Vestibular Rehabilitation

What Is It?

The vestibular system, or "inner ear" as it is commonly (and inaccurately) called, is not only integral, but is essential for integration between our body, gravity, movement, in the physical world. It is responsible for letting our brain know if we are standing, laying, leaning, moving, how fast, and in which direction all of those are accruing.

Why is it Important?

The vestibular system is one of the first sensory systems to exist in animals with spines (1). It is also the very first sensory system to develop in the womb, 7-9 weeks after conception (before our sex is even determined). It provides a foundation for the development of many, if not all, sensory systems, including vision, joint perception, sound localization, and even touch. (2). It is also critical in the ability to move our eyes, maintain balance, coordination, motor control, regulates autonomic functions such as heart rate, blood pressure, and digestion (3), our thinking (4), and even influences our emotional state (5).

Many neurological conditions are either caused by or include vestibular dysfunction. Some of these are more obvious, like dizziness/vertigo, falls, and imbalance. Even more, conditions may not be intuitive, such as cerebral palsy, migraine, attention-deficit hyperactivity disorder (in adults and children) (6), developmental coordination disorder, concussion, idiopathic scoliosis, autism (7), Parkinson’s disease (8), dementia (4), stroke, pain syndromes, and even whiplash (9). Vestibular dysfunction has even been reported in “healthy individuals.” 35.4% of all individuals over the age of 40, and greater than 85% of individuals over the age of 80 years. (10)

How does it Work?

Our clinical team evaluates all of the components of the vestibular system to determine how well the system is interpreting gravity, movement, body posture, and spatial orientation. Once they are able to identify any alterations in function or opportunities for enhancement, they implement some vestibular rehabilitation and optimization procedures that they have utilized for over a half of a century, in combination with novel procedures that are only offered at Plasticity.

Vestibular rehabilitation exercises are well described by Herdman (11). These exercises are named after the ratio of eye movement to head movement (“Times-0”, “Times-1”, “Times-2” Viewing Exercises), and are separated into two main categories: gaze stabilization exercises, and vestibular adaptation exercises.

An additional type of vestibular rehabilitation implemented at Plasticity is called Single/Multi-Axis Rotational Therapy (or “SMART” for short) and consists of two classes of movement: On-Vertical Axis Rotation, and Off-Vertical Axis Rotation (12-15). The R&D team at Plasticity realized how significant this type of therapy was and developed a one-of-a-kind device called the MARC™, which stands for Multi-Axis Rotational Chair.

MARC™ allows our clinical team to secure and rotate an individual — as small as 35 lbs, or as large as 400 lbs — in combinations of three directions: pitch (flips), yaw (turns), and roll (cart-wheels). These also happen to be the 3 direction that the vestibular system perceives (16). By rotating a person in these calculated directions, at clinically determined speeds and durations, our clinicians can deliver unique, customized, focused, and powerful vestibular stimulation (17).

How does it Help?

By combining vestibular therapy with other therapies offered by the Plasticity Clinicians and Therapists, we are able to improve the function, performance, and quality of life of individuals with many neurological challenges and desires.


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  3. Yates B. J. Vestibular influences on the autonomic nervous system. Ann. N. Y. Acad. Sci. 781, 458–473 (1996).
  4. Smith, P. F. (2017). The vestibular system and cognition. Current Opinion in Neurology, 30(1), 84–89.
  5. Winter L, Wollmer MA, Laurens J, Straumann D, Kruger TH. Cox's chair revisited: Can spinning alter mood states? Front Psychiatry. 2013;4:132
  6. Shum, S. B., & Pang, M. Y. (2009). Children with Attention Deficit Hyperactivity Disorder Have Impaired Balance Function: Involvement of Somatosensory, Visual, and Vestibular Systems. The Journal of Pediatrics,155(2), 245-249. doi:10.1016/j.jpeds.2009.02.032
  7. Christy, J. (2018). Considerations for Testing and Treating Children with Central Vestibular Impairments. Seminars in Hearing, 39(03), 321–333. doi:10.1055/s-0038-1666821
  8. Berliner JM, Kluger BM, Corcos DM, Pelak VS, Gisbert R, McRae C, Atkinson CC, Schenkman M (2018).Patient perceptions of visual, vestibular, and oculomotor deficits in people with Parkinson’s disease,Physiotherapy Theory and Practice. DOI: 1080/09593985.2018.1492055
  9. Storaci, R., Manelli, A., Schiavone, N., Mangia, L., Prigione, G., & Sangiorgi, S. (2006). Whiplash injury and oculomotor dysfunctions: clinical–posturographic correlations. European Spine Journal, 15(12), 1811–1816. doi:10.1007/s00586-006-0085-0
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