Vestibular Rehabilitation

The feeling of being dizzy, disoriented, or unsteady on your feet is unpleasant and can make daily activities difficult, but it can also be dangerous as it increases the risk of falls and related injuries. By focusing on the inner ear disorders and neurologic conditions that can cause this feeling, vestibular therapy aims to reduce dizziness and prevent these injuries from occurring.

What is Vestibular Therapy?

For those with issues related to dizziness and disorientation, vestibular therapy is a part of their physical therapy that focuses on exercises designed by a specialist. The aim of the rehabilitation is to improve balance and reduce problems related to their dizziness.

A physical therapist will use a detailed history of your health and a series of assessments in order to determine if you are a candidate for vestibular therapy. They may assess your visual stability, oculomotor function, standing balance, stability while walking, neck mobility and tenderness, and inner ear positional testing. If these tests indicate that vestibular rehabilitation will be beneficial, the therapist will develop a comprehensive treatment plan to improve your function in these areas.

How Much Does a Session Cost?

The cost of vestibular rehabilitation therapy will depend on location, your provider, the duration of your therapy, and insurance coverage. Many plans do cover the service as part of a comprehensive physical therapy treatment plan, but you should always check with your provider and insurance company. On average, each session costs between $75 and $100.

VRT, or vestibular rehabilitation therapy, can be used for a wide variety of issues.

What Conditions Does Vestibular Rehabilitation Treat?

Some conditions that can be treated through VRT include:

• Benign Paroxysmal Positional Vertigo (BPPV)
• Vestibular Neuritis/Labyrinthitis
• Unilateral Vestibular Hypofunction (UVH)
• Vestibular Migraine
• Persistent Postural Perceptual Dizziness (PPPD)
• Mal de Debarquement (MDD)
• Cervicogenic Dizziness
• Post-Concussion Syndrome (PCS)
• Neurological conditions like stroke, traumatic brain injury, etc.
• Recurrent Vestibulopathy

Most conditions related to persistent dizziness are candidates for VRT.

How Does VRT Help With Your Daily Activities?

For some people with these conditions, otherwise simple daily activities can become difficult. Severe dizziness and loss of balance may make it burdensome to get out of bed or perform simple actions like brushing your teeth or doing the dishes. VRT includes a number of techniques that can improve function in these areas.

For example, balance training is used to improve steadiness that can make it safer to stand for long periods or walk to and from other locations.

Is Vertigo Treated by Vestibular Therapy?

One of the most common reasons people seek out vestibular rehabilitation therapy is to address vertigo, particularly benign paroxysmal positional vertigo, or BPPV. This occurs when calcium particles (called canaliths) are dislodged from their normal location and collect in the inner ear. When this happens, the inner ear incorrectly signals the brain about head and body movements. This creates the sensation of vertigo, meaning feeling off-balance or dizzy.

By strengthening the vestibular system, VRT can help reduce these symptoms and help your other senses to compensate for vertigo.

What Causes Dizziness?

Dizziness can be described as feelings of unsteadiness, wooziness, lightheadedness, or a sensation of moving when you are not. This may happen when you are standing still, lying down, or during a position change; dizziness may be constant or appear in an episodic manner.

Occasional dizziness can be caused by sudden and unusual movements, like riding a roller coaster. But chronic dizziness may be the result of inner ear disorders, a side effect of medications, a sign of dysfunction in the neck or spine, or related to more serious problems with the brain and heart.

How Vestibular Therapy Treats Dizziness

Vestibular therapy focuses on a number of goals that are designed to reduce dizziness and strengthen senses that compensate for the causes of dizziness. These goals include enhancing gaze stability, improving postural stability, reducing vertigo, and improving the ability to carry out the activities of daily living. This is done by using adaptation/substitution to use vision, posture, strength, proprioception, and to compensate for dysfunction of the vestibular system.

Each patient’s plan will vary based on their needs and goals. Techniques used can include balance training that retrains the body to react properly to movement or specific eye/head movements that retrain the brain to react properly to vestibular input.

How Does Vestibular Physical Therapy Differ From the Usual Physical Therapy?

Traditional physical therapy is focused on improving movement, mobility, function, and range of motion, usually in response to an illness or injury that has compromised these abilities. Vestibular therapy follows the same principles but is focused on a specific set of conditions and outcomes related to vestibular systems. Techniques that are used in physical therapy, like balance training, may be more focused on decreasing the risk of falling rather than returning to sports, but the concept will be similar.

Depending on the underlying condition and goals, a patient may seek VRT on a short-term or an ongoing basis. Typically, patients will have one to two sessions a week for about 6 to 8 weeks. Programs also require some exercises to be done at home. Based on the severity of symptoms, diagnosis, and response, the program can last several months or be completed in several weeks.

How Long Will It Take For You to Feel the Benefits of VRT?

Most people will feel some improvement after a single session of vestibular rehabilitation therapy. This may be very mild or very marked, depending on the severity of symptoms and design of each program. Typically, benefits build from there, with incremental improvement seen over the course of the program. If you are seeing no change after a few sessions, your therapist may work with you to create a new plan that will better address your concerns.

Is There a Chance That Dizziness Will Recur After Being Fully Treated?

The goal of VRT is for the patient to learn ways to compensate for weaknesses in their vestibular system. Usually, if a program is followed and kept up over time, dizziness is reduced or eliminated for long periods. Not performing a maintenance/home program  is a common reason for recurrent dizziness. However, as conditions worsen, symptoms may reappear and need further treatment. For this reason, VRT is sometimes seen as a more short-term solution but is very effective in making daily life more pleasant and manageable.

How Does One Get Started with Vestibular Rehabilitation?

In some cases, another doctor may refer you to a physical therapist who can perform vestibular therapy. However, if you feel you are a good candidate, you can also seek care yourself. An initial visit will be a consultation that determines if you are someone who will benefit from VRT. Be sure to find a physical therapist who specializes in the techniques used in vestibular therapy and come prepared to share your symptoms with them.

What Should a Patient Expect at the First Session?

The first session will usually involve a number of assessments, both physical and verbal. You will discuss your general medical history and any concerns you have, including symptoms that make you suspect a vestibular issue. They will also assess areas including your balance, leg strength and flexibility, gait, visual stability and mobility, strength and mobility in the neck and arms, and positional testing such as inner ear exams. Based on the results of these tests, a physical therapist will determine if VRT can help and what a plan will look like.

Your first session may also include beginning exercises as a part of this plan. Examples include:

• Vision stability training
• Posture training
• Stretching and strengthening exercises
• Balance retraining
• Walking exercises
• Neck mobility and stretching exercises
• Ergonomic training

Is There a Specific Age Group that VRT Can Treat?

Vestibular rehabilitation therapy can help anyone with vestibular issues. Those over 75 years old are the most likely to experience these problems but are not the only candidates.

What Is the Vestibular System?

The vestibular system is a sensory system in the body that is responsible for providing our brain with input about motion, head position, and spatial orientation. It also assists with motor function that helps with balance, stabilizes the head and body during movement, and maintains posture. The vestibular system is crucial for normal movement and equilibrium.

The sensations involved in the vestibular system begin in the ear and use a series of tubes and canals to connect with the brain.

What Is Gaze Stabilization?

Gaze stabilization is a kind of exercise used in vestibular rehabilitation therapy that seeks to improve eye movements as they adjust to head movements. When you move your head, your vision should still be clear. Depending on the type of vestibular condition you have and how severe it is, you may need gaze stabilization to prevent blurriness during movement. A common example is fixating the eyes on an object while repeatedly moving the head back and forth or up and down for several minutes.

What Is Habituation?

Exercises meant to correct dizziness as it  relates to self-motion and visual stimulation is known as habituation. These exercises are very beneficial in cases of dizziness with movement, motion sickness, and those who report dizziness in a visually stimulating environment. The goal of habituation is to reduce symptoms through repeated exposure to specific movements or visual stimuli, provoking mild symptoms until the central nervous system is better able to habituate the stimuli. Over time, the symptoms should decrease.

What Is Balance Training?

Balance training is a series of exercises designed to improve steadiness to allow patients to participate in daily activities with less risk of falling. A therapist will ensure each exercise is both challenging and safe enough to avoid falls during therapy. Eventually, this should improve the ability to walk on uneven ground or in the dark. A comprehensive program may aim to improve the ability to sit, stand, walk, turn, bend over, and reach while maintaining balance.

Does VRT Help Vertigo?

Vertigo that is caused by Benign Paroxysmal Positional Vertigo (BPPV) is commonly treated through VRT. A therapist will first assess your inner ears through positional testing, which puts your head in various positions to try and reproduce the sensation of vertigo, to determine if you are a fit. If so, the therapist will then use repositioning maneuvers to treat the specific type of BPPV that has been identified.

Some individuals will continue to experience more general dizziness and imbalance over time, even after the use of repositioning maneuvers. In these cases, other exercises like balance training may be recommended.

Does VRT Hurt?

The exercises used in VRT can often be tedious but are usually not painful. However, you are likely to experience symptoms during many exercises as your body adjusts and learns to compensate. You should expect to experience some mild to moderate dizziness or disorientation during a session as a part of your recovery. But with time and consistency, you will see these symptoms decrease both during and after sessions.