Vestibular Balance
Training with C.A.R.E.N

Under ordinary circumstances, you are able to maintain balance when standing, walking or exercising without giving it too much thought. But sometimes things can go wrong in your vestibular system, making you dizzy and throwing you off balance. Vestibular rehabilitation therapy helps you restore your natural ability to maintain balance through exercise and other treatment methods.

Systems That Regulate Balance

In order to maintain balance while standing upright and moving about, your brain organizes, processes and integrates information from three distinct sensory systems:

  • Visual: Your vision provides important feedback about your body’s position in space relative to stationery objects.
  • Proprioceptive: Proprioceptors located in muscles and joints give feedback about the relationship between your lower extremities and the force of gravity.
  • Vestibular: Located in your inner ear, the vestibular system senses motion, equilibrium and spacial awareness.

When any of these systems is damaged or deficient, balance may become difficult to achieve and maintain. In particular, dysfunction of the vestibular system can interfere with your ability to coordinate head and eye movements, limiting your ability to participate in normal everyday activities, and diminishing your quality of life.

Causes of Vestibular Dysfunction

Your vestibular system is made up of three canals and two fluid-filled sacs, located in the inner ear. When you change positions or turn your head, the fluid shifts, stimulating hair cell receptors that tell your brain about positional changes. This information helps you maintain balance and visual focus. When the system malfunctions, information transmitted to the brain becomes impaired, causing dizziness.

A number of conditions can contribute to vestibular dysfunction. Some of the most common include:

  • Benign paroxysmal positional vertigo (BPPV)
  • Labyrinthitis (inflammation of the inner ear)
  • Vestibular neuritis (viral infection of the vestibular nerve)
  • Traumatic brain injury or concussion
  • Stroke

In many instances, vestibular dysfunction is not considered serious, but it does increase the risk of falls that can lead to serious injury.


Virtual Reality Rehabilitation

One relatively new and innovative approach to vestibular treatment is virtual reality physical therapy. During VR rehabilitation, the patient is immersed in an artificial environment via specialized equipment. During a VR session, the therapist is able to manipulate the environment in ways that disrupt or perturb balance, forcing the patient to respond with balance recovery strategies.

At NYDNR, virtual rehab is performed using C.A.R.E.N, our computer assisted rehabilitation environment, the most advanced technology for balance and vestibular disorders. As the patient moves within the virtual environment, the system provides enriched multi-sensory feedback, giving the patient and therapist information about the patient’s ability to restore balance after it has been disrupted. C.A.R.E.N therapy combines sensory motor training, visual exercises and habitation treatment.

With C.A.R.E.N’s instrumentation, the therapist is able to manipulate the platform and treadmill to disrupt balance in a controlled and protected environment. A safety harness allows the patient to move and interact freely, without fear of falling and injury. The brain’s neuroplasticity enables the patient to develop control over different sensory systems, to correct and compensate for deficiencies.

Vestibular Rehabilitation NYC

If you are suffering from dizziness and poor balance, the vestibular rehab specialists at NYDNRehab can help. In additional to virtual reality therapy, we offer a broad range of treatments to help you eliminate dizziness and restore optimal balance. Build confidence and enjoy life without fear of dizziness and falling. Contact us today, and see why NYDNR offers the best vestibular therapy in NYC.

About the author

Dr. Lev Kalika has revolutionalized the methodology of treating knee pain and other motor disorders of the lower kinetic chain by introducing unique integrative approaches and combining Dynamic Neuromuscular Stabilization (DNS), C.A.R.E.N (computer assisted rehabilitation environment), biofeedback force plate retraining and the most solid conventional approaches in his New York City’s Midtown practice. The results of these new methods are quicker, deeper and longer lasting when compared with basic physical therapy being used today.

Our Awards


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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