Vestibular and oculomotor dysfunctions are one of the most common abnormalities found in the brain- injured population. Following concussion, individuals may experience difficulty or discomfort with eye movements, visual tracking, visual focus, light sensitivity, excessive visual and cognitive fatigue; they may also experience low tolerance for near-point visual tasks (such as reading, using a computer, tablet or phone), low tolerance for busy, stimulating environments, dizziness or blurred vision with head movement, motion sensitivity, vertigo and/or imbalance. Symptoms may range from mild to severe, and can pose a barrier for individuals attempting to return to work, school, or daily life activities.
When indicated, rehabilitation for these types of impairments typically involves a progressive exercise-based program to help “re-train” specific vestibular-oculomotor skills in order to reduce symptoms and improve tolerance for the activities mentioned above. In some cases, you may require an Optometric evaluation or other specialist referral prior to engaging in this type of therapy.
Vestibular Rehabilitation Therapy
The vestibular system is located in the inner ear, and is a complex organ that provides our brain with moment-to-moment information relating to our head and body position in space. It not only helps us maintain our balance, but also allows us to effectively navigate our physical environment. The vestibular system is tied closely to, and works with, our visual system, auditory system, and somatosensory system (made up of sensors in the joints and muscles).
Each inner ear contains three semicircular canals and two sensory organs that make up the vestibular apparatus. Information related to posture, position, orientation and motion from each vestibular apparatus is synthesized and organized by our central nervous system. Symptoms of vestibular dysfunction vary depending on which part of the vestibular system is affected.
In regular life, we take for granted the ability to walk on uneven surfaces, get up in the middle of the night to go to the bathroom or change positions throughout the day. An impairment of our vestibular system can alter all of the above activities and many more. For some, vestibular impairment can be disabling and produce a significant amount of emotional and psychological stress.
Vestibular impairment can arise from a variety of causes including trauma (as with a concussion), a virus or infection, and age-related decline in function.
What are some symptoms of Vestibular Impairment?
Impairment of the vestibular system may include one or a combination of several symptoms including:
- Vertigo (spinning sensation)
- Dizziness (light headedness, rocking, floating)
- Nausea, motion sickness
- Hearing Loss
- Sense of "fullness" in the ears
- Tinnitus (ringing in the ears)
- Sensitivity to sound
- Sensitivity to light
- Difficulty navigating in the dark
- Difficulty navigating through busy spaces (like the grocery store)
- Difficulty with visual focus or tracking objects
- Muscle pain, changes in posture
- Difficulty with cognitive tasks (attention, concentration, memory)
- Mood changes (anxiety, depression)
What are some common vestibular conditions?
Here is a short list of some vestibular conditions that generally benefit from vestibular rehabilitation therapy:
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. It can be caused by direct or indirect trauma to the head or can result as a natural part of the aging process. In this condition, “otoconia” (often referred to as crystals) slough off of fine hair cells in our inner ear and travel within our semi-circular canals. The presence of crystals within one or more of our semicircular canals disrupts these “motion sensors” and produces brief bouts of vertigo when triggered by head movement and changes in position.
Vestibular Neuritis (also known as acute unilateral vestibulopathy) is the second most common cause of vertigo. This often starts after a viral infection in the upper lungs or gastrointestinal system and affects the vestibular nerve. Symptoms can be very sudden and severe during the acute phase and include vertigo, dizziness, nausea, imbalance, and disorientation. Symptoms eventually dissipate with time but affected individuals may go on to experience residual difficulties that require rehabilitation.
Labyrinthitis – similar to vestibular neuritis, is most often caused by a viral infection resulting in inflammation of structures within the inner ear. With Labyrinthitis however, there can be changes in hearing and tinnitus (ringing in the ear) along with vertigo, imbalance and disorientation.
Bilateral Vestibular Hypofunction, or reduction of vestibular input from both ears, may arise from a variety of causes including infections, autoimmune disorders, toxicity and neuropathies to name a few. Sometimes the underlying cause cannot be found. Patients with bilateral vestibular hypofunction often complain of imbalance and difficulty walking, and may also have a sense of disequilibrium and dizziness.
Migraine Associated Vertigo (MAV) is typically described as head pain (often throbbing or pounding in nature) combined with vestibular symptoms such as dizziness, motion sensitivity, sensitivity to light and sound, nausea, vertigo, imbalance, and vision changes. Vestibular symptoms may occur prior to, during, or after a migraine episode or may even occur independent of the headache event.
Concussion is known to produce an array of symptoms consistent with vestibular dysfunction including dizziness, disorientation, imbalance, nausea, motion sensitivity, fogginess and difficulty with attention and concentration. Concussion patients with vestibular involvement may be at risk of longer recovery timeframes, which is why early rehabilitation is important.
Vestibular impairment may also arise from a host of other conditions. For more information on vestibular disorders, visit https://vestibular.org/
What can I expect from my assessment?
One of our highly trained Healthcare Providers will conduct a thorough evaluation of your condition starting with an interview to gain information about:
- When your symptoms started
- What happened prior to the onset of your symptoms
- How you feel during and after each episode
- What triggers or activities worsen your symptoms
- History of previous vestibular episodes or conditions
- Medical investigations completed
- Current medications
The interview portion of the visit will be followed by a physical assessment. Tests performed during your physical assessment will help us determine which structures have been impacted, determine the specific impact this condition is having on you and your functional abilities, and help us to design a specific management strategy for you.
What is vestibular rehabilitation therapy
Vestibular Rehabilitation Therapy (VRT) is a specialized form of therapy designed to treat vestibular conditions and reduce symptoms of vertigo, dizziness, imbalance, and other associated symptoms. VRT typically involves the application of exercises (completed in the clinic and reinforced at home) that are designed to improve balance, motion tolerance, eye movement control, and overall function under conditions designed to challenge your vestibular system. Exercises prescribed are based on the type of vestibular condition you have as well as the specific functional limitations you are experiencing in your day-to-day life.