and Dynamic Balance Testing and TMJ Testing

As part of your vestibular assessment we go through many of these tests, as determined by the nature of your symptoms:

• We take a thorough history
• We take your blood pressure both when standing up and lying down
• We perform motion sensitivity testing, scoring both the intensity and duration
• We perform static and dynamic balance tests, to compare to normative and fall risk data
• We test for TMJ (temporomandibular joint disorder) and cervical spine mobility
• We screen for any serious problems with the following:

1. Cranial nerve scan
2. Vertebral artery scan
3. Carotid pulse
4. Carebellar tests
5. Scans for upper motor neuron lesions
6. Ligamentous stability of the upper cervical spine

What is Vestibular Rehabilitation?

Vestibular Rehabilitation is a proven, research-based branch of physiotherapy where specific individualized techniques are used to maximize the brain's compensation for vestibular pathology, or where manoeuvres are done to correct mechanical dysfunctions in the vestibular apparatus.

What Can Cause the Problems?

Vestibular disorders can come from pathologies in any area of this complex system. They can be insidious ("out of the blue") or due to factors such as trauma (motor vehicle accidents, falls, contact sports, blows to the head), infections, aging, medications, brain-related problems, or secondary to other diseases or injuries. Symptoms can include dizziness, imbalance, blurry vision, motion sensitivity, nausea, poor concentration, muscle guarding/restriction of movement, decreased activity levels or social interaction, anxiety and depression.