From the Guidelines
Vestibular rehabilitation exercises, including gaze stabilization, habituation, balance training, and walking exercises, are recommended for patients with persistent vestibular dysfunction after a Traumatic Brain Injury (TBI) or concussion, as they promote neural adaptation and compensation in the vestibular system, helping the brain relearn how to process balance information after injury 1. These exercises should be performed under the guidance of a physical therapist specializing in vestibular rehabilitation who can customize the program based on specific symptoms and progress. Some key exercises include:
- Gaze stabilization exercises, which involve focusing on a target while moving your head horizontally or vertically, starting with slow movements and progressing to faster ones, performing 1-2 minutes several times daily.
- Habituation exercises, which help reduce dizziness by repeatedly exposing yourself to movements that trigger symptoms, such as quick head turns or position changes, doing 5-10 repetitions twice daily.
- Balance exercises, which progress from standing with feet together on a firm surface with eyes open to more challenging positions like standing on one foot or using an unstable surface like a foam pad, practicing for 2-3 minutes several times daily.
- Walking exercises, which include walking with head turns, walking with narrowed base of support, and walking while focusing on a moving target, starting with 5 minutes daily and gradually increasing duration. It's essential to start with exercises that produce only mild symptoms and gradually progress as tolerance improves, as supported by the 2021 systematic review and meta-analysis 1. Additionally, a 2017 clinical practice guideline on benign paroxysmal positional vertigo highlights the importance of vestibular rehabilitation in promoting habituation, adaptation, and compensation for deficits related to balance disorders 1.
From the Research
Vestibular Exercises
- Habituation and adaptation exercises are commonly used in vestibular rehabilitation therapy (VRT) to promote vestibular adaptation and substitution 2, 3
- These exercises involve head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk 3
- Repeating the movements provoking vertigo and exposing patients gradually to various sensory and motor environments are also key exercises in VRT 3
Balance Exercises
- Balance exercises are an essential part of vestibular rehabilitation therapy (VRT) to enhance postural stability and improve activities of daily living 2, 3
- Exercises that challenge balance, such as standing on a foam pad or balance board, and performing upper-extremity tasks while maintaining balance, are commonly used in VRT 3
- These exercises help to improve gaze stability, postural stability, and reduce vertigo and dizziness symptoms 3
Common Barriers to Recovery
- Co-morbidities, including cognitive and behavioral issues, visual-perceptual dysfunction, metabolic dysfunction, and autonomic dysfunction, can hamper the effectiveness of VRT 4
- The duration of therapy and the time to recovery may be prolonged due to the complexity of the injury and the presence of co-morbidities 4
- Working closely with other disciplines, such as physical therapy, occupational therapy, and psychology, can help to optimize recovery outcomes 4
Effectiveness of Vestibular Rehabilitation Therapy
- VRT has been shown to be an effective modality for managing dizziness, vertigo, and imbalance following concussion or mild traumatic brain injury (mTBI) 4, 5, 2
- Studies have demonstrated statistically significant decreases in Dizziness Handicap Index scores and improved perceived disability associated with dizziness postconcussion 5
- However, the current evidence for optimal prescription and efficacy of VRT in patients with mTBI/concussion is limited, and further high-level studies are required to fully understand its effects 2