Vestibular Rehabilitation Therapy (VRT): Gotta jerk it out!

Ahhh, Vestibular rehabilitation therapy (VRT.) My comrade. My nemesis. The yin to my yang. The joker to my batman. This, dear reader, is the physical portion of the next 10 weeks of therapy in Santa Rosa.

Why VRT?

This therapy centers around an abusive love story between one of the most basic of neurophysiological entities and one that is a hallmark of critters with higher intelligence: the autonomic nervous system (ANS) and the sympathetic nervous system (SNS) The  And is your “reflex,”subconscious, automatic, always-on part of your brain that controls digestion, breathing, blinking, etc. system. This is the first in line to receive signals from physical stimulus via the outside world. The SNS is a more refined system that gets reports from the ANS and decides what to do with them.  These two systems usually talk to each other pretty well and make sweet, sweet life-preserving decisions together. (e.g. fight or flight response? That’s a big interplay between the ANS/SNS.)

Now, when the ANS is under attack, it triggers a cascade leading to conscious reactions from the sympathetic SNS which is meant to interpret the cries of “danger, danger Will Robinson” emanating from the ANS. This cascade is a biofeedback loop, and a effectively viscous one at that. It was meant to get your arse out of danger. On the African plains, this kept your ancestors alive. ANS stimulus,  SNS response, ANS stimulus to the changes effected by SNS, SNS reassesses the situation until you’re no longer in danger.

The theory behind VRT  as a chronic vertigo treatment is that your ANS  is receiving constant albeit  fallacious messages from your inner ear telling you that the world, she is out of balance. And if you don’t take measures to correct this, you’re going to fall, and this is a bad thing. This is the process going on during vertigo attacks, and in my case it’s incessant ear/brain chatter. And since it never stops, it always feels like my balance is threatened, even when it’s not. It’s the world’s most annoying case of “the boy who cried wolf.”

Normally a pretty legit system, in the case of the vertigo, the ANS/SNS biofeedback loop has a faulty sensor throwing a wrench in the relationship  My vestibular nerve is a very sketchy character, and it really shouldn’t be trusted. Still, my ANS has nthis fascination with what that nervy gossip has to say, so like a chick addicted to a misogynistic man, it keeps coming back for self-validation that it will never receive. This is the neurophysiological mechanism of my vertigo, and it is what the VRT seeks to fix.

Ok… But what is VRT?

Torture. I kid, but only slightly. Vestibular rehabilitation therapy is a collection of exercises to… well rehabilitate the inner ear. Specifically the balance mechanism or the vestibule/labyrinth portion of the inner ear (this doesn’t do anything for the cochlea.)

Because the inner ear is selling the ANS a bunch of lies, a common way to deal with the situation is to ditch the snitch like the treasonous body part it is–that entity is toxic, so cut it out of your life. Thus, in practice, those with vestibular system damage like cope with it by doing everything they can to not invoke the vestibular system or the nerves of the defective inner ear. This means not moving the head in a way that would cause a change in velocity, so nodding, shaking, tilting–anything that remotely uses the top few vertebrae–becomes something vestibular patients like to avoid.

The problem with that is it becomes life-restricting and generally counterproductive. Think about all of the ways you use your head in motion. It’s like… part of life, man–you need to go with the flow or you’re going to screw up your bodily chi. Plus, as it turns out, your brain? It’s kind of amazing. It has this wonderfully advanced compensation process if you’d only give it the proper chance. What does this mean? It means it’s going to get worse before it gets better. The very system you want to mollycoddle needs to be stressed so that the brain can recalibrate how you sense the world. To do this, it needs test points–big data, the more the better. In short… you’ve gotta jerk it out.

Seriously, this song is great  for VRT analogy. Because 80% of the exercises look a heck of a lot like gentle headbanging in very specific  directions. In general, however, this class of therapy follows a process called habituation.

Habitu-what now?

Habituation (n.): the diminishing of a physical or emotional response by to a frequently repeated stimulus
In other words, your brain, the all-powerful machine it is has a kind of loophole–if you do something enough, form a habit out of it, say, your brain will cease to recognize it as an event that requires major attention resources. In the case of vertigo, that can be difficult because the brain never really fully habituates to dizziness–it has small changes here and there that will throw you for another loop. However, the crux of the habituation argument, is that it doesn’t really matter where in the biofeedback loop the cycle is broken; if you can teach your brain to ignore certain types of stimulus in a multiplicity of ways, the response will diminish. Maybe not fully, but in the land of the dizzy, the woman who can walk upright is queen. So, with VRT, the goal is: in just 30 minutes a day, you, too could be less dizzy. With respect to vertigo disorders, there are two main categories of habituation excercises: Adaptatioon and Substitution.

Adaptation: This set of exercises relies on the vestibular system’s ability to compensate for the vertigo. These are the exercises that really suck, because the actually force you to use your vestibular system which… yeah, you’ve been avoiding that for a while now–it’s kind of why you’re here.  Basically this is where you move your head and eyes in rapid successions of coordinated movements to really force the system to understand “Hey. This is how we feel the world now. Recalibrate, please.” Ideally, these excercises will allow you to reestablish some of the functionality that had been lost to whatever malady coused you to spin in the first place.

Substitution: Because balance is not just your vestibular system at work, one of the ways you can better your balance with a damaged vestibular system is to train your auxiliary systems to take up some of the slack. This involves training your proprioceptory system like your core muscles and the muscles you use when walking (knees, ankles, hips, etc.) to sense your position in space more so than they would if your vestibular system worked properly. It’s kind of like a blind person using a cane to gather information about where they are through touch, except instead of blindness, you’re using touch to ascertain whether or not you’re moving, and how fast. The one other system that affects balance is visual cues–sight can also really be helpful for processing where your orientation in space, so there is a whole class of habituation exercises training your visual technique as well.

Sooo, all you have to do is exercise and you’re good to go?

Well, no, not quite. VRT is one of the dizzyland dweller’s bets tools, but it’s not going to be 100% effective. And that’s why it’s fantastic that it’s not the only tool at our disposal. Enter: Dielectical Behavioral Therapy.

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