Vestibular Rehabilitation

Individuals that are suffering from a vestibular disorder will most likely complain of some type of symptom related to eye function such as blurry vision, light sensitivity-photophobia, eye fatigue, double vision, reading difficulties, etc. This is not a problem with vision but the areas of the brain that control the stability and integration of eye with head movements known as the cerebellum.

The vestibular system is a sensory system.  It is just fluid within a closed part of the temporal bone that has 3 canals. There is no brain their; It “RELAYS” information to the brain and cerebellum via the vestibulochochlear nerve and serves three primary purposes: (1) sensation of motion and spatial orientation of the head, (2) it adjusts muscular activity and body position to maintain posture VIA THE CEREBELLUM which stabilizes in space the fixation point of the eyes when the head moves, providing a stable image. It is anatomically, and physiologically connected to our visual, and auditory system, and sends information to the proprioceptive system mostly the cervical (neck) spine.  If one of these systems breakdown, the other system takes over.  This breakdown creates a sensory mismatch, and it’s this sensory mismatch that causes disequilibrium. Disequilibrium is an alteration or disturbance in the central (brain) feedback.

The cerebellum ‘fine-tunes’ ocular motor function, speech, limb and trunk movements so they work together to maintain images clearly, and maintain smooth movements and balance . The cerebellum receives information from the vestibular system to coordinate incoming sensory information. The cerebellum is a major brain structure located behind the brainstem. It’s responsible for balance and also has a clear role in motor learning. The cerebellum does not abolish movements, speech or vision – it makes them slow, inaccurate, rough and variable. The cerebellum compensates for different loads and muscle lengths, improves movement accuracy and smoothness, and an intact cerebellum is a ‘prerequisite’ for optimal ocular motor function.

Patients are often treated with a ‘sit-and-wait’ approach; meaning it’s only after signs and symptoms have manifested and worsened that people often seek care. Early intervention is critical as is the case with most disorders. The longer someone’s brain is adapting to negative changes incurred as a result of a vestibular disorder, the longer it will take to rehabilitate their way out of it. The basis of a vestibular rehab program is to use the already existing neural pathway mechanisms for adaptation, plasticity, and compensation in the human brain. Individualized rehab programs will be prescribed to take advantage of this plasticity of the brain.

There are numerous types and causes of vestibular based problems; head injury by far is the most common and is often related to motor vehicle accidents and contact sports. If left untreated, many vestibular patients can suffer devastating and debilitating consequences such as vertigo, dizziness, balance problems, cognitive dysfunction, emotional disorders, headaches, muscle tone imbalances, autonomic dysfunction and much more.

Vestibular Rehabilitation Diagnosis and Treatment

A comprehensive evaluation is performed on each patient when he or she enters the program to determine the specific nature of the vestibular dysfunction. An individualized treatment plan is then developed.

We complete a very detailed examination, including a host of sensitive tests (including VNG, computerized balance testing, detailed neurological exam, tilt table testing and more) that we use to quantify, and objectively evaluate a patient with a vestibular disorder. These tests are used to access a peripheral, central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.

We rehabilitate a wide range of conditions that can result in vertigo, dizziness and imbalance—including, but not limited to:

      • Peripheral Vestibulopathy eg. BPPV
      • Central Vestibulopathy
      • Cervicogenic Dizziness
      • Cerebellar Ataxia
      • Dysautonomia eg. POTS (common in concussion)
      • Acoustic neuroma, Brainstem tumor, Cerebellar Tumor
      • Traumatic brain injury (TBI), Post-concussion syndrome
      • Visual Processing Disorders, Autism
      • Auditory processing Disorders
      • Post Stroke
      • Multiple Sclerosis
      • Movement Disorders

Vestibular Concussion radio- CBC.ca  Crosby’s doctor and rebuilding the brain

<iframe width=”560″ height=”315″ src=”https://www.youtube.com/embed/dvVZFqjvPlE” frameborder=”0″ allowfullscreen></iframe>


    RESEARCH

Blazquez PM1, Hirata Y, Heiney SA, Green AM, Highstein SM. Cerebellar signatures of vestibulo-ocular reflex motor learning. J J Neurosci. 2003 Oct 29;23(30):9742-51.

Sağlam M1, Glasauer S, Lehnen N. Vestibular and cerebellar contribution to gaze optimality. Brain. 2014 Apr;137(Pt 4):1080-94.

Blazquez PM1, Hirata Y, Highstein SM. The vestibulo-ocular reflex as a model system for motor learning Cerebellum. 2004;3(3):188-92.

Cheron G1, Dan B, Márquez-Ruiz J. Translational approach to behavioral learning: lessons from cerebellar plasticity. Neural Plast. 2013;2013:853654.

Kammermeier S1, Kleine JF, Eggert T, Krafczyk S, Büttner U. Disturbed vestibular-neck interaction in cerebellar disease. J Neurol. 2013 Mar;260(3):794-804.

Christian Quaia, Philippe Lefèvre and Lance M. Optican. Model of the Control of Saccades by Superior Colliculus and Cerebellum. J Neurophysiol 82:999-1018, 1999.

Ustinova K1, Perkins J. Gaze and viewing angle influence visual stabilization of upright posture. Brain Behav. 2011 Sep;1(1):19-25.

Kheradmand A1, Zee DS. Cerebellum and ocular motor control. Front Neurol. 2011 Sep 1;2:53.

K. Asakawa et al., Effects of ocular dominance and visual input on body sway”. J Ophthalmol. Vol. 51, No. 5,pp. 375-8, 2007.

Bill J. Yatesa,b,∗ and Adolfo M. Bronsteinc. The effects of vestibular system lesions on autonomic regulation: Observations, mechanisms, and clinical implications.  Journal of Vestibular Research 15 (2005) 119–129.

Chester A. Ray. Interaction between vestibulosympathetic and skeletal muscle reflexes on sympathetic activity in humans. J Appl Physiol 90:242-247, 2001.