Vestibular Rehabilitation Therapy

What is vestibular rehabilitation?

Vestibular rehabilitation therapy involves exercises that help you manage dizziness and balance issues (imbalance). Vestibular rehabilitation therapy takes time, but it can improve your quality of life.

Who needs to have this treatment?

Dizziness may be a symptom of certain medical conditions that also affect your sense of balance. Dizziness and balance issues may also cause muscle fatigue and headache. Vestibular rehabilitation therapy may help people with conditions including:

• Vertigo.
• Ménière’s disease.
• Benign paroxysmal positional vertigo (BPPV).
• Labyrinthitis.
• Vestibular neuritis.
• Migraine headache.
• Stroke.
• Traumatic brain injury (TBI).
• Falling risk.

How does vestibular rehabilitation therapy work?

Dizziness and balance go hand-in-hand. Vestibular rehabilitation therapy helps you manage dizziness symptoms, including imbalance. To understand how therapy works, it may help to know more about why you may feel very dizzy and how your body manages balance.

Dizziness

Dizziness happens when something affects your sense of spatial orientation. Spatial orientation is your brain calculating the position of your body in relation to your surroundings. When that happens, you may feel woozy or lightheaded. You also may feel unsteady, as if you’ve lost your sense of balance.

Balance

Your sense of balance relies on the relationship between your central nervous system (brain) and your sensory system. Your sensory system includes:

• Your vestibular labyrinth in your inner ear: This includes your semicircular canals (loops), which react when you turn your head, and otolith organs that react to gravity and movement.
• Your vision: Your eyes send your brain impulses that show where your body is in relation to other objects.
• Your skin, joints and muscles: When your body moves, it puts pressure on your tissues. Your tissues send signals to your brain, telling it where your body is in relation to space. For example, if you’re standing up and you lean back, you put pressure on tissues in the back of your foot and lower leg. That pressure lets your brain know you’re leaning instead of standing straight.

Your central nervous system pulls this information together so it can tell your body how to maintain balance. When something interferes with the system’s connection, your central nervous system can’t process information correctly. Vestibular rehabilitation therapy helps restore those connections, ultimately reducing your symptoms of dizziness and imbalance.

What happens before I start vestibular rehabilitation therapy?

You’ll need to have your symptoms evaluated. You may visit an audiologist for a vestibular test battery. These are different tests to evaluate how well the vestibular part of your inner ear is working. A physical therapist will evaluate your balance, your gait (how you walk), your arm and leg strength, and flexibility.

What happens during therapy?

Balance issues and dizziness may affect you in different ways. Your healthcare provider will tailor vestibular rehabilitation therapy to your specific need. They’ll show you how to do specific exercises so you can exercise at home, at your convenience. Therapy may include these exercises:

• Eye movement control.
• Balance retraining.
• Stretching and strengthening.

How long is a typical vestibular rehabilitation program?

That depends on your situation. How much therapy you’ll need depends on why you have dizziness or balance issues and how you respond to therapy. Most people have six to eight weekly sessions. Some people may only need one or two sessions. Other people may need several months of ongoing treatment, including doing exercises on their own.

What are the advantages of vestibular rehabilitation therapy?

Studies show vestibular rehabilitation therapy helps:

• Reduce your risk of falling.
• Improve your balance.
• Reduce your dizziness symptoms.
• Improve your ability to stabilize your vision.
• Increase your body strength.

Are there any risks to this therapy?

Vestibular rehabilitation therapy doesn’t cause physical risks. There’s always the chance therapy won’t completely resolve your dizziness or balance issues. This is particularly true if you’re not able to do the prescribed exercises on your own.

What can I expect after having this treatment?

That depends on your situation. In general, most people who continue doing their exercises have significantly fewer issues with dizziness and balance.

When should I see my healthcare provider?

Vestibular rehabilitation therapy rarely causes issues. However, if you’re doing exercises on your own, you should contact your healthcare provider if you have the following symptoms:

• A sudden change or fluctuation in hearing.
• Feeling pressure or a sense of fullness in your ear that’s painful or uncomfortable.
• New or increased ringing in your ear.
• Fluid coming from your ears.
• Any pain or discomfort in your neck and back that happens while you’re doing your exercises.

A note from Cleveland Clinic

It’s disorienting to feel extremely dizzy and lose your sense of balance, even if those sensations go away. Sometimes, dizziness and imbalance are persistent issues that affect your quality of life. Vestibular rehabilitation therapy involves exercises that help you regain your sense of balance and manage dizziness. If you’re concerned about dizzy spells or balance issues, talk to a healthcare provider. They’ll evaluate your situation and, if appropriate, refer you to providers who offer vestibular rehabilitation therapy.