A Guide to Vestibular Therapy: Unlocking Balance and Well-being

Tucked away in the inner ear, the vestibular system is a complex network of fluid-filled canals and tiny hair cells that sense head movements and gravity. This information is then relayed to the brain, which uses it to:

• Maintain balance and posture

• Coordinate eye movements with head movements

• Stabilize vision during movement

• Navigate through space

When the vestibular system is functioning optimally we move through the world with ease, but when it's disrupted, it can feel like the ground beneath us is shifting, leading to a range of symptoms from dizziness to loss of motor control that can significantly impact daily life. Vestibular therapy is designed to address these issues and help individuals regain their sense of equilibrium. In this article we explore the vestibular system, the vestibular system in development, concerns related to the vestibular system, and different forms of vestibular therapy. While this article offers a very thorough exploration of the vestibular system, concerns and vestibular therapy, I encourage you to speak with your Doctor if you do have concerns. 

The Vestibular System: A Brief Overview

To better understand the concerns that may arise when the vestibular system is compromised, let’s explore the three main components and development of this system (Zabolotnyi & Mishchanchuk, 2020): 

Three Main Components of the Vestibular System:

1. Semicircular Canals: These fluid-filled tubes are responsible for detecting rotational head movement.

2. Otolith Organs: The utricle and saccule sense linear acceleration and gravity.

3. Vestibular Nerves: These Craniosacral nerves transmit information from the inner ear to the brain.

When the vestibular system is functioning properly, it works in conjunction with the eyes and proprioception (the sense of body position) to provide a stable sense of the world around us. Additionally cerebrospinal fluid (CSF), which bathes our nervous system, is connected to the vestibular system through influencing intracranial pressure which affects our sense of balance within the brain. If any of these aspects are compromised through development or trauma to the head, we see disruption in the vestibular system's normal functioning, including motor control. 

Development of the Vestibular System

The development of the vestibular system, which is responsible for balance, spatial orientation, and coordination, begins early in utero and continues through childhood: 

1. Prenatal Stage: The vestibular system develops in the first trimester of pregnancy, allowing the fetus to respond to movement and gravity.

2. Infancy (0-1 Year): During infancy the vestibular system plays a critical role in helping babies understand movement and balance. Babies experience vestibular input through natural movements like being rocked, held, or moved in space. Crawling, rolling over, and later walking provide strong vestibular feedback that supports motor development.

3. Toddlerhood (1-3 Years): If you have had or work with children, you may remember they go through a phase where they can’t get enough spinning! This is part of developing their vestibular system, and why all parks have a spinner and swings! They also seek vestibular input through jumping, running, and other forms of movement to refine their sense of balance and spatial awareness, for development of gross motor skills and coordination.

4. Preschool Age (3-5 Years): By this age, children’s vestibular systems are becoming more refined, but they still actively seek out intense vestibular input to continue to develop their motor control and coordination. This is the age when we often see diagnoses of children whose vestibular systems have been compromised or are not fully developed. 

5. Childhood and Beyond: While the vestibular system continues to develop and mature throughout early childhood, it reaches near-adult functionality by age 8-10. However, children and even older individuals may continue to seek vestibular stimulation as a way of self-regulating their sensory systems. We will explore this shortly, but first let’s look at concerns that arise when the vestibular system is compromised. 

A Compromised Vestibular System: When to seek vestibular therapy

The vestibular system may be compromised through the developmental stages, due to trauma to the head, and even certain medications. Individuals with vestibular disorders may experience a variety of symptoms, including:

• Nausea and vomiting

• Sensitivity to light and sound or migraines (vestibular migraines)

• Nystagmus (involuntary eye movements), blurred or double vision

• Dizziness or vertigo (a spinning sensation often linked to changes in CSF pressure)

• Loss of balance, leading to difficulty walking, standing and coordination

• Vestibular neuritis or inflammation of the vestibular nerve leading to sudden vertigo and imbalance

• Tinnitus or Meniere’s disease, which may lead to hearing loss and ringing in the ear  

• Labyrinthitis or inflammation of the inner ear leading to hearing loss

• Struggle focusing, learning and performing in school or at work

• Self-esteem and confidence concerns, anxiety or depression

• And for children in particular it may affect social interactions and play

Interestingly, many neurodiversities often intersect with vestibular concerns, affecting balance, spatial orientation, and sensory processing. Here are some neurodiverse conditions that may relate to vestibular challenges:

1. Autism Spectrum Disorder (ASD): Individuals with autism often have sensory processing differences, which may include hyper- or hypo-sensitivity to vestibular input. Some may seek out activities that provide vestibular stimulation (e.g., spinning, rocking), while others may avoid them due to sensory overload.

2. Attention Deficit Hyperactivity Disorder (ADHD): ADHD can involve challenges with proprioception and balance, which are linked to vestibular processing. Some individuals may appear clumsy or have difficulty with activities requiring coordinated movement, and they may struggle with sitting still due to an under-responsive vestibular system, seeking extra vestibular stimulation.

3. Dyspraxia (Developmental Coordination Disorder): Dyspraxia affects motor coordination and is closely related to vestibular difficulties. Individuals may have trouble with balance, spatial awareness, and fine and gross motor skills, making everyday tasks and physical activities more challenging.

4. Sensory Processing Disorder (SPD): Vestibular concerns are central to SPD, particularly in the subtype known as Sensory Modulation Disorder. Children or adults may have extreme responses to movement and balance—either avoiding or excessively seeking vestibular stimulation. This can manifest in difficulties with activities that require balance, such as walking on uneven surfaces or playing sports. You can read more about this in another post.

5. Dyslexia: Though dyslexia is primarily a language-based learning difficulty, some researchers suggest vestibular issues may also play a role. Vestibular dysfunction can impact the coordination needed for eye movements, which could influence reading and writing.

6. Tourette Syndrome: Individuals with Tourette Syndrome in addition to an overly activated nervous system, may experience vestibular processing issues, often related to tics that affect posture and balance. These involuntary movements can make maintaining balance and coordination more challenging.

7. Anxiety and Panic Disorders: Vestibular dysfunction can also occur in individuals with anxiety disorders, where dizziness and balance issues may trigger or exacerbate anxiety. This is known as a "vestibular-autonomic interaction," where the body’s balance system is closely linked to emotional responses.

Addressing vestibular concerns in neurodiverse individuals often involves sensory integration therapy, occupational therapy, or other interventions such as Craniosacral Therapy that help improve balance, coordination, and sensory processing.

Vestibular Therapy: Promoting balance for holistic wellbeing

Vestibular therapy focuses on retraining the brain and vestibular system to work together harmoniously. As we have explored, the vestibular system and potential concerns can be complex, so a holistic approach involving medical advice, Craniosacral and other therapeutic exercises should be considered. A thorough medical evaluation to identify the underlying cause of vestibular symptoms is important, so you can be supported with an appropriate and holistic treatment plan. Depending on the concern, there are a number of ways we can approach vestibular therapy. 

Vestibular Therapy Exercises

Vestibular exercises are a cornerstone of vestibular therapy, and they can be tailored to meet the specific needs of both adults and children. Some common vestibular therapy exercises include:

• Gaze stabilization exercises: These involve focusing on a stationary object while moving the head in different directions, or rolling side to side to help improve eye-head coordination and reduce dizziness.

• Balance exercises: These challenge balance and coordination through activities like standing on one leg, walking on a balance beam, challenging heel to toe balance, or using a wobble board.

• Supine rolls: Laying on your back and gently rolling from side to side is a generally safe way to explore balance and and coordination

• Habituation exercises: These involve repeatedly exposing the individual to movements or positions that trigger their symptoms, helping the brain to adapt and reduce sensitivity.

• Canalith repositioning maneuvers: These specific movements are used to treat BPPV by dislodging calcium crystals from the inner ear canals (Mayo Clinic, 2024)

Fun & Functional Vestibular Therapy for Children

For children, vestibular exercises can be incorporated into fun and engaging activities, such as:

• Playing on swings and slides

• Rolling and tumbling

• Jumping on trampolines

• Riding bikes and scooters

• Dancing and playing sports

• And of course, spinning

All of these natural movements serve developmental needs, to explore physical boundaries of their body in space and refine their motor system, coordination and balance. Additionally, many children seek out these activities to support self-regulation when feeling over-stimulated or overwhelmed, particularly after school. Some children also benefit from this type of play before bed in order to calm their sensitive nervous systems. 

While spinning and other vestibular activities are beneficial, excessive spinning without appropriate rest can lead to dizziness or overstimulation. It’s important to allow children to explore these movements in a safe environment, ensuring breaks if they become disoriented or overwhelmed.

Craniosacral to Support Vestibular Therapy

Craniosacral therapy (CST) is a complementary therapy that focuses on the subtle rhythms of the craniosacral system, which encompasses the skull, spine, and CSF which we explored earlier. It involves gentle hands-on techniques to release restrictions and promote balance within this system. Some Craniosacral therapists, like myself, are also trained to offer additional support through play and movement therapy to support holistic wellness. When I work with clients, I always recommend a holistic approach and often refer clients to complementary practitioners. 

When to Seek Vestibular Therapy

If you or your child are experiencing symptoms of a vestibular disorder, it is important to consult with a healthcare professional, who can help you diagnose the underlying condition and recommend appropriate treatment, which may include vestibular therapy. Remember, vestibular therapy is a journey, and progress may take time. But with patience, persistence, and the guidance of a skilled team, you can reclaim your sense of balance and well-being.

Want to Learn More?

• Craniosacral Therapy: 1:1 support for clients of all ages

• Safe & Sound Protocol: 1:1 support for for neurodiverse individuals and other concerns

• Heart Centred Parenting: Tools to support parents of highly sensitive & neurodiverse children

Or please reach out to me,

Katie

Please note that this information is intended for educational purposes only and should not be considered medical advice. Always consult with a healthcare professional for personalized guidance.

Works Cited:

Mayo Clinic. (2024). Balance problems. https://www.mayoclinic.org/diseases-conditions/balance-problems/symptoms-causes/syc-20350474

Zabolotnyi, D. I., & Mishchanchuk, N. S. (2020). Vestibular system: anatomy, physiology, and clinical evaluation. In Somatosensory and Motor Research. IntechOpen.