VESTIBULAR REHABILITATION THERAPY (VRT)

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VESTIBULAR REHABILITATIONTHERAPY (VRT)

• GP Study Day 28/01/12
• Mairead Collins MISCP

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What is VRT?

• An exercise-based approach designed to maximise
  CNS compensation for Vestibular pathology
• Not new!
• Cawthorne Cooksey 1940s people who moved more
  did better, people should perform provoking
  movements
• Recent studies advocate customised approach

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Who is VRT suitable for?

• Vestibular Neuritis/Labyrinthitis
• Benign Paroxysmal Positional Vertigo (BPPV)
• Bilateral Vestibular Hypofunction
• Menieres Disease
• Central causes of vertigo brainstem infarct,
  cerebellar infarct, MS etc..
• (BPPV should be treated first with a particle
  repositioning maneouvre)

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Symptoms of Vestibular Impairment

• Dizziness on certain head movements
• Vertigo, nausea, vomiting
• General loss of balance often worse in
  darkness/uneven surfaces
• Increased symptoms in crowded places/with visual
  stimuli
• Reduced activity due to avoidance of activities
  that provoke symptoms

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Treatment Approach

• Three exercise approaches are used to reduce
• impairments (gaze instability, dizziness and
  postural instability)
• Use of Vestibular suppressants??
• Adaptation
• Habituation
• Substitution

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What does Physiotherapy involve?

• Initial assessment including subjective
  objective outcome measures
• An individualised home execise programme is drawn
  up for the patient to work on at home is
  progressed as necessary (usually fortnightly)
• In-house vestibular balance re-education
• Advice Education
• Generally expect to see improvement within 2-3
  months

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Goals of VRT

• Reduce symptoms of dizziness nausea
• Improve postural and gait stability
• Reduce falls risk
• Improve independence in ADLs
• Increase cardiovascular conditioning
• Decrease anxiety, fear social isolation

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