Vestibular Rehabilitation Therapy

Vestibular rehabilitation therapy or VRT is an exercise program tailored to the individuals presenting with symptoms of dizziness or vertigo. A specialized physical therapist with advanced training in VRT analyzes the patient's symptoms to identify the likely origin of the symptoms and then selects a series of exercises to improve balance and reduce problems related to  the dizziness.

Patients describe their symptoms in many different ways. They may feel:

• Dizzy
• Unsteady
• Woozy of floppy
• Lightheaded
• Like the world is spinning
• Like everything is spinning around (vertigo)
• A floating or swaying sensation
• As if they are about to fall over
• That they are tilting to one side

These symptoms can occur when you are standing still, lying down, changing positions or moving around. It can be constant or intermittent; they can last for just a few seconds, for hours or be there constantly. It is very helpful to your therapist to get a detailed report of these variables as it will help identify the cause of the problems.

Dizziness is usually not serious, but sometimes can be a sign of some underlying process in the brain that needs more investigation. It can be caused by a simple mechanical problem in the inner ear balance organ (BPPV). It can also be a side-effect of medication. It can be experienced as a result of some problem in the brain or brainstem. It can also be the result of some problem in your neck. The evaluation process will help narrow down the cause and determine how best to manage it.

Patients are typically referred for VRT because of dizziness, fall risk, balance issues, vertigo, Menière’s syndrome, benign paroxysmal positional vertigo (BPPV caused by loose floating called crystals in your inner ear), migraines or after a stroke or brain injury.

Common symptoms are:

• Dizziness or blurry vision with head movements
• Neck tightness, stiffness, and/or pain
• Imbalance or the need to hold onto objects when walking
• Headaches
• Frequent falls
• Generalized “dizziness, wooziness and foggy head” feelings
• Vertigo/spinning

In many cases, if patients continue to perform the exercises they have learned, balance and dizziness problems decrease significantly or completely disappear. VRT usually provides significant relief of symptoms. 

Patients are typically seen 1 to 2 times each week for 6 to 8 weeks, but this varies based on the patient’s diagnosis, severity of symptoms, and response to therapy. Some patients may be seen for only 1 to 2 sessions; other patients may need continued treatment for a few months.

References

Agrawal, Yuri, Bryan K. Ward, and Lloyd B. Minor. "Vestibular dysfunction: prevalence, impact and need for targeted treatment." Journal of vestibular research: equilibrium & orientation 23.3 (2013): 113.

Yardley, Lucy, et al. "Prevalence and presentation of dizziness in a general practice community sample of working age people." Br J Gen Pract 48.429 (1998): 1131-1135.

Agrawal, Yuri, et al. "Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004." Archives of internal medicine 169.10 (2009): 938-944.

Ribeiro, Karyna Myrelly Oliveira Bezerra de Figueiredo, et al. "Effects of balance vestibular rehabilitation therapy in elderly with benign paroxysmal positional vertigo: a randomized controlled trial." Disability and rehabilitation 39.12 (2017): 1198-1206.