Why Vestibular Rehabilitation?

Traditional (general) physical therapy will not be very effective for people who need vestibular rehab. Vestibular Rehabilitation is a sub-specialty within the physical therapy profession. 

Vestibular physical therapy, also called Vestibular Rehabilitation or vestibular rehab, is effective for recovery from BPPV and Vestibular Neuritis or Labyrinthitis. 

Vestibular Rehabilitation is also helpful with vestibular hypofunction, which causes dizziness, vertigo, and imbalance and can result from:

  1. A past episode of vestibular neuritis (or vestibular labyrinthitis) if that inflammation damaged the inner ear
  2. Reduced blood flow from high blood pressure, high cholesterol, or uncontrolled blood sugars in people with diabetes
  3. And/ or normal aging of the inner ear

The First Goal of Vestibular Rehabilitation

The first goal of Vestibular Rehabilitation Physical therapy treatment is to resolve any BPPV with the particle repositioning maneuvers. 

Other professionals who might also be specially trained to treat BPPV particles with repositioning maneuvers are audiologists, certain types of physicians, and occupational therapists. 

Vestibular rehabilitation physical therapists must make sure that BPPV has either been ruled out or effectively resolved before further Vestibular exercises and balance training can commence as needed.

After BPPV has been ruled out or resolved, then the other vestibular physical therapy techniques can be used. These special vestibular rehab techniques include habituation exercises and multi-sensory balance training.

During the time frame that BPPV is being treated, the vestibular rehabilitation physical therapist may also introduce some substitution strategies to reduce the risk of falling.

Sometimes people do not need any further care after BPPV is resolved because all their symptoms and imbalance clear up immediately. (Love that!)

How else can Vestibular Rehabilitation Help?

Further care would only be needed if they have remaining symptoms of dizziness, imbalance, or unsteadiness after BPPV is resolved. 

For example, once BPPV is resolved, people can have residual imbalance for up to 12 weeks. This is especially common in people who have had BPPV for years because their brain needs to adjust back to their “new normal.” 

The balance training, after BPPV is cleared with vestibular rehabilitation, would improve any residual imbalance. 

They can also have motion-activated symptoms from a conditioned response after BPPV is cleared if they have gotten used to feeling dizzy in certain positions. That is what the habituation exercises are used for – to clear up any leftover motion sensitivity or “motion-activated dizziness.”

Future need for Vestibular Rehabilitation

BPPV can recur (35% recurrence in general population, 50% recurrence in people with migraines) so they should be aware that they might need to seek particle repositioning treatment again if the symptoms recur.

There are other reasons why you may need Vestibular Rehab again as you continue to age, so I definitely recommend seeking out a Vestibular Physical Therapy evaluation if you experience dizziness, vertigo, imbalance, or falls.


This blog is provided for informational 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.

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