Vestibular Physiotherapy

The vestibular system

The vestibular system is a part of the inner ear.  It sends signals via the vestibulocochlear nerve to the areas of the brain which are involved in co-ordinating movements of your eyes and your head (so that you can see clearly even when moving) and in maintaining balance. It has five sensory organs that detect the acceleration and the velocity of head movement.  There are three semicircular canals and two otoliths, the utricle and the saccule. The semicircular canals sense angular acceleration or rotatory movement of the head, for example when you nod or shake your head. The otolith organs tell your brain the position of your head with respect to gravity, as well as when your head is moving in a straight line. The utricle detects linear movement in a horizontal plane, for example when your car stops suddenly; and the saccule detects vertical movement of the head, for example when you go up and down in an elevator.

Vestibular or inner ear conditions can cause a variety of symptoms including dizziness, vertigo, unsteadiness or imbalance, nausea, vomiting, rocking or spinning sensations, blurred vision and fatigue.  Anxiety and depression may also feature or be a natural result of living with vestibular symptoms.

There are a range of disorders that commonly interfere with the functioning of the vestibular system and result in the types of symptoms described previously. These include:

• Labyrinthitis and vestibular neuronitis - caused by viral infection of the inner ear.  They can result in damage to hearing and vestibular function (labyrinthitis) or damage to vestibular function only (neuronitis);
• Acoustic neuroma - a benign tumour which grows along the course of the vestibule-cochlear nerve:
• Meniere's Disease - a fluctuating disorder which involves the build-up of fluid in the inner ear;
• Benign Paroxysmal Positional Vertigo (BPPV) - a disorder caused by debris freely floating in the fluid of the inner ear;
• Otoxicity - caused by exposure to certain drugs or chemicals (e.g., intravenous aminoglycoside antibiotics) that damage the inner-ear nerve hair cells or the vestibulo-cochlear nerve;
• Migraine associated vertigo - typically characterized by head pain with symptoms associated with vestibular impairment such as dizziness, motion intolerance, spontaneous vertigo, sensitivity to light and sound, tinnitus, imbalance, and spatial disorientation;
• Stroke - an interference with the blood supply to the inner ear and vestibular areas within the brain; and
• Trauma - secondary to motor vehicle accidents or significant falls.

Vestibular rehabilitation

Vestibular rehabilitation is an exercise-based physiotherapy approach to the treatment of vestibular problems.  It involves a customised program of exercises that are designed to re-calibrate the balance system.  It is possible to significantly reduce dizziness and improve balance with this approach. A typical vestibular rehabilitation program may include:

• specific exercises to reduce dizziness (habituation exercises)
• eye-head coordination exercises (gaze-stability exercises)
• balance exercises
• fitness training
• education about specific vestibular conditions and how to best manage them

Wendy Holmes has completed post-graduate professional development in vestibular rehabilitation and has many years of experience in this complex field.   She is a member of the Vestibular Disorders Association (VEDA) and the Australian Vestibular Rehabilitation Association (Avesta).

Andrew To has also completed the Vestibular Rehabilitation: Advance Management Course and enjoys being able to help people with dizziness and balance problems. He has found it very rewarding being able to help many of these patients who may also suffer from other musculoskeletal conditions related to their dizziness such as headache or neck pain.