Barriers to Vestibular Rehab and Recovery
Before getting into the barriers to vestibular recovery we must understand it some more. It starts with central compensation. It is the process of the brain interpreting whatever level of vestibular input is available from the inner ear as equal to the other side.
To explain it to my to patients, I also call it “recalibrating.”
Central compensation for a vestibular injury occurs through a neurological process called “neuroplasticity.” This central compensation occurs in the brain.
In order to maximize neuroplasticity, certain training parameters must be followed. Those training parameters for vestibular rehab are well established through research and serve as the basis of effective vestibular recovery.
Failure to compensate, or recover fully from symptoms related to an episode of vestibular neuritis or vestibular labyrinthitis for example, is referred to as “chronic vestibulopathy.” There are many things that can create a barrier to central compensation, thereby preventing a full vestibular recovery with successful vestibular rehab.
Top Ten Barriers to Vestibular Recovery
- Anxiety or depression that prevents full participation in vestibular physical therapy
- Lack of access to adequate skilled care providers
- Fear of movement or avoidance of movement due to symptom provocation
- Lack of knowledge about the existence of vestibular physical therapy as a treatment option
- Stress that is preventing the brain from accomplishing neuroplasticity or creating new pathways to recalibrate
- Certain common medications prescribed for dizziness that prevent vestibular recovery by suppressing the central nervous system
- Other neurological impairments or CNS (central nervous system) diseases that restrict the brain’s ability to respond to an inner ear problem effectively
- Residual BPPV particles that have not been cleared and continue to cause dysequilibrium with certain movements, giving the brain a motion-activated error signal to continually process
- Musculoskeletal problems like altered bony alignment, tight fascia, or muscle spasms in the head, neck, face, jaw, or spine that have not been addressed and get exacerbated by the treatment protocols of Vestibular rehab physical therapy
- Misdiagnosis at the beginning and therefore mismanagement of a true vestibular condition
Vestibular Rehab is Effective
There is a large body of research today that supports the effectiveness of Vestibular recovery and is used to design successful treatment protocols. Therefore, if you are not getting results from your Vestibular Rehab, then you may be dealing with one of the barriers to vestibular recovery that I listed above.
You may want to discuss the list of barriers in this blog with your physical therapist, or seek a second opinion from a more experienced Vestibular provider.
Disclaimer
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
Had planned a trip to see u in San Diego but due to covid19 had to cancel. Had an accident 4 yrs ago when thrown from golf cart & knocked out. Now experiencing dizziness, balance issues & mobility & strength issues. Have been to an upper cervical doctor who put atlas back in place .so question I have ; is there anyone in my state that u would recommend? Marietta,Ga. Loved your website with the other 2 or 3 doctors.
Hi Gary,
I understand about restricting the travel due to COVID-19 and I have advised other people to hold off traveling here to see me for now as well.
Here is a blog that may help you find a local provider:
How to Find a Vertigo Doctor in Your Area
If you can make your way to Emory University, they have a very strong Vestibular Rehabilitation physical therapy program.
All my best,
Kim Bell, DPT
Hi, my name is Marina. I’ve been diagnosed with VM by neurologist, PPPD by Physio and unilateral hypifunction by audiologist. Have started VRT, 10 days now, but feeling so much more dizziness and nausea than usual. I know initially should feel worse before better, but I thought you should get back to baseline, but I seem to have become worse with my symptoms. Not on any meds. What do you think? PT has started me slowly but stills feels horrible.
Hi Marina,
It is common for symptoms to flare up as you start with vestibular PT.
I suggest you discuss this concern with your vestibular physical therapist to find out if this is what your PT expected.
Even if VPT does work, it can still make you feel more lousy temporarily.
But if you generally feel like you are trending in the wrong direction, then your treatment plan may need to be adjusted.
You may also need to use medications during this process. People with PPPD do well on an SSRI or SNRI medication, in combination with mental health therapy (specifically CBT or ACT) and vestibular PT.
Managing migraine-related dizziness is another discussion entirely. I recommend a book called “The Migraine Brain,” which proved very helpful to me.
I believe you will need a team approach with multiple specialty providers for the maximal recovery.
Hang in there and advocate for yourself as you go along. Ask questions and speak up if you don’t understand what is happening.
It’s not easy, but you can get through this!
If you have not already, I suggest looking for support at Vestibular.org.
Sincerely,
Kim Bell, DPT
Hi, My name is Jack and I live in Western Massachusetts. I am 56 years old and I’ve been suffering with vertigo for the past 5 years now.I was wondering if you could advice me of VRT therapy in my area as I have a problem locating the right therapist. I have seen a regular therapist for some head and eye exercise movement but that didn’t help.
Thank you so much in advance,
Kind regards,
Jack
Hi Jack,
I only recommend providers who I know personally, and I do not know any vestibular providers near you.
However, this article may help you with online directories you can search to look for local vestibular rehab providers.
I hope that helps!
I’ve had dizziness for 5 yrs. I have been diagnosed with vertigo/dizziness by a well known PT and went thru numerous other doctors only to be told go back to PT. After 6 months of no progress PT said to take time off. What do I do now?
Hi June,
Well, I think a good next step would be to write up a case summary in a concise format so that you can present the key points of your story efficiently to anyone else that you work with as you move forward.
Here is a link to my blog with questions that you can answer to share your story clearly and concisely.
You asked me what to do now, but I really do not have much information about your situation except the diagnosis you were given and that the PT you tried for far did not work.
The diagnosis of vertigo is kind of like the diagnosis of back pain. It describes the symptoms, but not the root cause.
There are many possible causes of dizziness/ vertigo, so I hope the blog I shared above will help you organize your story for whoever you end up seeing next.
Best wishes!
I had a labyrinthectomy in 1999 and also have a lazy eye, so a double wammy! I have however been well compensated within the bounds of safety until I was recently prescribed an alpha blocker to help with my BP. I also take atenolol which I have also been on for over 20 years. 6 days on the alpha blocker, which did not seem to cause orthostatic hypertension,and I have all the indications of decompensation.
I raised the question of my balance with the prescribing doctor but he wanted to try it anyway. Am I right to stop taking the alpha blocker.
Hi Barbara,
I will defer to the prescribing physician about your specific medication question. Please follow up with the prescribing doctor.
If you decompensated from the labyrinthectomy, then you may need vestibular physical therapy.
You can search for a provider using this blog.
If your lazy eye has decompensated, you may also need vision therapy. You can search for a provider at COVD.org.
I hope that helps!
Our son suffered a concussion in November from ice hockey game and all other symptoms have resolved or resolving though he still has significant balance issues difficulty standing still usually wants to fall backward he says feel very unsteady it is very scary to watch him
MRI was normal
He attends PT weekly with a vestibular trained therapist and does home exercises though don’t see we are making headway
Hi Teena,
That sounds scary!
I am glad you found this article. It is possible one or more of these barriers is causing an obstacle to his progress.
This article has other reasons why vestibular PT may not be as effective.
You may want to discuss these barriers with his current vestibular PT.
You always have the option to seek a second opinion as well. If you do, I suggest finding a concussion specialist.
Concussions are tough and can take quite awhile to recover from, sometimes years.
If he is still having issues after the vestibular PT is completed, you may want to look for a neuro-optometrist at COVD.org.
I cannot offer much more of an impression unless I examine him in person.
I hope you find answers and he gets relief soon!
I am 69 years old and have had multiple episodes of BPPV over the last 10 years that mostly resolve after a trip to the ER and vertigo medications.
Often, I am admitted for 1 day and they do an MRI.
Finally, I was referred to an ENT and was sent for vestibular therapy which helped a lot.
In December had another episode, and through testing there were no crystals found out of place.
Now I have what has been diagnosed as cervicogenic vertigo and vestibular headaches.
Apparently, I still am prone to getting one or the other “vertigos” without warning.
Have had a VNG and a Balance test as well.
The problem with these conditions is that there is NO WARNING!
What if I wanted to travel to another country. So frustrating…..,,,, Thank you for listening.