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Posted by portugalpress on September 27, 2018

Vestibular rehabilitation is a method that is being used more and more in physiotherapy for the rehabilitation of patients with vestibular disorders and equilibrium deficiency. It is, in fact, considered to be the best therapy for these cases. It aims to improve not only the equilibrium and symptoms of vertigo/dizziness, but also the patient’s self-confidence and, therefore, their quality of life.

When applying these techniques, a concise, objective assessment is important in order to reach a correct diagnosis. A personalised intervention protocol is then created, which is based on the lesion and the patient’s complaints.

Alterations of the peripheral and/or central vestibular system cause spontaneous nystagmus (repeated, involuntary movement of the eyes) and postural deviations, including such symptoms as vertigo, pathological nystagmus, imbalance, changes in vision, nausea, vomiting, stiff neck, vestibular ataxia and changes of consciousness, with significant functional limitations for the patient and his/her daily activities.

Vestibular rehabilitation acts on the neuroplasticity mechanism, seeking a more efficient central compensation in functional recuperation. Furthermore, evidence also concludes that early vestibular rehabilitation, during a vertiginous crisis, can improve dizziness and prevent future complications such as anxiety, reduced functional capacity and risk of falls.

Generally speaking, the objective of this method is adapting visual-vestibular interaction (eye-movement stabilisation) using repetitive movements of the head and/or eyes, contributing towards the recovery of the vestibulo-ocular reflex.

Intervention techniques for peripheral vestibular lesions (especially unilateral peripheral vestibular dysfunction, such as vestibular neuritis and labyrinthitis), bilateral vestibular dysfunction, multi-sensory impairment in the elderly, central vestibular syndrome, psychogenic vertigo, positional vertigo (benign positional paroxysmal vertigo and central positional vertigo) and visual vertigo can be used.

Basically, exercises for postural control, prevention of falls and functional re-education are used, based on principles of motor relearning that foster behavioural change and the development of motor skills.

There are specific repositioning manoeuvres in vestibular rehabilitation for patients with specific dysfunctional diagnoses, such as benign positional paroxysmal vertigo. This is the case of the canalith repositioning procedure or Epley, Semont and Liberatory manoeuvres, which are carried out by the therapist with the goal of repositioning the crystals, and can later be complemented with eye motricity, vestibulo-ocular, vestibular medulla and proprioceptive exercises.

Two or three sessions per week are usually carried out, depending on the stage of intervention and can encompass manual therapies as well as vestibular repositioning manoeuvres. Visual integration may also be necessary, ocular stabilisation and proprioceptive exercises, depending on the pathology.

It is equally important to teach patients exercises and strategies for balance control and coordination, aimed at improving their everyday lives.

By Célia Serrão

Célia Serrão is physiotherapist and vestibular rehabilitation specialist at the Hospital Particular do Algarve.