Vestibular Rehabilitation

Vestibular rehabilitation therapy (VRT), also known as vestibular rehabilitation (VR), is a specialized exercise program that uses repetitive movements to help manage dizziness, vestibular and balance issues caused by vestibular disorders, primarily vertigo and dizziness, gaze instability, and/or imbalance and falls.1

The goals of VRT are to:

  • Enhance gaze stability
  • Enhance postural stability
  • Improve vertigo
  • Improve activities of daily living

How does VRT work?

When the vestibular system is damaged, it sends abnormal signals to the brain. VRT uses specialized movements to help the brain adapt to these signals from the vestibular system by relying more heavily on cues from other parts of the body.

Conditions Treated

Vestibular rehab has been used to treat a variety of conditions, including:

  • Benign paroxysmal positional vertigo (BPPV): A balance disorder that can cause vertigo when you move.
  • Ménière’s disease: An inner ear disorder that can cause dizziness and hearing loss.
  • Stroke: Occurs when a blocked artery stops the flow of oxygen-rich blood to the brain.
  • Traumatic brain injury: An injury usually triggered by a blow to the head that causes brain damage.
  • Custom VRT exercises help with vestibular symptoms of these conditions, like dizziness, vertigo, loss of balance, and vision changes.

What can be expected from VRT?

During VRT, patients work with licensed physical or occupational therapists who have advanced training in this field. This assessment should include collecting a detailed history of the patient’s symptoms and how these symptoms affect their daily activities.

A customized exercise plan is developed from the findings of the clinical assessment, results from laboratory testing and imaging studies, and input from patients about their goals for rehabilitation. These exercise plans are typically performed on an outpatient basis but may be initiated in the hospital. A home-based exercise program is also prescribed that patients must perform regularly in order to achieve rehabilitation and patient goals.

How long does it take for vestibular therapy to work?

It takes on the average about 6-12 weeks for patients who regularly follow the programs to start noticing improvements.

What kinds of exercises are prescribed?

Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed:2

  1. Habituation – treat symptoms of dizziness that is produced because of self-motion3 and/or produced because of visual stimuli.4,5
  2. Gaze Stabilization – improves control of eye movements.
  3. Balance Training – improves steadiness so that daily activities for self-care, work, and leisure.

Resources:

  1. Vestibular Rehabilitation Therapy (VRT)
  2. Herdman SJ, Clendaniel RA. eds. Vestibular Rehabilitation. 4th ed. Philadelphia: F.A. Davis Co.; 2014.
  3. Shepard NT, Telian SA. Programmatic vestibular rehabilitation. Otolaryngol Head Neck Surg; 1995: 112(1):173-182.
  4. Pavlou M, Lingeswaran A, Davies RA, Gresty MA, Bronstein AM. Simulator based rehabilitation in refractory dizziness. J Neurol; 2004:251:983-995.
  5. Pavlou M, Quinn C, Murray K, Spyridakou C, Faldon M, Bronstein AM. The effect of repeated visual motion stimuli on visual dependence and postural control in normal subjects. Gait & Posture. 2011; 33:113-118.