Part 3: Vestibular Rehab for Children

This is the third part of The Balance Series. In the first part we reviewed the components of balance. In the second part we discussed the various vestibular dysfunctions that can occur in children. In this last article we will look at the different components of treatment.

Vestibular rehabilitation is a specific type of therapy designed to specifically treat vestibular disorders in adults or children. It is not the same as sensory integration therapy. Physical or occupational therapists with specialized training provide vestibular rehab. The goals of treatment will depend on the needs of the individual, but may include facilitating integration of reflexes, tolerance for visual motion, motor skills and coordination, learning skills, attentional abilities, balance reactions and movement patterns, promote sensory organization, facilitate sensory processing, decrease or eliminate dizziness, and normalize oculomotor control.

During each treatment session a child with vestibular dysfunction would participate in a combination of ocular motor (VOR), balance (VSR/reflex integration), and head/body movements. Activities are modified to be age appropriate for children from infancy through adolescence.

Vestibular rehab treatment interventions may include:

• Exercises that facilitate compensation, adatation and habituation. This involves stimulating the remaining sensory systems, stimulating the central nervous system to reinterpret abnormal vestibular inputs as normal and regenerate or initiate new activity in the brainstem nuclei and reducing or inhibiting responsiveness through repeated stimulation
• Repositioning or redistribution exercises are specific movement patterns to treat BPPV.
• Reflex integration exercises are done to stimulate reflexes and to facilitate protective and equilibrium reactions
• Ocular Motor Retraining exercises include gaze stabilization exercises (keeping eyes stable while moving the head), eye-head coordination exercises, convergency exercises, smooth pursuits/saccades and compensatory exercises.
• Balance Retraining and Coordination Exercises include training in use of ankle, hip and step movement strategies, sensory organization activities to promote balanced use of visual, vestibular and proprioceptive systems together, functional reach, bend, squat, kneel, and equilibrium tasks.

Vestibular disorders can be very responsive to vestibular rehab. Once the proper diagnosis has been attained it is important to initiate vestibular rehab as soon as possible in order to limit compensations the body develops.