Vestibular Rehabilitation Therapy
Vestibular rehabilitation (VR), or vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. For most people with a vestibular disorder the deficit is permanent because the amount of restoration of vestibular function is very small. However, after vestibular system damage, people can feel better and function can return through compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e. body sense) to substitute for the deficient vestibular system. The health of particular parts of the nervous system (brainstem and cerebellum, visual, and somatosensory sensations) is important in determining the extent of recovery that can be gained through compensensation.
For many, compensation occurs naturally over time, but for people whose symptoms do not reduce and who continue to have difficulty returning to daily activities, VRT can help with recovery by promoting compensation.
The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem(s). Therefore, before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder. Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.4
Habituation exercises are used to treat symptoms of dizziness that are produced because of self-motion3 and/or produced because of visual stimuli. Habituation exercise is indicated for patients who report increased dizziness when they move around, especially when they make quick head movements, or when they change positions like when they bend over or look up to reach above their heads. Also, habituation exercise is appropriate for patients who report increased dizziness in visually stimulating environments, like shopping malls and grocery stores, when watching action movies or T.V., and/or when walking over patterned surfaces or shiny floors.
Habituation exercise is not suited for dizziness symptoms that are spontaneous in nature and do not worsen because of head motion or visual stimuli. The goal of habituation exercise is to reduce the dizziness through repeated exposure to specific movements or visual stimuli that provoke patients’ dizziness. These exercises are designed to mildly, or at the most moderately, provoke the patients’ symptoms of dizziness. The increase in symptoms should only be temporary, and before continuing onto other exercises or tasks the symptoms should return completely to the baseline level. Over time and with good compliance and perseverance, the intensity of the patient’s dizziness will decrease as the brain learns to ignore the abnormal signals it is receiving from the inner ear.
Gaze Stabilization exercises are used to improve control of eye movements so vision can be clear during head movement. These exercises are appropriate for patients who report problems seeing clearly because their visual world appears to bounce or jump around, such as when reading or when trying to identify objects in the environment, especially when moving about.
WHAT SHOULD PATIENTS EXPECT FROM VESTIBULAR REHABILITATION?
VRT is usually performed on an outpatient basis, although in some cases, the treatment can be initiated in the hospital. Patients are seen by a licensed physical therapist with advanced post-graduate training.
VRT begins with a comprehensive clinical assessment that should include collecting a detailed history of the patient’s symptoms and how these symptoms affect their daily activities. The therapist will document the type and intensity of symptoms and discuss the precipitating circumstances.
Additionally, information about medications, hearing or vision problems, other medical issues, history of falls, previous and current activity level, and the patient’s living situation will be gathered.
The assessment also includes administering different tests to more objectively evaluate the patient’s problems. The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled. Testing assesses sensation (which includes gathering information about pain), muscle strength, extremity and spine range of motion, coordination, posture, balance, and walking ability.
A customized exercise plan is developed from the findings of the clinical assessment, results from laboratory testing and imaging studies, and input from patients about their goals for rehabilitation. For example, a person with BPPV may undergo a canal repositioning exercise for the spinning s/he experiences, whereas, someone with gaze instability and dizziness due to vestibular neuritis (a deficit from a weakened inner ear) may be prescribed gaze stability and habituation exercises, and if the dizziness affects their balance this may also include balance exercises.
An important part of the VRT is to establish an exercise program that can be performed regularly at home. Compliance with the home exercise program is essential to help achieve rehabilitation and patient goals.
Along with exercise, patient and caregiver education is an integral part of VRT. Many patients find it useful to understand the science behind their vestibular problems, as well as how it relates to the difficulties they may have with functioning in everyday life. A therapist can also provide information about how to deal with these difficulties and discuss what can be expected from VRT. Education is important for patients because it takes away much of the mystery of what they are experiencing, which can help reduce anxiety that may occur as a result of their vestibular disorder, If you are interested in leaning more, please contact us by clicking the link below.
We accept the following insurance benefits. Please call us if you don’t see yours on our list below.
Most Aetna Plans
Blue Cross Blue Shield
Medicare & Medicare Railroad
And most other private insurances
We are licensed providers with most private insurance companies, and we are licensed providers for Worker’s Compensation and Motor Vehicle Injuries. Physical Therapy & Wellness Institute is licensed by Medicare as an outpatient physical therapy clinic. Please contact our offices to inquire about our participation with your insurance plan.
What To Know Before Your First Appointment
When should I arrive?
To expeditte the process, you can download the required new patient paperwork, and complete it pror your initial appointment . If you are unable to do so, please arrive 15 minutes prior to your first visit to allow ample time to complete the registration forms.
What should I wear? Do I need to bring anything?
Please wear comfortable clothes that allow for freedom of movement.
We also ask that you bring your insurance card, the prescription from your healthcare provider, and any other reports. If you have braces, splints, or crutches, please bring them, as well.
What can I expect at my first appointment?
At the time of your initial vist a therapist will perfom a comprehensive evaluation, which will determine your current condition and allow us to formulate the most appropriate course of treatment. Once a course of treatment has been established, we’ll talk about incorporating home exercise programs to supplement your visits. The appointment will take approximately an hour.
Frequently Asked Questions
Do I need a referral from my physician to schedule an appointment?
Yes. Physical Therapist in Texas can evaluate you without a referral, but current Texas law requires that patients obtain a prescription from their healthcare provider prior to being treated a physical therapist. Physicians, dentists, chiropractors, podiatrists, physician assistants, and advanced nurse practitioners of all types (midwives, clinical specialists, FNPs) can prescribe physical therapy services. If you’ve already been referred, please schedule an appointment here.
Who will be in charge of my treatment?
After you are referred to Mason Physical Therapy & Wellness Center, a licensed physical therapist will complete a comprehensive evaluation which will then be used to formulate an individualized treatment plan. Based on findings at the time of your evaluation, a comprehenive treatment program will be established which will allow you to reach your goals.
How does billing work?
Mason PT & Wellness is in-network with the majority of insurance carriers. If you have insurance, the first thing we’ll do is verify your benefits so that we know how much your co-pay for therapy costs. We collect this co-pay at your visit and apply it to your account. We also submit a claim to your insurance company so they know you have come to see us. It typically takes your insurance company about 45 days to process this claim.
If you have questions at any time throughout the billing process, we are happy to help! You can find contact information for our billing office at (325) 294-4700
Do you accept my insurance?
We accept Blue Cross Blue Shield, United, Humana, Workers’ Compensation, Medicare and more. If you are unsure whether or not we accept your insurance, please call us at (325) 294-4700.