CONDITIONS TREATED
Rehabilitation
Management of Balance Disorders
The first step in management is to establish the reasons for the disordered function. This requires a very detailed history from the patient with a very full description of the symptoms suffered by the patient.
A detailed clinical examination of all the systems involved in balance will be supplemented by more specific tests and investigations.
With a working diagnosis a treatment programme can be devised. This will involve the treatment of any specific disease causing the problem, but equally or more important is a programme of rehabilitation to restore balance function.
Why is the Wellington Balance Unit different?
Traditionally dizziness or balance problems have been managed by either Neurologists or ENT Surgeons and Audiological Physicians. Much of the emphasis has been on the diagnosis of the problem and little attention given to treatment (unless surgery was necessary). Vestibular Rehabilitation, often neglected or fragmented and when performed was often left to general physiotherapists.
The Wellington Balance Centre is composed of all the disciplines involved in balance problems and offers comprehensive analysis and rehabilitation services. Our unique specialized comprehensive service brings together all expertise required to manage balance problems.
The physiotherapists working with the Balance Centre at the Wellington Hospital have special expertise and extensive experience in the area of Vestibular Rehabilitation which is a key component to recovery once diagnosis is identified.
Vestibular Rehabilitation
Vestibular rehabilitation has developed through recent years and now tends to be grouped into three approaches of Adaptation, Substitution and Habituation:
Adaptation: Is taking something that doesn’t work, work better.
This is linked to the plasticity of the vestibular system.
The current hypothesis is that a signal is required for this change (retinal slip) which causes an error signal that the brain then minimises by increasing the gain of the vestibular response. Specific exercises that target gaze stabilisation are the basis of the adaptation approach, with variations on distance, text size, background and speed used to progress the difficulty.
This is the main focus of vestibular rehabilitation.
Substitution: Is when something doesn’t work, use something else.
This approach is aimed at using alternative strategies to maintain gaze stabilisation when vestibular function is lost or compromised. It encourages saccadic eye movements and forced use of somatosensory, visual or remaining vestibular cues.
Habituation: Is taking someone who doesn’t feel good, feel better.
This approach encompasses repeated exposure to a movement that is symptomatic, with a reduction in symptoms over time. Using the Motion Sensitivity Test to determine problematic movements will then provide details of movements to habituate.
Cawthorne-Cooksey exercises come under the habituation approach.
Peripheral vestibular problems are treated using the adaptation and substitution approaches. Central problems are treated using the substitution.
Treatment will often be multi-faceted, incorporating more than one of the above approaches.
Physiotherapists at The Wellington Hospital are trained to perform Canal Repositioning Treatments and Liberatory manoeuvres to treat BPPV as indicated.
Other treatments such as gait re-education, general balance, relaxation and muscle strengthening can be incorporated. Strategies and advice will be discussed i.e. safety issues and functional goals will be set and reviewed with the patient.
Individualised home exercise programmes will be designed for each patient and reviewed as appropriate. Treatment duration will be dictated by the reviewing of goals and performance on outcome measures.