Vestibular Rehabilitation



Vestibular Rehabilitation: Terms

Habituation = repeated exposure to a provocative stimulus will result in a reduced pathological response, so the more you do something that makes you dizzy, the less you will eventually feel it… but it will take months.

Adaptation is a central process. It involves changes within the brain that result in a decreased sensation of dizziness. (Areas of brain involved in balance are: cerebellum, vestibular nuclei in brainstem, inputs via nerves from eyes, ears and feet, outputs via nerves to eyes and postural control muscles) Remember that you can have a problem with your brain and/or a problem with how these systems work together.

Negative feedback = Deliberately producing errors in the systems involved with balance so that the patient feels dizzy, and the brain learns to adapt and recalibrate, to lessen the effects of the error.

VOR = The vestibulo-ocular reflex (VOR) generates the rapid compensatory eye movements that support stable vision while the head is in motion. This allows you to see without blurring while your head or body is moving.

Integration = Integration must occur all the time for normal balance. The brain has to integrate information from the eyes, ears and feet to stay upright. Problems may develop in situations where the information coming from the eyes conflicts with information from ears or feet. A simple example of this is where the illusion of movement from watching a train pass, conflicts with what your feet and ears tell you, causing you to feel unbalanced.

Central vs Peripheral –

Central problems arise from inside the brain, within the balance areas. Examples of this would be stroke, head injury, epilepsy or migraine. All these central conditions are generally harder to treat and take longer.

Peripheral problems are outside the brain: those that affect the inner ear, eg menieres, BPPV (positive hallpike dix test), vestibular neuronitis or semicircular canal dehiscence, to name but a few. In fact there are thought to be over 300 different reasons why a patient may become dizzy.

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