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Vestibular Rehabilitation

PRO Physical Therapy offers a Vestibular Rehabilitation Program for individuals who experience symptoms of dizziness, vertigo, disequilibrium or decreased balance/stability. These symptoms may be due to dysfunctions of the central or peripheral vestibular system.

The peripheral vestibular system is a portion of the inner ear involved in the maintenance of balance and gait stability. The central vestibular system is located in the cerebellum, or main balance center of the brain. Symptoms that may be associated with a vestibular disorder include vertigo (the experience of movement in the surroundings that is not actually occurring), lightheadedness, imbalance, disequilibrium, spinning and motion sickness. These symptoms may or may not be accompanied by other manifestations of inner ear disorders such as hearing loss or ringing in the ear (tinnitus.)

For patients who are diagnosed with a vestibular problem, physical therapy directed at resolving the source of the difficulty or encouraging compensation from other aspects of the balance system has proven very effective.

Recent studies have shown that patients often benefit from rehabilitation exercises that enhance the nervous system’s adaptation process to inner ear dysfunction, increase the patient’s postural stability, or relieve the specific symptoms. At PRO Physical Therapy, our therapists have specialized training in vestibular rehabilitation treatment and understand the needs of this population.

Statistical Prevalence

  • Forty percent of people over the age of 40 experience dizziness or balance problems at some point in their life.
  • Ninety million Americans (42 percent of the population) will complain of dizziness to their doctors at least once in their lifetime (NIH).
  • By age 75, dizziness and balance disorders are one of the most common reasons for seeking help from a physician.
  • Dizziness-vertigo is among the 25 most common reasons that Americans visit the doctor (Ambulatory Medical Care Survey, 1991).
  • U. S. physicians report a total of more than 5 million dizziness-vertigo visits per year.
  • The cost of medical care for patients with balance disorders had been estimated to exceed $1 billion per year in the United States.
  • About 20% of all dizziness is due to BPPV. The most common cause of BPPV in people under age 50 is head injury. About 50% of dizziness in older people is due to BPPV. In half of all cases, BPPV is idiopathic, which means that it occurs for no known reason. BPPV is also associated with migraine.

What Is Vestibular Rehabilitation? (VEDA)

Vestibular rehabilitation is an exercise approach to treating symptoms of dizziness associated with peripheral vestibular pathology. It’s an alternative form of treatment involving specific exercises designed to:

  • decrease dizziness
  • increase balance function
  • increase general activity levels

What Vestibular Diagnoses Can Be Treated?

  • Common Peripheral Vestibular Disorders
  • Benign Paroxysmal Positional Vertigo – vertigo caused by change in position
  • Vestibular Neuritis – infection to the vestibular nerve
  • Anterior Vestibular Artery Ischemia
  • Ménière’s Disease – recurrent spontaneous attacks of ringing in the ear, vertigo, nausea/vomiting and imbalance
  • Labyrinthitis – viral or bacterial infection to the labyrinth of the inner ear
  • Vestibular Toxicity – dysfunction of vestibular system by certain medications
  • Multi-factorial gait and balance disorders
  • Chronic imbalance arising from multiple types of inner ear disorders including Ménière’s disease and disequilibrium imbalance arising from central vestibular structures
  • Common Central Vestibular Disorders
  • Multiple Sclerosis
  • CVA or Stroke
  • Parkinson’s Disease

Discuss Vestibular Rehabilitation with Your Physician if You Have Any of These Symptoms

  • History of frequent falls within the last six months
  • Lightheadedness or imbalance
  • Vertigo (spinning sensation) with or without nausea
  • Difficulty walking in visually busy environments (such as the grocery store or mall), in poor lighting, and/or on uneven surfaces
  • Head trauma or Injury
  • Peripheral vestibular disorders such as vestibular neuritis, Labyrinthitis, Acoustic Neuroma
  • Neurological conditions such as MS, Parkinson’s disease, CVA

Benign Paroxysmal Positional Vertigo (BPPV)

What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is a disorder that causes vertigo, dizziness, and other symptoms due to debris that has collected within a part of the inner ear. This debris, called otoconia, is made up of small crystals of calcium carbonate (sometimes referred to colloquially as “ear rocks”). With head movement, the displaced otoconia shift, sending false signals to the brain.

Symptoms of BPPV are almost always precipitated by a change in head position. Getting out of bed and rolling over in bed are two common “problem” motions. Some people feel dizzy and unsteady when they tip their heads back to look up. An intermittent pattern of these symptoms is usual.

Diagnostic tests for BPPV include tests that look for the characteristic nystagmus (jumping of the eyes), such as the Dix-Hallpike test and electronystagmography (ENG).

Particle-repositioning maneuvers, including the Epley maneuver and the Semont-liberatory maneuver, are very effective in treating BPPV and can be performed in the clinic in about 15 minutes. The goal of these maneuvers is to move the detached otoconia out of one of the semicircular canals. Treatment may also include individualized vestibular rehabilitation therapy exercises designed to help “retrain the brain.” When present, this diagnosis can often be resolved within 3 visits over the course of 5-10 days.