VESTIBULAR REHABILITATION

Physical therapy for dizziness and imbalance is called as vestibular rehabilitation, or more generally, balance rehabilitation.

Symptoms of vestibular dysfunction include but are not limited to imbalance, nausea, dizziness, true vertigo, and blurry vision, and poor depth perception, loss of balance when walking, falling, confusion, and disorientation.

Vestibular rehabilitation therapy (VRT) has been a highly effective modality for disorders of the vestibular or central balance system. It includes combined specific head and body movements with eye exercises. If the exercises are correctly performed, muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease.Most VRT exercises involve head movement, and head movements are essential in stimulating and retraining the vestibular system.

Goals of VRT (Vestibular Rehabilitation Therapy)

• Improve balance
• Minimize falls
• Decrease subjective sensations of dizziness
• Improve stability during locomotion
• Reduce overdependence on visual and somatosensory inputs
• Improve neuromuscular coordination
• Decrease anxiety and somatization due to vestibular disorientation

These conditions can benefit from Vestibular Rehabilitation Therapy:

• BPPV (Benign Paroxysmal Positional Vertigo)
• Bilateral & Unilateral dysfunctions
• Otolith Dysfunction
• Vestibular Labyrinthitis
• Acoustic Neuroma or vestibular neuritis.
• Ototoxicity
• Meniere’s Syndrome
• Neurologic Disorders (stroke, brain injury, multiple sclerosis)

VOR stimulation exercises

Gaze stabilization is the ability to hold the visual world steady while the head and/or body are moving. The vestibulo-ocular reflex (VOR) helps to provide gaze stability when the head moves.

Balance exercises

Static balance activities used for training include Romberg position and standing on one leg. Exercises are made more challenging and incorporate the use of the vestibular system as patients improve by altering the surface they stand on (e.g.: foam, trampoline, tilt board), performing activities with eyes closed and lastly incorporating head motions while maintaining balance.

Dynamic balance is trained by performance of activities including ambulation with head turns, full body turns and marching in place. Dynamic activities are made more challenging as the patient improves by altering the surface (e.g.: balance beam, treadmill), and performance with eyes open and eyes closed.

Cawthorne Cooksey Exercises

1. In bed or sitting

Eye movements -- at first slow, then quickly -up and down, from side to side and diagonally. Focusing on finger moving from 3 feet to 1 foot away from face

Head movements at first slow, then quick, first with eyes open and later with eyes closed -bending forward and backward and turning from side to side, tilting from side to side and moving diagonally.

2. Sitting

Eye movements and head movements as above

Shoulder shrugging and circling

Bending forward and picking up objects from the ground

3. Standing

Eye, head and shoulder movements as above.

Changing from sitting to standing position with eyes open and closed.

Throwing a small ball from hand to hand above eye level

Throwing a ball from hand to hand under knees

Changing from sitting to standing and turning to one side and then to another.

4. Moving about

Walk across room with eyes open and then closed

Walk up and down slope with eyes open and then closed

Walk up and down steps with eyes open and then closed

Sit up and lie down in bed

Sit down in a chair, then stand up

Recover balance when pushed in a specific direction.

Throw and catch a ball

Engage in any game involving stooping or stretching and aiming, such as bowling, volleyball, or shuffleboard.

Plantar fascitis/heel pain/bone spur/exostosis

Plantar fascitis/heel pain/bone spur/exostosis Plantar Fasciitis is a very common cause of heel pain. It is inflammation of the plantar fascia of the foot. It causes heel pain which may radiate to the toes. It can occur as a result of repetitive microtrauma. It’s an overuse injury. Plantar fasciitis is commonly caused by a heel spur which is a bony growth that occurs at the attachment of the plantar fascia to calcaneum. The Plantar Fascia is a broad, thick band of tissue that runs from medial tubercle of calcaneum of the heel to the front of the foot. It forms the longitudinal arch of the foot. SYMPTOMS ·                        Pain is usually on the medial side of the heel and under the heel. ·                        Pain is usually severe in the morning and decreases as the day progresses. Pain is worse on walking bare-foot. A limp may be present. ·                        Tenderness is present on the medial side of the calcaneum at the origin of the plantar fascia. CAUSES 1.      Tightness of calf muscles which can lead to pronation of the foot. This in turn produces repetitive over stretching of the plantar fascia leading to inflammation and thickening of the tendon. 2.      Foot arch problems- pes cavus and pes planus 3.      Excessive stress on the plantar fascia due to excessive running or obesity. TREATMENT – 1.      Use NSAIDS and take rest. 2.      Ice therapy can be applied to reduce pain and inflammation, 3.      Taping of plantar fascia can be done to support it and to reduce stress on plantar fascia. 4.      Stretching of plantar fascia and calf muscles is also important. 5.      Strengthening of intrinsic muscles of the foot. 6.      Silicon heel pads/cushioned heels can be used. PREVENTION It is possible by maintaining good flexibility of calf muscles, avoid prolonged standing.