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Vestibular System & Aphasia

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Vestibular System

“As we move and interact with gravity sensory receptors in the ear are activated, and impulses appraising the central nervous system about the positioning of the head in space are directed to various parts of the brain and down the spinal cord. It is believed that sensory impulses from the eyes, ears, muscles and joints must be matched to the vestibular input before such information can be reprocessed efficiently. If this is true, what we see, hear and feel makes sense only if the vestibular system is functioning adequately.” Pyter, J. Johnson, R. 1981

The vestibular system is the first sensory system to develop. It is visible at two months gestation and fully formed by the fifth month of gestation. It is one system that feeds input to the reticular activating part of the central nervous system, responsible for awareness it is sometimes referred to as the “wake up the brain system” allowing us to focus our attention. Electric stimulation of the Median Nerve also is used to wake up coma patients by stimulating the reticular system.



Very few people know that there are visual and vestibular projections to tongue motor neurons.

A study accepted in 1993 and published in Brain Research bulletin Vol. 33 pp. 7-16, 1994 was about conveyance of visual input on the hypoglossal nerve modulated by the Vestibular System demonstrating visual input played a part in control of tongue posture in rabbits.

We have noticed improved speech in patients who were involved in our vestibular stimulation program for improving static and dynamic balance problems.

The vestibular system has several functions. It is most known for its function of maintaining balance, but because of its neurological connections it plays important roles in posture, tone, coordination, vision, and arousal. Problems in the vestibular system can result in symptoms including poor balance, increased tone in arm flexors and leg flexors, blurred vision, vertigo, spatial disorientation, increased heart rate and increased respiration.

The first sensory system to fully develop is the vestibular system at 5 months after conception. The primary structures of the vestibular system are located in the inner ear. There are three semicircular canals in each ear that are filled with fluid and hair cells. When the head moves the fluid moves which stimulates the hair cells. This information is then sent to the eyes for adjustments so vision is not blurred. It is sent to the muscles for maintaining balance. It is also sent to the reticular activating system in the brain stem to increase alertness.

To treat deficits in the vestibular system you must stimulate it by movement of the head in space. Spinning is a very effective way of stimulating the vestibular system. Spinning should be done 1-2 times everyday. You begin with 5 spins in each direction. When you stop spinning the eyes will move side to side very quickly. This is called nystagmus. You must wait for the nystagmus to stop before spinning in the other direction. If there is a significant increase in nystagmus or an excessively long recovery period, or if the person breaks out in a cold sweat, becomes nauseous, or has a marked increase in heart rate, decrease the number of spins and progress at a slower rate. Continue to spin daily until nystagmus is no longer noted.

Vestibular stimulation, when combined with balance and gait activities, as instructed by your therapist, should help you see progress in coordination, alertness and agility.

"Physical Therapy Program for Vestibular Rehabilitation:  by Smith-Wheelock, Shepard NT, Telian SA, American Journal of Otolaryngology

"Mechanisms of dynamic visual acuity recovery with vestibular rehabilitation" by Schubert MC, Migliaccio AA, Clendaniel RA, Allak A, Carey JP, Pub Med


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About Raymond Cralle

Raymond Crallé has been a practicing Physical Therapist for 39 years, most of that time in his own private practice. There is no physician ownership since Crallé was one of the original private practices in Florida founded by his mother Ruth Crallé in 1957. Read More

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