Vestibular Compensation and Vestibular Rehabilitation. Current Concepts and New Trends

This review explores the mechanisms behind vestibular compensation and how vestibular rehabilitation (VR) aids in restoring balance by enhancing adaptation, substitution, and habituation. Vestibular compensation refers to the brain’s ability to adapt to balance disturbances caused by damage to the vestibular system. The vestibular system integrates inputs from visual, proprioceptive, and vestibular receptors, all of which are essential for maintaining postural control. When one vestibular nucleus loses input (deafferentation), both static and dynamic balance are disrupted, making rehabilitation necessary.

VR helps correct misused or underused visual, proprioceptive, and vestibular inputs, which are critical for postural control. Without rehabilitation, patients may face incomplete recovery, poor balance, increased risk of falls, and reduced quality of life. VR employs strategies like gaze stabilization and balance exercises, customized to each patient’s specific needs to enhance compensation and restore function.

Vestibular rehabilitation originated during World War II when British practitioners Sir Terence Cawthorne and Harold Cooksey observed that early mobilization of head-injured soldiers led to quicker recovery. Since then, VR has evolved significantly, with an improved understanding of sensory reorganization and the need for individualized treatment plans based on the unique balance of vestibular, somatosensory, and visual inputs for each patient. Thorough patient evaluation is crucial before beginning any rehabilitation program.

Today, VR has proven to be an effective treatment for various vestibular disorders, including unilateral and bilateral vestibular deficits, as well as benign paroxysmal positional vertigo (BPPV). VR techniques have advanced, and new diagnostic tools are increasingly used to better assess vestibular deficits, especially in elderly patients. These tools help improve rehabilitation outcomes by tailoring treatment to address the specific causes of imbalance.

Patients undergoing VR are assessed on multiple factors, including proprioception, vision, motor skills, and cognitive function. Elderly and neurologically impaired patients often require additional evaluation to avoid overlooking related conditions that might impact the effectiveness of VR. Rehabilitation techniques used today include rotational chair exercises, which aim to improve the vestibulo-ocular reflex (VOR), and diode light ramps that enhance eye control and nystagmus correction.

A key aspect of VR is dual-task training, which involves performing cognitive tasks while maintaining balance. This is especially important for older adults, as they often face increased fall risks due to age-related impairments in attention and postural control. These exercises help improve patients’ ability to balance while simultaneously engaging in mental tasks, reducing the likelihood of falls and improving overall stability.

One of the challenges in vestibular rehabilitation is the variability in how patients respond to treatment. Compensation generally leads to recovery, but some patients experience persistent instability, requiring further attention. Understanding individual differences, such as the degree of visual dependence and other preexisting conditions, is crucial in developing personalized rehabilitation strategies that address specific postural control challenges.

In conclusion, vestibular rehabilitation is a vital tool in restoring balance and postural control in patients with vestibular disorders. With individualized treatment plans, the use of advanced diagnostic tools, and a focus on both physical and cognitive exercises, VR helps patients recover more fully, improving their overall function and quality of life.

Give us a call or send us a message if you would like to chat further if you are experiencing dizziness or balance difficulties to see if a Vestibular consultation could benefit you.

Deveze, A., Bernard-Demanze, L., Xavier, F., Lavieille, J.-P., & Elziere, M. (2014). Vestibular compensation and vestibular rehabilitation: Current concepts and new trends. Neurophysiologie Clinique/Clinical Neurophysiology, 44(1), 49-57. https://doi.org/10.1016/j.neucli.2013.10.138