WHAT IS THE VESTIBULAR SYSTEM?

The Vestibular system consists of the semi-circular canals (see below) and the Otoliths (utricle and saccule-see below) in the inner ear, on both sides of the head, as well as specific parts of the base of the brain (the brainstem) called the vestibular nuclei. 

Information from the inner ear travels along the vestibular nerves to the brainstem.  This information is analysed and the brain responds by sending messages along nerves to the muscles of the limbs, body and eyes.  In this way the vestibular system is involved in the control of balance, and coordination of eye and head movements.  This enables us to sit, stand and walk without falling, and to maintain clear vision, no matter the position or speed of movement of the head. 

Problems in one inner ear can lead to an imbalance in the information coming to the brainstem resulting in one or more of the following:

• Vertigo – sense that the world, or sometimes self, spinning or moving
• Dizziness – various sensations including spinning or wooziness in the head
• Light headedness
• Blurred vision – often when moving your head
• Disequilibrium – the sense of being off balance
• Veering to one side when walking
• Falls
• Motion Sensitivity – dizziness, imbalance and/or nausea triggered by changes in position, repeated movements, or traveling in a vehicle

Problems in the inner ear on both sides of the head are often more severe than those experienced by people with problems on one side only. When only one side is affected the unaffected side can take over some of the role of the damaged side and compensate for the loss, resulting in minimal reduction in function.  However, when both sides are affected the vestibular system has difficulty functioning normally.  As a result you might experience:

• Blurred vision when moving your head, walking or in a moving vehicle, this often results in:

   objects in the distance appearing to jump or    bounce,
   difficulty reading street signs,
   difficulty recognising peoples facial features at    a distance.

• Disequilibrium – the sense of being off balance
• Unsteadiness in standing or walking, especially with head movements, on uneven surfaces and in poorly lit or dark environments
• Falls

In addition, secondary effects can develop, particularly in cases where the vestibular problems have been present for a while.  These occur as a result of avoiding movements or activities that provoke your symptoms or make you feel unsafe.  They can include:

• Stiffness and/or pain in the neck from restricting head or eye movements
• Headaches or eye aches
• Reduced fitness or stamina
• Inability or reduced ability to participate in recreational and sporting pursuits, or to perform certain work/home duties

Many patients have neck pain and headaches associated with their vertigo, dizziness or imbalance.  Musculo-skeletal physiotherapy can provide some relief for these symptoms, however, if the problem is vestibular in origin then the neck pain and headaches are usually secondary problems.  In this case treatment of the neck will not have a lasting effect and only resolution of the vertigo, dizziness or imbalance will achieve this. 

WHY VESTIBULAR REHABILITATION CAN HELP

Numerous research studies have demonstrated the effectiveness of vestibular rehabilitation as opposed to general balance and conditioning programs. Many patients report that they have had "balance retraining" and found it did not help them. However, frequently these patients were seen by therapists who lacked specialised training and certification, and they did not recieve a specific program targeting there individual needs.