Vestibular Rehabilitation Therapy at Home in New York City
Does it feel like the room is spinning when you begin to sit or lay down…and again when rising? Do you sometimes feel light headed, foggy, disoriented…or experience nausea or vomiting with movement…perhaps car sickness? Have you noticed blurred vision, headaches or a ringing in your ears with movement or walking in dimly lit places? Have you fallen or have a fear of using stairs? Balance disorders can surface at all ages but become more common as we get older. We offer vestibular assessments & rehabilitation programs, in the comfort of your own home, to restore not only your balance but your confidence in living your full life.
What is the Vestibular System?
Health Conditions Treated
Will Vestibular Rehabilitation Therapy Help Me?
How is it Practiced?
What are the Exercises?
What Can I Expect in Treatment Program
Vestibular Rehabilitation Therapy for Children
What is Vestibular Rehabilitation Therapy?
Symptoms of dizziness, blurred vision, feeling off-balanced, falling or stumbling are treated and improved with a specialized type of physical therapy called “Vestibular rehabilitation therapy”. Research (source & source) has proven that vestibular rehabilitation therapy can be effective in resolving symptoms related to numerous vestibular (inner ear/balance) disorders. The vestibular system is a complex sensory labyrinth, a kind of inner ear system full of passageways that regulates our spatial orientation and balance. The vestibular system consists of:
- semicircular canals of fluid able to detect different types of movements: shaking side to side, tilting left and right, or nodding up and down. These semicircular canals stabilize our eyes keeping our vision stable when moving our head.
- 2 specialized organs called “otolith organs” can detect movement in the horizontal and vertical plane including gravitational forces, tilting movements, and linear acceleration.
The vestibular nerve transmits signals to the central nervous system where those signals are interpreted and used by the brain for movement coordination. Since there are 2 vestibular systems (2 ears), one on each side of the head they need to be ‘on the same page” with symmetrical signals transmitted and interpreted by the brain in order to function properly.
If the vestibular system is injured, the brain can manage with signals that are not symmetrical and imbalanced by learning to rely more so on alternative signals arriving from other body systems to achieve vestibular balance. This can be accomplished through exercise strategies or vestibular rehabilitation therapy, wherein symptoms can be alleviated and people can resume their normal day to day functioning.
What is the Vestibular System?
The vestibular system enables you to detect motion, head position and the ability to properly react when sensing change. It’s composed of:
- 2 inner otolith ear organs
- the vestibular centers of your cerebellum and midbrain
- the signal transmitting peripheral vestibular nerves
The vestibular otolith organs (the utricle and the saccule) function like sensors measuring head rotation and tilt, up/down motions, and forward/back. The vestibular system is commonly referred to as a labyrinth or as earlier stated, an inner ear system full of passageways due to the many semicircular canals contained within it. The vestibular nerve is the communication line tethering your inner ear system to your midbrain and cerebellum, transmitting information about all sensed forms of motion to your brain for processing.
While the brain receives and processes spatial orientation and movement information from the vestibular system, it also receives additional supportive information from other body sensors such as your tendons, joints, and muscles throughout your body. Still even more ‘sensors’ such as your touch, hearing and vision, and even functions such as emotion and memory provide supportive balancing information to the brain. The brain then considers all sources of information on balance and transmits instructions to your entire body accordingly so that you react properly to each situation. Hence vestibular rehabilitation therapy encompasses improving all aspects of your body, all sources of signals, consequential in achieving proper balance.
Health Conditions Vestibular Rehabilitation Therapy Effectively Treats
Vestibular rehabilitation therapy can be effective for anyone coping with:
- Vertigo (sense of spinning)
- Ménière disease.
- Benign paroxysmal positional vertigo (BPPV).
- Vestibular neuritis.
- Migraine headache.
- Traumatic brain injury.
- Falling risk.
- General dizziness or lightheadedness
- Nausea, vomiting, fatigue
- Neck tightness, stiffness and/or pain
- Imbalance and difficulty walking
- Vision matters (shaky vision with head movement, double vision, difficulty focusing)
- Brain fog, mild memory issues, difficulty concentrating,
The objective with vestibular rehabilitation therapy is to train your brain to consider all external signaling reference points and sensors such as your tendons, joints, and muscles throughout your body to help you regain spatial orientation and balance.
Will Vestibular Rehabilitation Therapy Help Me?
If you are coping with one or more of the above symptoms, then Vestibular Rehabilitation Therapy will help in reducing the symptoms. Having said that, many dizziness complaints can be due to numerous factors not involving your vestibular system therefore it’s important to be properly assessed to establish whether or not you have a vestibular condition and if vestibular rehabilitation therapy can improve what you’re experiencing.
In the comfort of your own home or office we can perform a physical therapyl evaluation involving:
- Central neurological testing (various reflex tests)
- Cranial nerve tests of specific brain-based functions
- Cervical tests of your neck’s joint, blood flow and muscle function
- Visual oculomotor function tests
- Balance testing
- Gait assessment (walking / mobility tests)
- Positional testing on a bed or couch
The findings from an assessment and any deficits identified will determine if vestibular rehabilitation therapy will be helpful along with the goals of a treatment plan.
How is Vestibular Rehabilitation Therapy Practiced?
Learning vestibular rehabilitation therapy exercises is not difficult but does require consistency to realize improvement and reach all therapeutic goals. It’s common for a patient to perform exercises 2-3 times in a day, which can be challenging for those with an active schedule. Patients that set up regular schedules incorporating exercises into their daily routine realize the fastest and best outcomes.
It’s important to know that patients tend to notice vestibular rehabilitation therapy exercises will slightly increase their symptoms. This is a positive sign that you’re doing the exercises effectively as your vestibular system is being stimulated. Note that with consistency and time, your symptoms gradually subsiding indicates that you’re ready to perform more complex vestibular rehabilitation therapy exercises – until all symptoms are significantly reduced and in many cases, entirely resolved.
What are Vestibular Rehabilitation Therapy Exercises?
Vestibular rehabilitation therapy exercises differ from patient to patient because impairments and their effects differ with no two cases being identical. Generally vestibular rehabilitation therapy exercises aim to achieve what is called central brain compensation, or a realigning of how your vestibular system’s impairments function. Simply put, the brain needs retraining on correctly interpreting the many balancing signals it receives from the many different sources. The objective in repetition of these exercises is to allow the brain to accurately interpret and learn from the stimulation produced in the exercises. Central brain compensation can be segmented into 3 categories:
The process that takes place in the brain where nerve impulses shift away or “adapt” to the damaged vestibular system’s transmitting of incorrect signals. Adaptation exercises enable the brain to recalibrate itself accordingly.
Habituation exercises enable you to desensitize yourself gradually to vestibular movement and stimulation when you are exposed to it repeatedly. Habituation exercises treat symptoms of dizziness produced from high visual stimulation or head motion. Figure skaters achieve the ability to spin rapidly in circles on the ice without getting dizzy or losing balance from practicing habituation exercises regularly.
Substitution is a recovery principle using other body strategies or functions to replace any vestibular function that’s missing. Making large eye movements across your field of vision towards a specific target before moving or pivoting your head toward the specific target to view it is an example of a substitution exercise. In this case you’re relying on your vision to initially ‘spot’ as opposed to relying on head movement to initially spot.
What Can I Expect from Vestibular Rehabilitation Therapy?
Vestibular rehabilitation therapy starts with a thorough clinical assessment in your home or office that will include collecting a detailed history of your symptoms, their intensity, precipitating circumstances, and how these symptoms impact your daily activities. We’ll gather information about hearing or vision problems, medications, other medical issues including history of falls and your current living patterns (fitness routine, commuting and work habits, use of stairs, etc).
The assessment includes administering a series of tests to more objectively and accurately assess the symptoms you’ve reported. We will screen your visual and vestibular systems to observe and measure how well your eye movements are controlled. Testing assesses coordination, balance, posture, walking ability, muscle strength, spine and extremity range of motion.
A plan is then customized, tailored from the findings of the clinical assessment, any results from lab testing, and input from you about your personal goals for rehabilitation. Expected vestibular rehabilitation therapy outcomes include:
- Decreased dizziness symptoms
- Decreased nausea or vomiting
- Improve focus or concentration and memory
- Improved balance in standing or sitting
- Decreased risk of falling
- Improved ability to stabilize vision or gaze and ability to focus or track on objects at varying distances
- Enhanced neck mobility, reduced stiffness and/or pain
- Less fatigue and improved sleep
- Feeling less anxiety and better able to cope with stress
- Improved confidence to return to preferred lifestyle
In addition to the exercises, caregiver education is an important part of vestibular rehabilitation therapy. Many of our patients find it helpful to understand the science of their vestibular challenges, and how they’re connected to their difficulties with everyday life. Plus, education removes much of the mystery of what you’re experiencing, which is helpful in reducing anxiety that’s common with vestibular disorders.
Pediatric Vestibular Rehabilitation Therapy for Children
We’re experienced in evaluating children and developing vestibular therapy programs tailored to help children with balance concerns and sensory processing disorders. We work closely with your child’s doctors to provide seamless, comprehensive care that helps with mobility, visual-motor skills and motion sensitivity at the right pace for your child so they build new skills gradually and safely. Children with vestibular challenges generally cope with one of two main types of vestibular dysfunction: hyposensitive or hypersensitive, to vestibular inputs or signals.
Children showing hypersensitivity signal input typically avoid movement and can become irritated when they are moving. Their brains have difficulty processing the vestibular input signals they are receiving, making intense movement disconcerting and uncomfortable. They may be observed:
- Avoiding motion-intense playground equipment like see-saws, slides, swings, balance beams, or merry-go-rounds.
- Being satisfied to sit and be stationary than jump, run, or spin.
- Avoiding sports or physical games.
- Eschewing any activity that requires careful balancing.
Then there is the other end of the spectrum where children with hyposensitivity input signal vestibular dysfunction are identified in physical therapy settings often after parents report symptoms including:
- Excessive seeking of movement-intense behavior, like swinging, bouncing, spinning, and jumping.
- Appears impervious to dizziness.
- Seems to lack safety precautions, awareness/self-preservation.
- Gravitates toward playground equipment playing harder/longer than other kids. Takes risks and is a bit of a thrill seeker
What is Pediatric Vestibular Therapy?
Vestibular therapy helps children address challenges affecting their ability to control balance and coordination. Whenever your child moves, their brain processes information about what they see, where they are and how they are moving. If your child has difficulty with vestibular function, they might seem off-balance or uncoordinated. You might notice that they avoid activities such as swinging or seek activities that make them feel unbalanced, like spinning in circles. Vestibular therapy uses specific activities to help your child move in more coordinated, balanced and safe ways. Click here to see our full table of contents on Vestibular Rehabilitation Therapy.
What are the benefits of Pediatric Vestibular Therapy?
Vestibular therapy improves balance, coordination and motor planning skills, helping your child become more stable as they move. Vestibular therapy can help children who have dizziness (vertigo), delayed motor function development and other mobility problems. This type of therapy can also help children who have sensory processing disorders related to vestibular function. They may be too sensitive to vestibular input (such as changing direction or moving their head), so they avoid certain movements. Or, they might not be sensitive enough, so they are constantly moving. The goal of their therapy is to help them feel more comfortable with different movements or feel calmer so they can stay still. You should expect your child’s everyday routines and behaviors to improve. Click here to see our full table of contents on Vestibular Rehabilitation Therapy.
What are the side effects of Pediatric Vestibular Therapy?
Some children who experience dizziness may feel dizzier when they start therapy, but these symptoms should improve within a few days. Some children with sensory processing disorders may feel overstimulated or tired after therapy. We’re careful not to push your child too aggressively, keeping activities within their abilities and comfort zone. If you notice that your child is hyperactive, tired or stressed after therapy, please let us know so we can adjust their treatment plan. Click here to see our full table of contents on Vestibular Rehabilitation Therapy.
Patients often have to wait weeks or months to gain access to providers—long enough for conditions to move from acute to chronic. I bring physical therapy to you, to meet your wellness goals with the convenience of a mobile service that comes to your home or office. My goal in delivering you personalized one-on-one care is for you to have a pain-free and healthy lifestyle. I provide a mobile physical therapy experience to Northern New Jersey and New York City that empowers, educates, and restores balanced healthy movement without the drive to appointments, having to re-schedule your day, or cope with crowds and traffic. – Jim Palmer, Physical Therapist
What clients are saying…..
I started PT with Jim over FaceTime in the height of COVID. I have done a lot of PT, but this is the first PT that feels function oriented and strength building. Jim is encouraging and affable. He is always ready to cheer on my small wins! I highly recommend seeing Jim in-person or online!Catherine Galateria
Working with Dr. Palmer has been a pleasure. He took time up front to understand my injury, assess where I was stronger and where I was weaker and to talk through what I wanted to achieve. I can’t speak highly enough of Jim. He’s both technically excellent as well as just a genuinely nice person.Alex Lorton
…. After listening intently to my symptoms and doing some manual tests, Jim realized I had a different injury than the doctor had prescribed. He recommended fresh strengthening exercises which, combined with his stretching, improved my condition quickly. Jim also set me up for lasting relief by teaching me how to address the pain if/when it arises again.Marc Adelberg