Vestibular Rehabilitation

Vestibular Rehabilitation Therapy (VRT) is basically a posh long name for balance and co-ordination exercises!

I first came across these after seeing a young girl on You Tube who was unable to balance to walk without a special frame until she started these exercises 10 mins in morning and 10 mins at night just after her 8th birthday, .. 10 months on she was walking unassisted a few steps (though still very wobbly.. 2 years later she was walking around with no falling over and it had also improved her speech and learning at school.

The company is based in Australia and seems to work with children,  although they have 2 videos on their channel that you can copy the exercises (film yourself)  and send it to them and he designs you a custom exercise routine.  There is a charge for this although I can’t find a price mentioned on the site.

But after reading their site and the theory behind what they do:

“Sensory Learning asserts that those with symptoms of poor cerebellar or vestibular nuclei processing, (poor calibration) should see improved processing, if they perform exercises that are known to improve processing in these areas of the brain”

As an adult who also has an house to run,  housework to do,  a dog to look after, I decided to see if I could incorporate some of these aspects into my daily routine.

I watched the videos on the Sensory Learning Channel to see what kind of exercises they were using to show which areas were affected,  this gave me an idea where to start.

http://www.youtube.com/user/SensoryLearningAus#p/u/2/3jwx8m5IhTU

Some I was able to adapt like I replaced the ball exercise with sitting on my beancube instead and instead of bouncing on it sit upright whilst playing a game on wii fit that involves co-ordination of hands this gives me a multi-tasking exercise (using hands at same time as keeping balance – although I have my legs out to side of cube to give me a wider base so I can keep balance whilst concentrating on something else).

The exercise where he stands and lifts one foot of ground is similar to exercise on wii fit yoga so I do that one standing on balance board and holding onto the old zimmer frame I have around the front. I lean just enough to take weight off that leg and foot slightly off balance board whilst trying to keep my red dot in the yellow circle (thats on wii fit yoga to show you are doing exercise right)

I’ve never been much of a gym bunny,  I don’t see point spending a fortune to go to gym and still having all work to do when you get home and been too knackered. If you use rollator or chair as I do hanging the washing out can prove quite a physical workout. I used to use electric chair to push rollator into garden with washing basket on it so was only doing stretching as I put things on rotary dryer.  (I have an adjustable one that lowers to w/c height)

So instead I push rollator to rotary dryer which involves keeping balance  and co-ordinating legs to walk out into garden.  I transfer washing basket to an old chair I have in garden then sit on the rollator seat.  This takes the least stretching forwards and bending as the washing basket is same height as me and the rollator seat is higher than my manual chair.

To make it harder I use manual chair instead (using it like walker and pushing it out with basket on seat) and put washing basket on floor so bending down then stretching up,  picking up pegs and getting them on the clothes gives your fingers a workout.  I frequently drop pegs so Inca sits nearby and just picks them up as I drop them and gives them back to me,  thats part of her laundry duties! (she also unloads the washing machine and carries the peg basket out for me).

By the time I’ve hung my washing out I have done my 10 mins exercise and included standing,  walking,  bending,  stretching and co-ordination of fingers to get pegs on.  Then its time for a sit down and a cuppa!

When I have to put things in dryer or don’t have any floors to mop (which again gives you good workout involving bending and using legs to push myself around on rollator seat whilst arms are doing mopping motion) I do 30 min routine on Wii fit that includes,  stretching,  balancing etc.  I may also go on a different game later after tea if I have nothing else on usually one not quite as physical but which involves co-ordination of hands if I haven’t done a lot of typing during the day.

If my balance is particuarly bad and struggling to stand and keep balance I’ll work on arms instead and do tennis or boxing and concentrate on sitting balance I try and exercise legs that day by pushing myself around on rollator seat so legs are still getting exercise but I’m not risking any falls trying to walk about when I’m really struggling to keep balance.

If I cant get on floor to do exercises (usually in winter when back is really stiff from cold) I do stretches on bed but I warm muscles up first using electric blanket so back and leg muscles are warmed through this then makes it easier for me getting up and dressed without pulling any muscles trying to get my clothes on!

I’m fairly sure also that jiggling about on a scooter everyday over the fields etc has helped keep my core muscles strong as my sitting balance is much less affected.

Zazen on wii fit is a good one for sitting balance you just have to sit cross legged on balance board with eyes closed and stay sat up without shifting balancing or slouching or the candle goes out.  I have the zimmer frame behind me for that one so I can feel the bar on my back and I know I haven’t moved and also hold onto the sides.  You could do this in front of a sofa or chair (that’s against a wall) if you need something sturdy behind you to stop yourself falling right back or have someone stand behind you.

I also use weights on ankles and arms as I find it makes muscles less twitchy which could throw me off balance. (remember to take them off before you weigh yourself on it though!). You can also get a balance belt which may help you keep a sense of central balance but won’t help if you are using the weight to steady your arms/legs individually.

Some of the balance games I also do from sitting,  I enjoy doing snowball fight from sitting as I can’t do that standing (as you have to hold wii remote and balance and I need both hands on frame to balance me standing) I can also do the circus balancing one and chicken flap one – which is seriously hard work on the arms.  you sit on board and flap your arms like a chicken to land on these platforms in middle of sea to get across to a boat.  Gets me as out of breath as boxing does.

There’s also a good one (cant think of name) I sit on board and hold wii remote horizontal the wii remote works the top horizontal paddle and you shifting left and right works the bottom ones,  there are three coloured buckets and you have to direct the balls coming down into the right colour bucket.  This is serious multi-tasking one as sometimes you right hand needs to be tilting wii remote down as your body is tilting to left as more than one comes down at once as the game continues.  These are all on the newer Wii Fit Plus.

When I first got this game I couldn’t do it all but with bit of experimenting with poistioning to help me keep sitting balance and shift weight without falling over I can now do it for first few mins when only single balls or 2.

I also couldn’t do the tightrope game when I got first wii fit when you just have to take steps slowly on board and bend knees to make person jump over an obstacle,  I have since managed that one,  but cant do the obstacle course or majorette one on newer wii fit plus as they require faster movement of legs (marching or running). I can also manage the hula hooping one from sitting on board,  a tip I picked up from a US site when a woman mentioned her husband did it that way as he couldn’t stand at all.  That’s great for core muscles but be careful not to pull anything!!  Again its perseverance.. .first time I managed 4 full circles and was knackered and pull my side…  after few years practice now I got up to 200 once in the time given.

My centre of gravity has also improved since I first got original Wii fit when I was miles off centre,  now I’m a fraction off and sometimes I can get it dead on centre.

These exercises wont cure you or stop the progression (didn’t stop symptoms appearing in my arms too despite constant exercising since I first got Wii, typing lots and propelling chair)  but I do personally feel they helped me keep strength in arms, legs,  trunk muscles and bone density (to prevent/slow down muscle wasting)

I would recommend anyone to get doctors advice before undertaking such an intense routine everyday,  particuarly if you’re already further along and haven’t exercised/stood for long for some time.

Luckily I was fit before as I already had Inca when the ataxia started so she was getting walks 5 mile a day anyway.  I kept walking for as long as I could with stick until using chair/scooter for distance and starting indoor exercise routine instead.  I wasn’t always able to do it everyday when fatigue was very bad so for people whose main issues are fatigue and weakness of muscles you should get medical advice before attempting.

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8 thoughts on “Vestibular Rehabilitation

  1. Thank you so very much for writing this up for me!

    For anybody else who may be interested, as well as the YouTube videos which Kati already linked to, I found this article helpful: http://emedicine.medscape.com/article/883878-overview the part which describes exercises is about the last quarter of the article, the heading is “Exercise Protocols” – the first part is about research and may be interesting to medical geeks like me but isn’t really relevant.

    The exercises they describe are pretty much just what you’ve written about incorporating into your daily routine – walking with the smallest amount of support you can manage, keeping balance while moving arms around (lots of thet hings you said), keeping balance when sitting on something that moves (like the rollator while moving!), and reaching up and down while keeping balance (hanging out washing!). I’m really impressed that you’ve managed to work so much useful exercise into your daily routine – that’s quite a feat!

    Since the Sensory Learning Australia people are just a phone call away from me, I might give them a call and ask about prices. Obviously, my situation is very very different from yours – I am fairly sure that the worst part of my balance problems is just from being stuck in bed so long with no need to balance …. like my body’s forgotten how and/or forgotten it needs to do it. I think that should be pretty easy to get it started again if I give it enough input, so having information about the exercises is really helpful for me. Thank you!!!!!

  2. Your welcome. I hope they can give you some useful information. It maybe worth you getting a wii and wii fit if you can get one for good price (do they have an australian ebay?)
    You could always sell it again if you found it really wasn’t working for you. I found it great for motivating me to exercise and stop me getting bored as you can alternate between games that use balance/co-ordination and yoga and balance exercises.
    As it only does a few of each before stopping it gives you chance to have quick sit down before deciding whether to do same one again or switch to something else.
    I find its just right for me as I can’t stand for long and keep the rollator just behind me to sit back down on between exercises.

    If you are clumsy like me or frequently drop things I use an hair scrunchie tied around my hand with wii remote in, for games like tennis etc where you can randomly wave your arms around and still manage a good game of tennis! Good one for exercising your arms if your aim is really rubbish! The Wii Tennis is a bit boring though after a while so I also got Mario Power Tennis which allows you to use same controls, work through tournaments and has mini games.

    I’m quite good at bowling too although I cant do the under arm movement, I just kind of hold my arm up and do a rough flinging movement and I’ve managed 5 strikes in a row! :O)

    Good luck! x

  3. My brother’s agreed to lend me his Wii with a Wii Fit and other extras he’s got for it, and Dad’s going to lend me a TV so I can test it out for a month or so! If I’m still using it and progressing after a month it’s probably a pretty good guess it’s worth investing in 🙂

    I don’t have trouble with clumsiness much, it’s strength and balance. I’ve looked at all the Wii Fit/Wii Sports videos I can and lots of them look like they’d be REALLY helpful for me, especially modified to do sitting down like you described.

    Also I found another site online which has vestibular rehab exercises – I’ll put the URL in here in case others are interested: http://www.tchain.com/otoneurology/treatment/cawthorne.html Apparently these are “standard” exercises often prescribed when people don’t get individualised ones. Some of them look useful for me so I’ll do those ones.

    Have written up my own ideas of program I need today and plan to start working on those exercises and also to call the Sensory Learning people after the weekend. Stay tuned!

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  6. Excelent! Its great to hear that people are getting benifit from the videos. I am Holly’s therapist and authour of the video. I’m always happy for people to use the information to create thir own programs. I attempt to walk a line between being “open source” and also charging money for appointments. (My costs so you know, if one was to get a program through me, is betwen $55 and $27 (Australian Dollars) a week and programs can last from 9 weeks for those with simple balance problems to 4 or 5 years for long term problems). I see people via skype and also face to face which is obviously prefered. I am a registered nurse in Australia and have been specialising in this field for over 10 years now. I would highly reccomend Dr Hain also linked above as he in my opinion is one of the clinicians that is at the very top of this field. Also another Physiotherapist in the field if you are researching it is Susan Herdman at Emory University in Atlanta. They would have to be the top names.
    Also you are %100 correct that “Vestibular Rehabilitation Therapy (VRT)” is a posh long name for balance and co-ordination exercises. If you are searching for literature in journals its good to know this as it will give you the best search results. Many thanks for your posts and best wishes. Ian.

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