Vestibular rehabilitation therapy is a very specific type of physical therapy to help people with balance and dizziness problems. Typically, it’s an add-on to the medical treatment of underlying inner ear issues or related health conditions.
Some basic facts
A supplemental and practical treatment option for many people with dizziness and/or balance problems, vestibular rehabilitation therapy has been helping people for more than 70 years. Since the late 1990’s especially, the techniques and their effectiveness have advanced as research into best practices has made significant headway.
Simply defined, vestibular rehabilitation therapy is a kind of exercise-based physical therapy uniquely tailored for each individual to address their specific balance and vestibular-related needs and concerns.
By its very nature, it’s goal-oriented. The focus is on improving daily functioning and quality of life for people with balance and other problems tied to dizziness. The therapy is offered by physical and occupational therapists who go on to get post-graduate training in vestibular rehabilitation.
Experts recommend that vestibular rehabilitation therapy take a team approach, with the therapist and the person’s physicians staying in close communication, coordinating treatment and monitoring progress.
A common symptom
Many people experience dizziness. In fact, more than 10 million people in the United States go to the doctor for it each year.
Although it’s most common among older adults—75 and up—anyone can experience symptoms of dizziness. What’s more, it can come on for any number of reasons, such as cardiovascular or brain issues, neck problems, from medicine and its side effects, or from trouble with the inner ear and vestibular system. The wide range of potential causes makes it all the more important to see a physician for a thorough assessment. Ruling out any serious underlying medical conditions and getting appropriate treatment is essential.
To help physicians make an accurate diagnosis, it’s useful for anyone who experiences these symptoms to take note of the following and to discuss it with their doctor:
- How often do these symptoms come on?
- What are the activities right before or when the symptoms crop up?
- Are the symptoms any worse at night or in dark rooms?
- What do the symptoms feel like? Does it seem as if the room is spinning around, or is it more like being thrown off balance?
- Have the symptoms caused any falls or prompted a change in daily life?
The trouble with balance problems
Without ever really thinking about it, most of us rely on our ability to stay upright and balanced in order to function on a daily basis. When dizziness causes us to lose this ability, or our sense of balance, it can have a profound impact on our lives and outlook.
When someone becomes dizzy when they’re moving about, not only does it increase their risk of falling, but it also may lead to fear—stripping away their confidence in their ability to do everyday tasks. Too often, it starts a downward cycle: The person may stop doing normal activities, which can lead to too much sitting and inactivity, which then can spiral into the weakening of muscle strength and flexibility, joint stiffness, fatigue, frustration, and even depression.
Vestibular rehabilitation therapy—when provided by a properly trained and licensed professional—is designed to address these functional and quality of life issues. When practiced with commitment and consistency, it can make a meaningful difference in people’s lives.
How vestibular rehabilitation therapy can help
Vestibular rehabilitation therapy is most effective once the root cause of the dizziness is identified, medically treated, and stabilized.
Often, people start vestibular rehabilitation therapy because they want to:
- improve their balance, mobility, and day-to-day functioning
- reduce their risk of falling—while bolstering their confidence in their ability to move around safely
- better manage and decrease motion sensitivity and the dizziness/vertigo itself
- boost physical strength so they can more easily stay upright, balanced, and mobile
- stabilize or improve their focus when they move their head and neck
- address any secondary symptoms, like anxiety, nausea, difficulty concentrating, and related fatigue
Therapy can be short-lived, or it can go on for many months. It all depends on the underlying cause, the type and severity of the person’s symptoms, and how often and consistently the individual does the vestibular rehabilitation exercises at home. Still, the most common timeline is six-to-eight weeks of therapy, with a session with the therapist once or twice a week.
Although vestibular rehabilitation therapy doesn’t have a direct impact on the mechanical function of the vestibular system, it helps people through compensation. That is, it helps train the brain to use the body’s other senses to adjust for any deficit in the vestibular system.
The big picture
Vestibular rehabilitation therapy typically starts with a thorough assessment by the physical or occupational therapist, who will likely discuss medical history, individual goals, and collect detailed information about the symptoms. This probably will involve some positional testing to determine which movements trigger the dizziness, vertigo, and/or other symptoms. In addition, the therapist likely will evaluate balance, posture, and how the person walks; assess flexibility, range of motion, muscle strength, and coordination; check the individual’s visual focus and eye tracking; observe neck mobility and strength; evaluate skin sensation and position awareness; and examine the inner ear.
From there, the actual work begins. The therapist will put together a customized plan to boost functioning, quality of life, and importantly, to reduce symptoms and the risk of falling.
The plan itself will vary from person to person. But the most common types of exercises are habituation training, gaze stability training, and balance training. Therapists also may include the use of virtual reality, biofeedback, vestibular prostheses, and/or other approaches.
Habituation exercises are based on the concept that the brain can be trained to ignore the false or irregular signals it’s receiving from the troubled vestibular system that are causing the symptoms. With repeat exposure to the movements and/or stimuli that set off the dizziness—within the structure of a carefully designed therapy program—many people find that their symptoms decrease as the therapy begins to yield results. This can help those who get dizzy when they move their head in a particular way or in visually busy environments—like at the movies or in stores, for instance.
Gaze stability training
Vestibular rehabilitation therapists use gaze stability training to help the brain learn to rely on the somatosensory and visual systems (which also aid balance) when the vestibular system is damaged. They often use the repetition of carefully designed visual stabilization exercises with people who have trouble reading or focusing while moving. Staying visually focused on an object while moving the head in particular ways is an example of the type of exercises that therapists use.
Vestibular rehabilitation therapists use balance training exercises to provide people with movement strategies for managing the real-world physical environment—like when walking on uneven pavement or in a darkened room. The goal is to reduce any fall risk and to make it easier for the person to continue doing everyday activities safely. This training covers common activities, like walking, bending, reaching, and so on.
What to expect
The results of vestibular rehabilitation therapy vary. This is because progress and outcomes depend on the underlying disorder, the extent of the problem, the severity of the symptoms, the state of the person’s physical fitness and health conditions before the vestibular issue even developed, the presence of other life stressors, and how often and regularly the person does the exercises at home.
Researchers continue to study and improve vestibular rehabilitation techniques. And experts consider it a valuable add-on to the proper medical treatment of underlying balance disorders.
For additional information on balance disorders, see AHRF webpages Balance Disorders: An Overview and Common Balance Disorders & More. To find a vestibular healthcare specialist, visit VeDA.
Academy of Neurologic Physical Therapy
American Physical Therapy Association