Will vestibular rehab help me?
Do you experience dizziness, vertigo, balance problems, or falls? Maybe you have been told to go to vestibular rehabilitation therapy but you’re not sure what it involves? Read on to learn more about vestibular rehab, how it works, and whether it could help you.
What is vestibular rehabilitation physiotherapy?
Vestibular rehabilitation is an exercise based therapy focused on reducing your symptoms of dizziness, vertigo, and imbalance. Vestibular rehabilitation with a specially trained physiotherapist will help determine the cause of your symptoms and the most effective treatments to help your dizziness, improve your balance, and get you back to your usual activities.
In your first session, your physiotherapist spends time talking with you and asking questions to better understand your problems and goals. They do a complete physical assessment of your inner ear balance organs and the parts of your brain that deal with dizziness/balance, and evaluate your balance and walking abilities. They will try to figure out the cause of your symptoms, and will talk with you about what they found in their assessment and what the best plan is to help you.
Treatment is individualized and designed to help reduce your dizziness and vertigo symptoms, improve your balance, and get you back to the activities that are important to you. This can include physical maneuvers for vertigo, balance and gait training exercises, or eye and head exercises. Vestibular rehab involves a tailored series of exercises for you to complete at home. Your physiotherapist will provide information about your condition and support you during your rehab.
How does vestibular rehab help?
Specific physical repositioning maneuvers are very effective at treating the most common cause of vertigo, Benign Paroxysmal Positional Vertigo (BPPV). In our clinic, we use infrared goggles to more accurately diagnose and treat BPPV.
For other conditions involving impaired inner ear balance function (e.g. vestibular neuritis), rehab involves exercises designed to help your brain compensate for loss of vestibular function through neuroplasticity. This “brain training” encourages your brain to form new connections and pathways. Specific eye and head exercises help fine tune how your brain interprets signals from your inner ear, to improve gaze stability and reduce your dizzy symptoms. Balance exercises also train your brain to process incoming signals from your balance systems more accurately and to generate balance responses more efficiently. Sometimes adding specific strength or mobility exercises for your lower body and core will help your balance and walking abilities. Habituation exercises are used to help your brain become less sensitive to movements that provoke dizziness.
Will vestibular rehab help me?
There is a very good chance that vestibular rehab will help significantly improve or even completely resolve your symptoms if they are triggered by head or body movements (e.g. turning your head) or triggered by changing positions (e.g. bending down, looking up, lying flat, turning over in bed). If you have been avoiding movements that trigger dizziness this can actually slow down your recovery, and a vestibular physiotherapist can help determine what exercises will help you most.
If you have balance problems or have fallen, a vestibular rehab assessment can help determine if you are an increased risk of falling and if there are inner ear issues contributing to your imbalance. Treatment sessions can target balance and gait training and give you a home exercise program to improve your balance and increase your confidence in your abilities.
You may benefit from a comprehensive assessment with a vestibular physiotherapist if a “wait and see” approach isn’t helping your symptoms, if you have been told that it’s “just vertigo” and there isn’t anything that will help, or if you’ve been told that balance problems are a “normal” part of getting older. A full evaluation may help explain your symptoms and find strategies to help you feel better.
Specific conditions that benefit:
Vestibular neuritis/labyrinthitis
Dizziness and imbalance after concussion/mild traumatic brain injury
Unilateral vestibular loss/hypofunction
Bilateral vestibular loss/hypofunction
Visual motion sensitivity or visual-vestibular mismatch
Meniere’s Disease if you have symptoms or imbalance in between attacks
Age-related imbalance and dizziness
Ramsay Hunt syndrome
Balance problems related to central vestibular disorders
Dizziness and imbalance after stroke
Is there scientific evidence that vestibular rehab helps?
Yes! There is good quality research that supports vestibular rehab and clinical practice guidelines for evidence-based care. There are high-quality randomized controlled trials that provide evidence that vestibular rehab is safe and effective treatment for loss of peripheral vestibular function. For BPPV, there is very good scientific evidence that physical repositioning maneuvers are very effective in the short term and that adding vestibular rehab exercises has further benefit for longer term functional recovery.
How will I know if treatment is helping?
Your physiotherapist will track your progress with specific outcome measures and physical assessments, but the most important measure of progress is whether you feel better and whether you are able to do more of the things that are important to you.
How long will it take to get better?
If you have Benign Paroxysmal Positional Vertigo, symptoms often resolve in 1 to 2 sessions. Otherwise it depends on your condition and your goals, but in our experience to see results most people typically require 4 to 6 visits which are typically spaced out every 2 to 4 weeks.
How do I know if my physiotherapist can do vestibular rehab?
Physiotherapists are movement experts who can give you basic exercises to help balance and mobility; however, vestibular rehab is an area of physiotherapy practice that requires special postgraduate training. This training ranges from introductory weekend courses to comprehensive certificate programs. If you’re not sure what training your physiotherapist has, just ask!
At Vestibular Health, our physiotherapists have completed extensive training including the competency certificate course through Emory University/Duke University, advanced level courses in vestibular rehabilitation, postgraduate courses in neurological and concussion rehabilitation, and mentorship with otolaryngologists and neurologists. We understand the full spectrum of vestibular disorders, including the medical, surgical, and rehabilitative aspects of care. We have worked within multidisciplinary teams that include ENT/otolaryngology & neurotology, neurology, neuro-ophthalmology, psychiatry, nursing, psychology, kinesiology, and occupational therapy so we know how to collaborate and communicate with your other health care providers. We stay up to date on the latest research literature, attend and present at conferences, and provide training for other clinicians. We are dedicated to helping people with dizziness and balance disorders - it’s all we do!
I’m still not sure if vestibular rehab is right for me, how can I find out more?
Call us! Our physiotherapists would be happy to talk to you about your specific issues and figure out whether vestibular rehab is a good fit for you.
“The behavioural, training strategies, and exercises you taught me have most certainly improved my balance problems, especially in crowds, and have given me a new confidence in myself. I still practice the balance exercises you taught me several times a week, because they are the keys to improving and maintaining my postural stability.”
Patient with bilateral high velocity vestibular loss
