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Vestibular Rehabilitation

August 11 | 2021
Posted by Erin Mills Physiotherapy

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Vestibular Rehabilitation – What is it?

Vestibular rehabilitation

Vestibular rehabilitation involves the treatment of disorders related to the vestibular system of the body.  However, to understand these types of conditions and the treatment that is involved, it is helpful to know a little about the vestibular system.

What is the vestibular system?

  • The vestibular system is a complex system that deals with controlling balance and eye movements.
  • It includes structures that are found in the inner ear and the brain
  • The vestibular system picks up information about movement and spatial orientation from your surroundings and sends this information to the brain
  • This system allows us to do all our daily activities from reading, driving, walking, running and playing sports to name just a few.
  • The brain combines this information with other sensory information from your body to coordinate smooth and well-timed movements
  • As a result, if there is a disease or injury that affects the structures of the vestibular system, then dizziness and balance problems can result

 Are vestibular disorders common?

There is a lot of recent research out there that reveals just how common these vestibular problems are.  For example:

  • 35% of Americans over the age of 40 have experienced some form of vestibular dysfunction. That’s roughly 70 million people.
  • Approximately 8 million American adults report a chronic problem with balance.
  • An additional 2.4 million Americans report a chronic problem with dizziness.
  • 80% of people over the age of 65 years of age have experienced dizziness.
  • 85% of people over the age of 80 have a vestibular dysfunction.
  • 75% of people over the age of 70 have a balance problem.

Majority of people who are suffering with issues of dizziness and balance are the elderly.  For example, in Canada, people are generally living longer and the population is ageing.  As a result, it is not surprising that vestibular disorders are so common.  However, it is also important to note that vestibular problems can occur at any age, including in children.

What are the most common signs and symptoms of a vestibular disorder?

Vestibular rehabilitation

  • Imbalance or unsteadiness
  • Vertigo
    • An illusion of movement happening in the environment
    • It’s usually a spinning or whirling type of movement
  • Dizziness
    • A lightheaded, floating or swaying sensation
  • Blurred or bouncing vision
  • Nausea
  • Hearing changes
  • Anxiety
  • Lack of coordination
  • Problems with concentration and memory
  • Motion sickness
  • Increased sensitivity to noise and bright lights
  • Fatigue
  • Anxiety and depression

What are some of the causes of vestibular disorders?

  • Trauma
    • Whiplash and blows to the head
    • Trauma is a common cause for vestibular problems in people under 50 years of age
  • Exposure to sudden or extreme pressure changes
    • Examples include scuba diving and air travel
  • Changes to vestibular organs related to ageing
  • Ear infections
    • Infections can damage the structures of the vestibular and hearing systems, including the nerves
  • Antibiotics
    • High doses or long-term use of certain antibiotics can cause permanent damage to the inner ear
  • Migraines or strokes
    • These disorders can reduce or block the blood flow to the vestibular system structures
  • Idiopathic causes
    • This term is used when the underlying cause is unknown


What are some examples of vestibular disorders?

The most common vestibular disorders are:

  • Benign paroxysmal positional vertigo (BPPV)
  • Vestibular migraine
  • Labyrinthitis or vestibular neuritis
  • Meniere’s disease
  • Age-related dizziness & impaired balance
  • Vestibular damage due to head injury
  • Secondary endolymphatic hydrops
  • Perilymph fistula

Less common vestibular disorders include:

  • Superior canal dehiscence
  • Acoustic neuroma
  • Bilateral vestibular hypofunction
  • Ototoxicity
  • Neurotoxic vestibulopathy
  • Mal de Debarquement Syndrome
  • Autoimmune inner ear disease

For more information on vestibular disorders, please visit Balance & Dizziness Canada.

Can vestibular disorders be treated?

For some people, the symptoms of a vestibular disorder may improve without any treatment.  That is to say, the vestibular system heals over time or the brain learns to compensate for the changes.  In other words, the brain is an expert at changing itself to manage the body’s function.

On the other hand, for a lot of people, symptoms of vestibular disorders become an ongoing problem.  As a result, these issues become very disruptive to a person’s quality of life.   In these cases, treatments therefore can provide significant relief of symptoms.  Additionally, for some people a complete cure can be achieved.  However, for those where the disorder cannot be cured, the focus of treatment is on management of the symptoms.

For example, treatment options for people who have persistent symptoms can include:

  • Vestibular rehabilitation
  • Diet changes
  • Medication
  • Specialized equipment
  • Mindfulness strategies

What is vestibular rehabilitation?

Vestibular rehabilitation is a treatment program designed to reduce problems related to dizziness and vertigo.  Additionally, vestibular rehabilitation also helps to improve balance problems.  This specialty treatment is usually provided by an experienced Registered Physiotherapist.  More specifically, vestibular rehabilitation is an exercise-based program.  However, it can also include manual therapy and education.

At PhysioNow, we have experienced registered physiotherapists who have training in vestibular rehabilitation.  Firstly, the physiotherapist will go through a detailed history of when and how the symptoms started.  Furthermore, they will ask questions about the factors that aggravate the symptoms the most.  This will allow the physiotherapist to get a good understanding of the patient’s condition.  Secondly, the physiotherapist will perform specialized physical tests that will test different parts of the vestibular system.  Consequently, these tests will help to pinpoint the source of the symptoms and provide a pathway for treatment.

For example, these physical tests may include:

  • Specific head maneuvers
  • Visual screening
  • Cervical Spine movements
  • Motion Sensitivity Testing
  • Balance Assessment
  • Gait Assessment

The amount of testing completed will depend on the presenting symptoms and how much the patient is able to tolerate.

What are the benefits of Vestibular Rehabilitation?

Once the physiotherapist has a good understanding of the patient’s condition, they can start with the treatment of the vestibular disorder.  More specifically, the exact treatments provided will depend on the assessment findings.  In other words, vestibular rehabilitation is very specific to the patient and will vary depending on the presenting symptoms.  Furthermore, for some patients, the treatment may be quick and easy.  However, for others it may take a long time for changes to occur.

Above all, the overall goals of vestibular rehabilitation are to:

  • Improve symptoms of dizziness and vertigo
  • Increase balance ability
  • Improve the patient’s ability to see clearly when they are moving their head
  • Improve the overall general physical condition
  • Reduce the patient’s social isolation
  • Decrease the patient’s motion sensitivity

What does the treatment for Vestibular disorders look like?

Vestibular rehabilitation treatments are not specific to a certain structure or injury site. More specifically, the treatments are targeted towards symptom reduction or  symptom adaptation.  For example:

  • If a patient has persistent dizziness when they are turning their head, then the physiotherapist will prescribe exercise programs that will help retrain the system to become less and less dizzy with those head movement over time.
  • If a patient loses balance when they are walking, then the physiotherapist will prescribe exercises to help strengthen and improve their balance.

Vestibular treatment plans may include:

  • Manual (Hands-on) treatment
  • Specialized exercises for the head, eyes and neck
  • Balance training
  • Education


Why is Vestibular Rehabilitation important?

The cost of vestibular problems can be substantial.  For example, the research shows that people who have a vestibular dysfunction have an 8-fold increase in their risk of falling.  Furthermore, the cost of falls in the USA by the year 2020 is estimated to be in the range of 55 billion dollars.  Therefore, vestibular problems result in a huge economical cost.  However, if physiotherapists can intervene and provide a service to help prevent these individuals from falling, the economical cost can be significantly reduced.  In other words, many people will have a better quality of life and there will be huge cost savings for the health care system.

The concept of vestibular rehabilitation is relatively new in the health care world.  However, the positive effects of vestibular rehabilitation have been consistently proven in the research.  Consequently, without vestibular rehabilitation, a lot of people resort to emergency rooms and medication to manage symptoms, which are usually unsuccessful.  Most importantly, this therapy provides a much-needed service for patients who are suffering with these types of symptoms.  Furthermore, vestibular rehabilitation gives people their independence and quality of life back.  In short, vestibular rehabilitation needs to be made widely available so that more people have access to this specialty treatment.

At PhysioNow, we have several Registered Physiotherapists who are trained in vestibular rehabilitation.  If you or a loved one is having signs and symptoms of a vestibular problem, call us today to book your appointment!


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