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.

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.

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.

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.