Vestibular Rehabilitation Therapy (VRT) has proven to be effective in improving symptoms related to vestibular and balance disorders (BPPV, Meniere’s disease, vestibular neuritis, etc.). Specifically, VRT aims to address issues such as vertigo, dizziness, visual disturbance, and imbalance. The ultimate goal of this type of therapy is to help patients beat these symptoms and restore their quality of life.
The first step toward successful VRT begins with a comprehensive assessment of the patient. This generally includes recording a detailed symptomatic history and interviewing them on how their life is affected by these symptoms. The practitioner will then perform a screening to observe and assess any abnormal eye movements. Additionally, they’ll assess muscle strength, overall range of motion, posture, balance, and the patient’s ability to walk to see if there are any issues or abnormalities.
From all that input comes the rehab plan
Different types of vestibular afflictions require different types of treatments. A patient experiencing vertigo-like symptoms may need to repeatedly perform a canalith repositioning exercise, while someone with gaze instability and dizziness from inner ear weakness may be prescribed gaze instability and habituation exercises. If their dizziness affects their balance, they may also be given balance exercises to perform.
When designing a VRT plan, it is paramount to try and make it easy for the patient to do in the comfort of their home. This helps eliminate any excuses to not do them. No matter the exercises, each patient must be advised that to make them work, they need to be committed to doing them on a regular basis. To avoid discouragement, they should also be warned that, at first, the exercises may cause their symptoms to worsen, but they will see gradual improvement over time.
What to tell your patients about what to expect
Many factors can affect how successful a patient’s recovery will be, the most obvious being the type of disorder they have. Stable disorders, such as vestibular neuritis or labyrinthitis have the best chance to achieve a positive outcome from VRT. Fluctuating conditions, including migraine and Meniere’s disease, or a progressive vestibular disorder, such as multiple sclerosis, can make recovery more difficult. Pharmacological therapy may be an option a doctor or therapist can recommend for patients with fluctuating or progressive disorders. Once medication helps stabilize a condition, VRT can help reduce their symptoms.
VRT can’t help a couch potato
A sedentary lifestyle causes a decrease in a patient’s ability to tolerate movement. As a result, their threshold to fend off symptoms of unsteadiness, dizziness, and loss of balance is substantially reduced. Remind patients that in addition to faithfully doing their VRT exercises, they must get up, get going, and keep as mobile and active as possible.
Performing VRT can be a pain for some
Some patients may not be able to do VRT exercises that have been prescribed for them because they are too painful. For such patients, their pain tolerance needs to be regularly questioned and assessed. Physical therapy and pain medication may help these patients get the most out of their VRT. Just as pain can inhibit vestibular rehabilitation, so can other factors, including cardiovascular concerns, vision problems, and cognitive impairment.
Stay in touch with patients who are undergoing VRT
In between regularly scheduled visits, give your patients a call or shoot them an email to get a quick update on their VRT. Ask how they are doing. Are they experiencing pain while exercising? Do they notice any improvement in their condition? Speak with their spouse, roommate, or caretaker, to get their perspective on their progress. Most importantly, help relieve any anxieties they may have by reminding them that with slow, progressive movements and activity, they will notice see improvement.
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