Barriers to Vestibular Rehab and Recovery

Before getting into the barriers to vestibular recovery we must understand it some more. It starts with central compensation. It is the process of the brain interpreting whatever level of vestibular input is available from the inner ear as equal to the other side.

To explain it to my to patients, I also call it “recalibrating.”

Central compensation for a vestibular injury occurs through a neurological process called “neuroplasticity.” This central compensation occurs in the brain.

In order to maximize neuroplasticity, certain training parameters must be followed. Those training parameters for vestibular rehab are well established through research and serve as the basis of effective vestibular recovery.

Failure to compensate, or recover fully from symptoms related to an episode of vestibular neuritis or vestibular labyrinthitis for example, is referred to as “chronic vestibulopathy.” There are many things that can create a barrier to central compensation, thereby preventing a full vestibular recovery with successful vestibular rehab.

Top Ten Barriers to Vestibular Recovery

  1. Anxiety or depression that prevents full participation in vestibular physical therapy
  2. Lack of access to adequate skilled care providers
  3. Fear of movement or avoidance of movement due to symptom provocation
  4. Lack of knowledge about the existence of vestibular physical therapy as a treatment option
  5. Stress that is preventing the brain from accomplishing neuroplasticity or creating new pathways to recalibrate
  6. Certain common medications prescribed for dizziness that prevent vestibular recovery by suppressing the central nervous system
  7. Other neurological impairments or CNS (central nervous system) diseases that restrict the brain’s ability to respond to an inner ear problem effectively
  8. Residual BPPV particles that have not been cleared and continue to cause dysequilibrium with certain movements, giving the brain a motion-activated error signal to continually process
  9. Musculoskeletal problems like altered bony alignment, tight fascia, or muscle spasms in the head, neck, face, jaw, or spine that have not been addressed and get exacerbated by the treatment protocols of Vestibular rehab physical therapy
  10. Misdiagnosis at the beginning and therefore mismanagement of a true vestibular condition

Vestibular Rehab is Effective

There is a large body of research today that supports the effectiveness of Vestibular recovery and is used to design successful treatment protocols. Therefore, if you are not getting results from your Vestibular Rehab, then you may be dealing with one of the barriers to vestibular recovery that I listed above.

You may want to discuss the list of barriers in this blog with your physical therapist, or seek a second opinion from a more experienced Vestibular provider.


This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

Accessibility Toolbar