Vestibular Therapy

In the inner ear there are two principal structures: the cochlea and the vestibule. The former allows us to hear while the latter is instrumental to our balance and sense of the body’s position in space (spatial orientation). The vestibule generates signals whenever you turn, spin, tilt or accelerate/decelerate forwards or backwards. This information is then reconciled with other signals in the central nervous system and modulated to make our perception of the world around us “accurate” or efficacious. These signals are then transmitted to networks of neural tissue that innervate all the muscles in your body including ocular and cervical muscles, thus making our response to what we sense as efficient as possible. This entire system is known as the vestibular system. This system is very important in maintaining accurate visual perception, precise balance and appropriate neck control. It is also important in cognitive processes.

Anyone who has felt turbulence while standing still on a plane will appreciate the effect of the vestibular system. For children, perhaps you can recall the last time you spun in circles for as long as you could? Once you decided you had had enough and chose to collapse on the grass, do you remember staring at the sky and watching the clouds spinning around you even though you were not moving? This was your central vestibular system perseverating the vestibular response to your eyes so that they could keep up with what you were doing.

The sensations of dizziness and disequilibrium can be normal physiological responses to certain activity, i.e. the child spinning endlessly in the park from our example above. Generally, whenever there is a mismatch between signals coming into your central nervous system, you may get some illusionary symptoms; have you ever been seated on a stationary train and thought you were moving backwards when in fact the train next to you starting moving forward? What if there is an abnormality in the way your vestibular system detects and transmits information about motion? Or if another system (i.e. visual, somatosensory) is sending erroneous signals? Or if the way your brain interprets and modulates this signals is awry? There are various causes for dizziness and disequilibrium and it is easy to understand that to correct the ensuant dysfunction, one has to correct the underlying cause for the same.

Vestibular rehabilitation therapy is a specialized exercise-based program designed to reduce dizziness, vertigo, disequilibrium, gaze instability and imbalance. Often, simple maneuvers can be performed to immediately reduce vertigo. Fortunately, in the context of a concussion, vestibular issues have excellent prognosis. The principle aim is to retrain the way the brain interprets and weighs the various sensory inputs it receives (vestibular, visual, somatosensory) to improve your performance so that it is commensurate with your goals. It also involves training your beliefs and expectations of what you are going through and what you are capable of, this is the all-important 4^th dimension to neurological performance enhancement. Finally, it involves strategies to improve the autonomic nervous system.