Making Sense of your Sensory System: Addressing Issues of Balance with Vestibular Rehabilitation

The room is spinning when you wake up. There is an unsteadiness to your feet when you stand. When you go to walk, you feel off balance and can’t get your bearings.

“Odd,” you think to yourself, “I didn’t do anything to make this happen.”

What you may have is a bad sense of communication. No, not verbal communication. This conversation is the one your brain is having with the signals from your inner ear.

Welcome to the vestibular system.

Vestibular system – what’s happening behind the curtain?

Vestibular is a fancy word for the sensory system located in your inner ear and the way it works with the rest of your body. The inner ear does many things behind the scenes and we typically don’t even know it is working at all if it is working well.

Let’s break it down.

The inner ear is for more than just hearing, it also detects movement. The structures inside the ear sense when the head moves in any direction. Those sensors talk to many areas of the brain and even to your spinal cord to create the balance reaction and response to disturbances in movement.

Minor shifts in ground surface, turning your head when you are walking or catching your foot and tripping when walking — the inner ear coordinates with your brain and muscles to control these reactions.

So in the simplest terms, the inner ear tells our brain when we’ve moved, how much we’ve moved and where we are in space. By doing so it keeps our balance in check.

It’s when the inner ear isn’t working properly that the world can go out of balance – literally and figuratively.

Common vestibular disorders and their symptoms

Often you hear someone say, “I have vertigo.”

Vertigo, a sensation of motion when there is no actual movement, is a symptom of inner ear dysfunction, not a condition. Many common conditions can suddenly make you feel off balance, dizzy or affect your ability to feel stable.

Vestibular disorders:

• Benign paroxysmal positional vertigo (BPPV) – The most common inner ear disorder causing brief vertigo episodes. Can be triggered by specific head movements including getting up from the laying down position, laying back in the dentist’s chair or into a hairdresser’s washing sink as a few examples. BPPV occurs when the crystals of the inner move from their proper position to other spaces in the inner ear.
• Unilateral and bilateral vestibulopathy – This is also known as unilateral or bilateral vestibular hypofunction (UVH or BVH) and can cause dizziness and various levels of loss of balance and spatial orientation.
• Vestibular neuritis/labyrinthitis – Caused by infection of the vestibular nerve or inner ear structures. Often results in sudden, severe vertigo, nausea and imbalance.
• Meniere's disease – This rare inner ear disorder, believed to be caused by an abnormal buildup of fluid in the inner ear, affects sense of balance and hearing. Severe dizziness, ringing in the ears (tinnitus), hearing loss and a feeling of fullness or congestion in the ear are all common.
• Vestibular migraines – A recurring neurological condition where episodes of vertigo, dizziness and/or imbalance occur due to a migraine and can occur with or without a headache.
• Persistent postural-perceptual dizziness (PPPD) – A chronic vestibular syndrome that causes dizziness and imbalance. The dizziness can feel different for everyone, it may feel like swaying or rocking, a swimming or heavy sensation or a fuzzy feeling— but not visual spinning. Often described as a constant sensation of floating or rocking without nausea. It is worse when standing, moving or when in complex visual environments like stores or crowds.

These specific vestibular disorders can create dizzy spells, vertigo and/or imbalance. If the vestibular system and balance reflexes are not working well you can experience imbalance and unsteadiness in the lower symptom range to the extremes of dizziness and vertigo.

Finding balance

It’s no secret that when you are off balance, your interaction with the world changes. Suddenly going down stairs, walking in public or driving a car become daunting tasks.

Seeking help from a vestibular rehabilitation therapist early on not only helps to shorten episodes of vertigo and imbalance, but is also crucial in prevention of falls and further issues.

Balance is essential to participating in life. It’s never too early to seek help. At the first signs of imbalance, small to substantial, bringing attention to it with a medical professional or a rehabilitation expert can prevent bigger issues from developing.

Seeking vestibular rehabilitation is as easy as contacting your local rehabilitation provider and telling them what you’re experiencing to schedule an appointment for evaluation.

A look inside therapy

A vestibular therapist will begin with a set of tests focused on balance and a closer look at the vestibular system. This clearly defines where the issues are stemming from and what functions of the body are impacted.

A comprehensive examination includes various clinical tests that assess the sensory system and balance. Therapists look at how your sensory system responds in different situations such as level versus unleveled surfaces, head turns, low light situations, etc. During the evaluation, a therapist will take the time needed to pinpoint sources of imbalance to inform their treatment strategies.

The tests measure how the eyes, brain and inner ear are working together and when they are not working efficiently. This includes looking at the vestibular system’s most intricate mechanisms including its reflexes, the ocular motor system, the vestibular spinal reflex and balance. Strength, coordination and sensation will also be examined since they play a role in balance and walking.

You’ll receive extensive education on the cause of your symptoms and an individualized treatment plan to address the cause of your dizziness or imbalance. Some areas of focus include:

• Exercises for your vestibular reflexes
• Repositioning maneuvers for vertigo
• Dynamic walking training
• Balance retraining
• Stretching and strengthening
• Eye movement control

All are key elements in helping you to right yourself and your balance system. Progress is encouraged not only through your care plan with the vestibular therapist in the center, but through guidance on home exercises to maximize improvement.

Removing fear of falling

Fear of falling is a risk factor of falling. Said another way, if you think you are going to fall, you are more likely to fall.

Many people who feel off balance will walk slower, or lean on furniture or walls to walk. Those tactics, among others, actually increase the risk of falling. Additionally, our balance responses can change when we are worried about falling.

Working with a rehabilitation expert can help eliminate fear through improving balance and confidence. With these skills you can return to more natural movement, reducing the chances that you will experience a fall.

Through dynamic walking tests, therapists can score your risk of falling. Using the results, vestibular rehabilitation targets retraining the vestibular reflexes and recalibrating the way the brain is reading the inner ear to restore balance to the system.

Outside of the vestibular system, a therapist works with you to build core strength, stretch and strengthen the muscles involved in fall prevention and focus on your ability to multitask (e.g. walk and text, walk and have a conversation, walk while carrying groceries) to increase your ability to walk safely and effectively. With their support, you learn how to adjust to move safely in the world.

Returning balance to life

You don’t have to just live with or accept balance issues resulting from aging, injury or condition.

Together with a vestibular rehabilitation therapist, you can make sense of your sensory system and take advantage of benefits including:

• Reduced risk of falling
• Improved balance
• Reduced dizziness symptoms
• Improved ability to stabilize vision while moving
• Increased body strength

That’s not all. Our clinical experts collaborate with your primary care provider, neurologist or other specialists to ensure your whole care team is on the same page.

So, when the world starts spinning, put on the brakes with vestibular rehabilitation.

Clinical contribution to this blog provided Physical Therapist Melissa Bloom, national coordinator of concussion and vestibular services.