Vestibular rehabilitation exercises or therapy for vertigo

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Vertigo is characterized by feelings of dizziness, sensations of the surroundings spinning & moving around, nausea, vomiting, motion sickness, photo & sound sensitivity, & migraine headaches.

Vertigo isn’t a condition of its own, rather a symptom of some underlying illness. Vertigo is of primarily two types; peripheral vertigo, & central vertigo. Peripheral Vertigo refers to a problem with the inner ear & the vestibular system, which is the body’s natural system to maintain balance & spatial position with respect to gravity & head movements. Central Vertigo refers to a problem with the brain & how it perceives balance information received from the vestibular system.

In people who suffer from Peripheral Vertigo, Benign Paroxysmal Positional Vertigo(BPPV) is by far the most common type of vertigo experienced by patients. BPPV is caused by the tiny calcium crystals called otoconia, which normally reside in the middle ear, accidentally getting deposited inside the semicircular canal of the inner ear.

These crystals are motion-sensitive, which means they react to any changes in the position of the head with respect to gravity. This causes them to interfere with the working of the tiny hair on the surface of the inner ear. Due to the presence of these crystals inside the inner ear canal, the hair mistakenly perceives their motion as the motion of the body, sending out false signals to the brain. The brain then sends confusing messages to the body’s sensory organs, causing false spinning sensations, dizziness, nausea, vomiting, & other symptoms associated with vertigo.

The treatment for Vertigo generally involves treating the underlying condition that is causing the vertigo symptoms, in the first place. For BPPV, this usually means dislodging the calcium crystals deposited inside the semicircular canal of the inner ear, & placing them back in their original position in the middle ear.

This can be done with the help of canalith repositioning maneuvers that help reposition the calcium crystals from the inner ear back into the middle ear in some simple-to-perform steps. Examples of canalith repositioning maneuvers include the Epley Maneuver, Brandt-Daroff exercises, Semont maneuver, the Semont-Toupet maneuver, & the Foster maneuver.

Other treatment options include Vestibular Rehabilitation Therapy/Vestibular Rehabilitation Exercises.

What are Vestibular Rehabilitation Exercises for Vertigo?

Vestibular Rehabilitation Therapy is sometimes also known as vestibular compensation therapy. It basically is a set of exercises designed to train your brain to make up or compensate for the losses in the natural vestibular system. Naturally, when the brain figures out that the right & left sides of the vestibular system is sending out differing balance signals, it depends on other organs to provide a more accurate picture of the position of the body.

Vestibular Rehabilitation Therapy for dizziness & vertigo employs this natural mechanism of the brain to devise a set of exercises specially designed for this vestibular compensatory process. Vestibular Rehabilitation Exercises for vertigo treatment are a class of specialized treatment strategies for vertigo. They should only be prescribed by a vertigo specialist or your doctor. You should not indulge or perform any exercises before consulting with your doctor first, as they might worsen your vertigo symptoms.

Below, we tell you a few exercises that are often recommended as part of the vestibular rehabilitation therapy for dizziness & vertigo treatment.

Cawthorne-Cooksey exercises:

Cawthorne-Cooksey exercises help relax the neck, the head, & the shoulder muscles. They also train the eyes to move independent of the position of the head, maintaining a good balance in everyday situations, & desensitize your vestibular system to the head positioning & movement triggers.

Before performing the exercises, your doctor will evaluate you thoroughly to check your fitness level for the exercises. This is done to ensure that you don’t injure yourself or worsen your condition by performing any of these exercises.

You will generally be asked to perform some simple exercises first to build up your fitness levels & strength before moving on to the next set of exercises. Doing so helps your brain compensate for the vestibular losses more effectively & efficiently.

As a rule of thumb, you might notice that your symptoms initially get worse before slowly improving after you regularly perform the exercises.

Before moving you to the next stage of exercises, your doctor will evaluate whether your symptoms improved somewhat with the help of the previous set of exercises, or not. Your doctor will only move you to the next set of vestibular rehabilitation exercises for vertigo if your symptoms show some improvement after the first(or previous) round of exercises.

Some of the exercises that can be recommended as part of your vestibular rehabilitation therapy exercises for vertigo are:

Eye movement exercises:

In these, you basically move your eyes in:

  • up & down direction
  • side to side
  • Focus on your finger by moving it from a distance of three feet to one foot away from your face.

Head movement exercises:

In these, you move your head in:

  • forward & backward directions
  • side to side

Sitting exercises:

In these, you perform:

  • Head movement exercises as described above
  • Shrug & circle movement of the shoulders
  • Bending forward & picking up objects from the ground
  • bending from side to side & picking up objects from the ground

Standing exercises:

In these, you perform:

  • eye, head, & shoulder exercises as described above
  • switch from a sitting to a standing position with your eyes first open, then closed
  • Throw a ball from your hand to above eye level
  • Throw a ball from hand to hand & under the knee
  • Switch from a standing to a sitting position while turning around in between

Moving about exercises:

In these, you perform:

  • walking up & down a slope
  • walking up & down some steps
  • Throwing & catching a ball
  • any sports or activities involving stooping, stretching, & aiming(for eg., bowling)

Gaze stabilization exercises:

These exercises help stabilize your gaze while you track a moving or stationary object, & reduce the appearance of nystagmus while doing so. To perform these exercises, follow the steps mentioned below:

  • Look straight ahead & focus on any letter of your choice, held in front of you at eye level.
  • While turning your head from side to side, focus your eyes on the said target. Keep increasing the speed of your head movement. All this while, keep the letter in focus. If while performing the exercises, you get too dizzy, slow down a little before starting again.
  • Perform the exercises for a length of time that brings on vertigo or dizziness symptoms in a mild to moderate intensity. Over time, keep increasing the time limit for the onset of symptoms. As you perform the exercises regularly, you will notice that the time required for symptoms to appear goes up.
  • As you become stronger, try making the exercises a bit difficult by placing the focus letter in a busy background, to make your brain work harder to keep your eyes focused even in a busy background. Perform this exercise about three to five times a day.

Other vertigo exercises that your doctor may recommend to you as a part of your vestibular rehabilitation exercises for vertigo treatment are the Brandt-Daroff exercises, canalith repositioning maneuvers like the Epley Maneuver, & the Semont maneuver, & the liberatory maneuver.

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