Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises

Abstract

Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are 1) to enhance gaze stability, 2) to enhance postural stability, 3) to improve vertigo, and 4) to improve activities of daily living. VRT facilitates vestibular recovery mechanisms: vestibular adaptation, substitution by the other eye-movement systems, substitution by vision, somatosensory cues, other postural strategies, and habituation. The key exercises for VRT are head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks, repeating the movements provoking vertigo, and exposing patients gradually to various sensory and motor environments. VRT is indicated for any stable but poorly compensated vestibular lesion, regardless of the patient's age, the cause, and symptom duration and intensity. Vestibular suppressants, visual and somatosensory deprivation, immobilization, old age, concurrent central lesions, and long recovery from symptoms, but there is no difference in the final outcome. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery. Here the authors review the mechanisms and the key exercises for each of the VRT goals.

Keywords: balance rehabilitation therapy; balance retraining therapy; gaze stability; habituation; postural stability; vestibular rehabilitation therapy.

Fig. 1

Exercises for enhancing gaze stability. A: Head turns. B: Head-trunk turns.

Fig. 2

Exercises for enhancing eye movements. A: Exercise for saccade and vestibulo-ocular reflex: 1, look directly at a target, ensuring that your head is aligned with the target; 2, look at the other target; and 3, turn your head to the other target. B: Exercise for imagery pursuit: 1, look directly at a target, ensuring that your head is aligned with the target; 2, close your eyes; 3, slowly turn your head away from the target while imagining that you are still looking directly at the target; and 4, open your eyes and check to see whether you have been able to keep your eyes on the target; if not, adjust your gaze on the target.

Fig. 3

Swaying back and forth. A: Bend forward and move the center of your body backward with your toes up. B: Bend backward and move the center of your body forward with your heels up. Repeat several times.

Fig. 4

Exercises for improving vertigo. A: Stand with one arm elevated over the head, with the eyes looking at the elevated hand. B: Bend over and lower the arm diagonally with the eyes continuously looking at the hand until the hand arrives at the opposite foot. Repeat with the other arm.