Vestibular Rehabilitation

What is vestibular rehabilitation?

Vestibular rehabilitation (VR) consists of exercises to treat dizziness and balance problems. It is a very well established and accepted intervention for people suffering with balance and vestibular (inner ear) disorders.

Who performs vestibular rehabilitation?

Physiotherapists as well as some occupational therapists and audiologists perform vestibular rehabilitation. They are ideally suited based on their training in restoring function, balance, and strength through exercise. It is very important that the person administering the rehabilitation programme has experience and an interest in treating people with vestibular disorders for optimal results. Usually physiotherapists undergo postgraduate training in VR and join our professional network (ACPIVR).

How can I access vestibular rehabilitation?

Not all physiotherapy departments offer VR, and this will depend on your location. Most vestibular physiotherapists accept referrals from a primary care doctor (GP), ENT (Ear, Nose and Throat) doctor, or neurologist. Some may also accept self-referrals. You can talk to your GP about what services exist in your area and check our map of providers here.

When people are referred by their GP, the treating therapist may use their professional judgement as to whether additional testing or a referral to another specialist team is needed. A specialised centre usually consists of a combination of ENT, neurology, audiology and physiotherapists. An audiologist will often perform special hearing and balance tests of the inner ear. The doctor and/or therapist will obtain a full history and interpret the tests. A referral to a psychologist and/or psychiatrist may be needed if you have additional anxiety or depression associated with your condition.

Who can benefit from vestibular rehabilitation?

People with inner ear (vestibular) and central (brain) disorders can be helped with VR. Many people experience very real symptoms of dizziness and balance disturbance due to a problem with the function (or dynamics) of the balance system, and not due to a structural vestibular or neurological disease. These symptoms have many different names but are often described as ‘functional disorders’. Symptoms like these can also improve with VR. See table 1 for a list of disorders that have shown a change after vestibular physiotherapy.

Table 1 Diagnoses that have shown changes after vestibular physiotherapy
Peripheral Central Functional (psycho-physiological) or multisensory disorders
Benign Paroxysmal Positional Vertigo (BPPV) Cerebellar disorders Mal de Debarquement
Bilateral Vestibulopathy Head trauma Older adults (e.g. falls)
Meniere’s Disease Multiple sclerosis Persistent Postural Perceptual Dizziness (PPPD)
Unilateral Peripheral Vestibulopathy (aka labyrinthitis or neuritis) Stroke
Vestibular schwannoma (aka acoustic schwannoma) Vestibular Migraine

What factors are related to recovery?

The degree to which people improve depends on their diagnosis, medication use or non-use, other health problems, motivation, family support plus other psychological factors. There is evidence that suggests that an individualised exercise programme is better than a generic exercise programme.

What can I expect from a vestibular physiotherapist?

Most therapists will start by asking you lots of questions to obtain a thorough history considering the initial onset and course of your condition. Then they evaluate eye and head movements, and screen for the presence of Benign Paroxysmal Positional Vertigo (BPPV). A comprehensive evaluation of standing and walking balance is then performed. Your individual goals and expectations of treatment can then be determined.

Based on the findings from the examination, a home exercise programme (HEP) is usually developed. The length of time seen, and number of visits needed to improve can vary. Most of the improvement occurs due to the performance of the HEP, because you will have more time at home to practice compared with in the clinic, so it is very important to follow the therapist’s recommendations. During follow-up visits, the physiotherapist may decide to update the HEP based on your symptoms and progress with the exercises.

The frequency of visits can vary, and duration of VR can last from as little as 1 to 2 weeks to several months. Most physiotherapists offer appointments lasting between 30 minutes and one hour. Your symptoms largely dictate how long the exercises last. People with dizziness can get worse if they are prescribed exercises that are too advanced, so it is important to work with your physiotherapist to make sure they are appropriate for your condition and stage of recovery.