Treatment can involve manual head manoeuvres and/or a progression of exercises aimed at reducing vertigo and dizziness, visual issues, imbalance, and falls. The purpose of treatment is to enable the central nervous system to compensate for reduced function of the inner ears. During the initial stages of treatment, there may be a temporary increase in symptoms due to stimulation of the vestibular system. But with time and consistency, symptoms should decrease until they are more manageable or completely resolved.
Treatment will target issues with muscle tone, and any abnormal movements that may be present. The health of the eye is very important and advice about how to protect the eye will be given. Education about how the workings of the facial nerve works and the process of recovery is an important part in therapy. A home exercise programme guided and reviewed by the therapist may include some of the following: exercises to help relearn and develop balanced facial movements, stretches to lengthen muscles, massage to maintain muscle mobility and health, relaxation of the facial nerve and muscles and/or exercises to reduce involuntary, unwanted movements.
Peripheral Nerve Injury
Treatment will aim to improve mobility and balance as well as decreasing unpleasant sensation or pain. Some of the following techniques may be utilised in sessions: passive movement, gait re-education, balance training, massage of soft tissues, desensitisation exercises and hydrotherapy, stimulation of nerve pathways using mirror imaging and/ or using graded discrimination tasks and exploration of objects without visual feedback. A home exercise programme may be developed to strengthen muscles and improve fitness. Assessments for splinting or orthoses may also be recommended.
Abnormal gait can be treated using a number of approaches, depending on the presentation of the gait and what has caused it’s deterioration. Gait re-education will focus on re-educating the muscles to weight bear, shift and control leg movement. Sometimes referrals for orthoses or walking aids will be required. Treatment may also target improving balance, muscle strength, range of movement and proprioception. Consideration will be given to improving confidence in walking indoors, outside and using stairs where appropriate.
Treatment may take a compensatory approach enabling the development of practical strategies to manage symptoms day to day. This could include focusing on gait and coordination training, balance and trunk control plus movement retraining and specific goal task practice to challenge and build stability.
Treatment and an exercise programme will be developed to target muscle stiffening and shortening. Attention will also be given to developing strength in the muscles. This will enable patients to improve their balance and posture, enhance their functional abilities and develop stamina and fitness. Hydrotherapy and relaxation techniques can be used to supplement these treatments. Provision will be made to ensure treatment is provided prior and following botulinum toxin treatment if this is deemed an appropriate adjunct treatment.
A focus of treatment is to educate why pain has developed in joints, muscles and/or soft tissues. Guidance will be given on the importance of regular, appropriate movement and exercise, via an exercise plan. Additionally other techniques may be utilised including soft tissue massage and stretching to relieve tension and spasm, joint mobilisation, acupuncture, corrective exercise, and postural awareness.
A postural management programme will be developed as part of treatment considering best positioning when walking, sitting, and lying. Therapy may focus on improving range of movement and muscle tone. If required, advice and provision of splinting and orthoses will be organised and recommendations around specialist seating or wheelchairs made. An important aim of treatment is to prevent or minimise secondary problems from poor posture such as contractures, pain, tissue damage or chest infections.
Treatment to reduce spasticity typically includes exercises in stretching, weight bearing and opposing group muscle strengthening, positional stretching, and use of cold/heat packs. Provision will be made to ensure treatment is provided prior and following either botulinum toxin treatment or surgery if these are deemed an appropriate treatment in addition to medication and therapy.
The emphasis of treatment is to focus on developing proprioception skills and stability using exercises that challenge the body with less stable postures so that muscle groups have to work harder to remain balanced (i.e., single leg standing). These exercises can also be combined with equipment like wobble boards/cushions. Progression of balance is achieved through limiting other senses that support balance, such as vestibular or sight and this will be guided and reviewed by the physiotherapist to manage falls risk.