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Vestibular rehabilitation is a relatively new discipline that has been designed to help people with dizziness and imbalance. A new application of old ideas, vestibular rehabilitation (the word "vestibular" refers to the "vestibule" of the inner ear, an organ which regulates one's balance) uses techniques from physical therapy and occupational therapy to treat patients with vertigo and balance disorders. Assisted by a computerized balance feedback machine, this type of therapy has been responsible for some measurable improvement in about 90% of patients.


Dizziness is not only difficult to diagnose, it can be very difficult to treat. Certain types of vertigo can be managed with diet or medications. Some may require surgery, others may require the Canalith Repositioning procedure (a nonsurgical cure for benign positional vertigo). There are some forms of dizziness that neither surgery nor medications can help. This may include people who have suffered head injury, spinal cord injury, stroke, diabetes and other peripheral neuropathy patients, blindness and poor vision and inner ear disorders such as labyrinthitis, Meniere's disease, and postoperative brain tumor patients.


These diagnoses are what vestibular rehabilitation was designed to treat. For example, if a patient suffers a stroke, or some sort of nerve injury, physical and occupational therapy can train the patient to compensate for his loss. Likewise, if a patient has lost components of his balance system, he can be trained to regain balance using the remaining components.


Once the diagnosis is made, a rehabilitation plan is developed. Posture strategies and ideal head and body positioning are taught. Exercises to strengthen each component of balance are performed. Think in terms of re-calibration. If your compass is 5 degrees off to one side, you will want to re-calibrate it so that it reads correctly each time. If you list 5 degrees to one side, you will need to readjust your posture to re-calibrate it back to the center.


Some of the rehabilitation is done with the aid of the Balance Master or the SwayMeter machine. The SwayMeter (Patented by Dr. Li) gives computerized feedback of a patient's control of his or her center of gravity. If a patient's weight is centered too far to the right, the computer can help adjust that center of gravity closer to the left. The Balance forceplate can determine which direction a patient may tend to fall and assign exercises to prevent falls in that direction.



One cannot expect bulging muscles after only one trip to the gym. Likewise, Vestibular rehabilitation takes time. The exact regimen is tailored individually to the patient, depending on the physical condition, motivation and diagnosis of the patient. In general, therapy lasts 45 minutes per session a few times per week and may take 4-8 weeks.



There is, of course, homework to do after each session. Certain exercises suitable to the home environment are taught. Once patients motivate themselves to stick to the program, they can experience dramatic changes in their lifestyles. Vestibular Rehabilitation may not work for everyone, however in the 90% that it does affect, it is well worth the effort.



Who needs this treatment?

People who are have problems with vertigo or who have a sense of imbalance. People who have suffered head injury, spinal cord injury, stroke, diabetes and other peripheral neuropathy patients, blindness and poor vision and inner ear disorders such as labyrinthitis, Meniere's disease, and postoperative brain tumor patients may all be candidates. (People with Benign Positional Vertigo should undergo the canalith repositioning procedure first since that can be cured in one treatment.)


What is involved? How is it done?

The treatment procedures may vary depending on the specific problem and the patient. Therapy is scheduled with our therapist on an outpatient basis. Sessions last approximately 45 minutes and may be once, twice, or even three times a week depending on the individual. It may take several weeks to see any progress.


Is it painful?

No, but there may be a temporary worsening of the symptoms of dizziness in the beginning. It requires dedication and hard work to overcome this problem.


What is the success rate?

Success has been excellent. Over 90% of patients show some level of improvement. Many are able to resume working and recreational activities.

Have there been any complications?

It is very important to note that vestibular rehabilitation may actually worsen the symptoms of dizziness and cause nausea before any signs of improvement are seen. This is similar to the muscle soreness and pain one experiences when beginning any new physical activity. No patients have reported permanent worsening of their vertigo or balance.






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