Easy, Inexpensive, and Effective: Vestibular Exercises for Balance Control

The common symptoms of vertigo, dizziness, and disequilibrium occur in 5% to 10% of all patients seen by general practitioners and in 10% to 20% of all patients seen by neurologists and otolaryngologists. Incidence increases with patient age, and the symptoms occur most frequently in persons older than 75 years of age (1). Dizziness and vertigo are not disease entities but, rather, are the outcome of many physiologic and pathologic processes (2). Consequently, dizziness and vertigo have many causes, including vestibular rotational vertigo syndromes with nausea and vomiting, visual vertigo, presyncope light-headedness and hypoglycemic dizziness, drug intoxication, phobias, panic attacks, physiologic motion sickness, and height vertigo (2). Although the prophylaxis and treatment of dizziness and vertigo differ depending on the cause, physical therapy for balance control is common to all.

Balance control is one of the key functions of the vestibular system. The 3-neuron vestibuloocular reflex is responsible for balance control (3). The vestibular system, together with the visual and somatosensory systems, promotes static and dynamic spatial orientation, locomotion, and control of posture (3). Inputs from the visual system and neck proprioception improve the vestibuloocular reflex, which, by itself, cannot generate eye movements that perfectly compensate for head movements (4). These overlapping functions of different sensory systems allow one sense to substitute, at least in part, for deficiencies in the others. Vestibular exercises, central vestibular compensation, and peripheral vestibular restoration all stimulate and support this substitution of one sense for another.

In this issue, Yardley and colleagues (5) report their single-blind, randomized, controlled trial of the efficacy of vestibular exercises. The average age of the patients was 62 years, and the average duration of their symptoms was 99.5 months. These patients had movement-provoked dizziness, which is typically a sign that the symptoms are of …