Vestibular Rehabilitation

Our primary specialty service is vestibular rehabilitation therapy (VRT) for patients that have been diagnosed with a vestibular deficit. Once a vestibular deficit diagnosis has been made by our physicians or audiologists, patients may be referred to the rehabilitation department for VRT if their condition is appropriate for our program.

A VRT program is designed to address balance, dizziness, and overall fitness of the patient. Patient education is also stressed to facilitate patient understanding of what we are trying to accomplish with their individualized rehabilitation program through informational handouts and in-clinic education by our knowledgeable staff. Physical therapists maintain communication with the physician during the course of the patients program to ensure optimal patient care and to also address any related issues regarding the progress of the patient.

At all NDBC clinic's, patients are evaluated by physical therapists that are specially trained and certified in treating vestibular disorders. All of our physical therapist's are required to complete our internal certification program prior to treating any patients. This ensures that all patients receive a high continuity of care at all NDBC clinics and all therapists are properly trained before working with any patients. Because of the complexity of vestibular disorders, we believe proper education and training is essential to achieving consistent outcomes for our patients. This aspect of our VRT program is what makes our specialty clinic rise to the top above the "one stop shop" physical therapy programs around today.

These conditions can benefit from Vestibular Rehabilitation Therapy: 

  • BPPV
  • Bilateral & Unilateral dysfunctions 
  • Otolith Dysfunction
  • Vestibular Labyrinthitis
  • Acoustic Neuroma
  • Ototoxicity
  • Meniere’s Syndrome
  • Neurologic Disorders (stroke, brain injury, multiple sclerosis)

What is Vestibular Rehabilitation Therapy (VRT) 

Vestibular rehabilitation therapy has been demonstrated to be a highly effective treatment for most individuals with vestibular or central balance system disorders. In a number of studies, customized VRT programs have been reported to be significantly more effective in resolving symptoms than generic exercises, and especially medications.

The basis for the success of a VRT program is the use of already existing neural mechanisms for adaptation, plasticity, and compensation in the human brain. Compensation and adaptation have been demonstrated to be closely related to the direction, duration, frequency, and magnitude of the stimulus. Specifically designed VRT exercise protocols take advantage of this plasticity of the brain to increase sensitivity and restore symmetry, which results in an improvement in vestibular-ocular control, an increase in the gain of the vestibuloocular reflex (VOR), better postural strategies, and increased levels of motor control for movement. Other factors that may affect the degree of compensation that can be achieved for an individual patient include physical status, intactness and accuracy of other sensory systems, integrity of central brain mechanisms, age, and higher sensory functions (mainly memory, motor coordination, and the ability to determine proper strategies in the correct order.

Individualized Therapy Programs

At all NDBC clinics we utilize NeuroCom's Smart Equitest Computerized Dynamic Posturography (CDP) for objectively measuring the functionality of our patients' three sensory inputs when they are entering our Vestibular and Neurological rehabilitation programs. This establishes a starting point for the patient for their rehabilitation program and enables us to re-test the patient after a month to see how they are progressing. This gives us immediate feedback on the overall effectiveness of a patient's individualized therapy program and helps us to fine tune each patient's program to maximize results. Patients also use the CDP in their daily treatment sessions with our physical therapists. Our treatment protocols push the patient beyond normal comfort levels in the safety of the CDP equipment to help build confidence and re-learn their normal limits of stability and their center balance.

Several factors must be considered when designing a VRT program for an individual patient. Therapeutic efficacy may be limited by the extent and location of damage to the vestibular system, and the current activity level of the patient. Status of visual and proprioceptive systems, physical strength, motor skills, and integrity of the cerebellum are critical to the successful application of a VRT program. Other factors that are involved in the outcome of a VRT program include general physical health, decision-making and cognitive abilities, age, memory, and the presence of psychological and anxiety disorders.

VRT is typically designed as a therapist-directed patient-motivated home-based exercise protocol. VRT exercises are graduated, beginning at the minimal skill level that the patient is capable of performing; complexity is increased as compensation and habituation occur. Patients have regular follow-up visits with the therapist until compensation and habituation are complete and optimal balance is attained. Generally, patients see the therapist twice weekly for about 4 weeks, then cut back to once week for an additional 2-4 weeks.

The accurate diagnosis and assessment of a patient is critical for a successful individualized rehabilitation program. The diagnosis and assessment include quantifying the degree of damage to peripheral vestibular structures and central vestibular pathways and evaluating the level of physiologic and neurologic compensation that may have already occurred. Functional abilities such as gait, ambulation with head movement, balance with altered sensory cues, and balance under static (ie, sitting, standing) and dynamic conditions are assessed. Sensory evaluation should include visual and proprioceptive abilities since multi-sensory deficits can impede functional progress. Our therapists have been specifically trained in vestibular rehabilitation and are capable of providing a very thorough evaluation for our patients to ensure a successful rehabilitation program is achieved.