Regain Your Sense of Balance With Balance and Vestibular Rehabilitation

This Kind of Rehab Can Reduce Your Symptoms of Vertigo

Physical therapist working with a patient.
Physical therapist working with a patient. Hero Images / Getty Images

Your sense of balance is associated with normal functioning of the inner ear and the vestibular system. Your inner ear contains a network of passages called the bony labyrinth, which contains our cochlea (associated with our hearing) and our vestibular system (associated with our balance). 

The vestibular system, or apparatus, contains three main parts, including the utricle, saccule, and three semicircular canals.

The system as a whole functions to provide you with the sensation of motion, equilibrium and how you are spatially oriented in your environment. When you have dysfunction with your vestibular system, you will likely suffer from nausea, dizziness, imbalance, headaches, and difficulties with vision.

You may feel like you are sea-sick and suffer from a decrease in quality of life as well as your ability to function properly in your job or other roles. Common disorders associated with balance and vestibular dysfunction include:

Is a Rehabilitation Program the Right Choice For Me?

If you identify with one of these disorders, note that not all balance and vestibular disorders benefit from rehabilitation programs. For example, if you have a perilymph fistula or Meneire's disease, rehabilitation may not have as significant a benefit in treating your symptoms.

In these two instances medical management or surgery is the method of choice for treatment.

On the other hand, disorders such as BPPV, vestibular neuritis and vertigo have shown to have successful rehabilitation programs to help alleviate symptoms and improve your quality of life. The only real restriction is related to if you have visual, somatosensory (sensation of pain, warmth, and pressure) and vestibular impairment.

If you have impairment in all three areas, rehabilitation efforts have been shown to be ineffective. Once you and your physician decide that a rehabilitation program is the best choice for you, you will need to spend time in finding the right center to meet your needs.

Finding the Right Balance and Vestibular Rehabilitation Center

Once you decide to participate in a rehabilitation program, it is important to find a physical or occupational therapist that is trained in vestibular or balance disorders. You may be lucky enough to find someone advertising online in your area with these qualifications, but often you will have to do some leg work and contact the different rehabilitation centers in your area and discuss your needs.

When asking them about their program, you can ask if any of their therapists have are board-certified neurologic clinical specialist (NCS). If they do not, that is not necessarily an indication that they do not have a good program. When asking questions about their program, ask how they target the different goals of rehabilitation for someone with a balance and vestibular disorder.

Goals of Balance and Vestibular Rehabilitation

Your chosen physical or occupational therapist will have several goals that they will need to meet. During the first visit, you will have both subjective and objective assessments that they will need to perform. During the subjective portion, your therapist will ask you detailed questions about what makes your symptoms worse and what improves them. They will be trying to determine whether or not you have a central (related to the brain or nerves) or a peripheral (other causes like inner ear disease). They will also ask questions to determine whether or not you have any impairments or disorders that would obstruct progress with a rehabilitation program.

Following a thorough history, your therapist will perform a functional assessment and develop a plan of care that will achieve the following goals:

  1. improve symptoms related to head or eye movement, mobility and gait
  2. decrease your risk of falling
  3. reduce or eliminate symptoms of vertigo

Balance and Vestibular Rehabilitation Methods

In order to achieve the goals of therapy, you will be introduced to many different techniques based on your symptoms and your related disorder. Exercises such as walking, strengthening, balancing, and situational exercises are all important aspects to your program. It is also particularly important to begin the program as soon as possible, as you will naturally not want to do much physical activity due to your symptoms which can cause you develop other physical impairments.

You will be expected to participate in therapy sessions between 2 to 3 times per week and perform some of the exercises at home 2 to 3 times per day. If, during the exercises at home, you develop symptoms that last longer than 20 to 30 minutes, you should contact your therapist. You will likely be given a modified exercise over the phone to reduce your risk of having symptoms.

If your balance problem is related to inner ear or vestibular dysfunction, your sessions will likely only last up to three months. However, if your disorder is related to your nervous system, the rehabilitation sessions will likely require a longer course of treatment. Remember, its crucial to perform the rehabilitation as prescribed, likely consistently, to achieve the outcome you'd like.

Finally, increasingly more research is being done to enhance the therapy that you can perform at home. Some programs may encourage the use of Tai Chi or Wii Fit as part of their home-based sessions—do your research and find the option that you like best. It's more likely you'll stick to it that way, too.


American Hearing Research Foundation. (2012). Balance and Vestibular Rehabilitation Therapy.

Miller, JL, Schubert, MC & Shephard, NT. (2015). Cummings Otolaryngology: Vestibular and Balance Rehabilitation. 6th ed.

Whitney, SL & Furman, JM. (2008). Ballenger's Otorhinolaryngology Head and Neck Surgery: Vestibular and Balance Rehabilitation. 17th ed. Pages 343-350.

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