In this blog, I share the Key Points about Vestibular Rehab proven by research and found in the medical literature.

Vocabulary: Vestibular Rehab is short for Vestibular Rehabilitation. It is specialized physical therapy for the inner ear balance system, or the vestibular system. Exercises can include training for the inner ear, the brain, the sense of touch, the balance reflexes and the focus of your attention.

Vestibular Rehab: What You Need to Know

Key Point #1:

Undiagnosed Vestibular Problems (inner ear problems) can cause falls, even if they aren’t bad enough to cause complaints of dizziness or vertigo. One epidemiological study found that:

• One out of three US adults over 40 years old had a Vestibular Deficit upon clinical exam, with or without complaints of dizziness or vertigo.
• Dizziness in US adults over 40 years old had 12 times increased risk of falling within a year.
• Patients with sub-clinical vestibular dysfunction still had 6 times increased risk of falling but did not have complaints of dizziness.
• Sub-clinical means they are not actively complaining of dizziness or vertigo, but show a vestibular deficit when examined.

Most of these things can be improved or resolved with a proper vestibular rehab treatment.

Key Point #2:

All Older Adults should be Screened for BPPV during a Physical Therapy Clinical Exam due to Normal Aging of Vestibular System and high rates of falls in the elderly.

One study recommended: “Even if the older adult physical therapy patient does not present with a vestibular diagnosis or complaints consistent with it, it is recommended that the older adult always be assessed for BPPV during the clinical examination because of its prevalence.” (Oghalai, 2000). 

Sadly, this is not happening for all older adults who are seen in physical therapy on a routine basis.

Key Point #3:

Specialized Physical Therapy, called Vestibular Rehab, is Recommended prior to Diagnostic Testing for people with dizziness and vertigo, due to the success rates.

Evidence-based BPPV Clinical Practice Guidelines published by the American Academy of Otolaryngology recommend a referral to a Vestibular Specialist for BPPV evaluation and treatment, prior to diagnostic testing for patients with vertigo and dizziness due to the prevalence of BPPV and the success rate of this conservative approach. (BPPV Guidelines, revised in 2017)

Key Point #4:

Vestibular Rehab improves balance even in people without Vestibular Problems.

Researchers have shown that balance and fall risk will improve with exercises to strengthen the vestibular system EVEN IN THE ABSENCE of a specific vestibular dysfunction. (Research findings by Courtney Hall, et al.)

Key Point #5:

There is a strong body of evidence supporting vestibular rehab physical therapy and its success for people with dizziness, vertigo, imbalance or chronic falls. Therefore, a consultation with a Vestibular Physical Therapist is HIGHLY recommended for anyone with dizziness, vertigo, imbalance or unexplained repeated falls.

You can find a Vestibular Specialist in your geographical area using the Provider Directory at the Vestibular Disorders Association.  Be sure to find someone who claims they can perform “particle repositioning maneuvers,” which are required to resolve the most common vestibular disorder, BPPV.

Sometimes, people need 6-8 weeks of Vestibular Rehab Exercises after BPPV symptoms are ruled out or resolved for a full recovery, depending on the root cause of symptoms.