What is Vestibular Rehabilitation Therapy (VRT)?

By Rachel Long PT, DPT

The vestibular (inner ear) system senses change in positions and processes sensory information to control eye movements and balance.  Many people experience dizziness, vertigo and/or disequilibrium that can be caused by a problem with the vestibular system. It is important to recognize that vertigo and dizziness are symptoms (often of an inner ear problem) and are not diagnoses.  Dizziness can also be a symptom of cardiovascular, neurological, metabolic, vision, or psychological problems which is why a thorough examination by a qualified medical professional is necessary to determine the root cause.


 After non-vestibular causes of dizziness can be ruled out, a vestibular assessment can be performed by an ENT, neurologist, or physical therapist that is specialized in vestibular therapy. A thorough history is obtained which gives good insight about the individual’s potential diagnosis.  There are 3 systems that contribute to balance: visual system, vestibular system, and proprioceptive system (sense of where your body is in space).   Eye movements are observed using specialized infrared goggles that put the patient in the dark but allow the therapist to visualize the eye.  Certain eye movements are not observable (or difficult to see with the naked eye) until fixation is blocked.  The infrared goggles are an essential diagnostic tool that can provide the most accurate diagnosis to guide treatment.  Eye movements are also observed with particular head movements and position changes. A series of balance assessments are also performed as a part of the vestibular examination. 

Once a vestibular diagnosis has been made, a patient may be an appropriate candidate for vestibular rehabilitation therapy (VRT).  VRT is an evidenced based program utilizing exercises or positioning techniques for eliminating or significantly reducing vertigo, dizziness, imbalance, and visual problems.

Diagnoses treated with VRT:

  • BPPV (benign paroxysmal positional vertigo)
  • Unilateral or bilateral vestibular hypofunction
    • Can be associated with Meniere’s disease, labyrinthitis and vestibular neuritis
  • Concussions
  • Neck related dizziness
  • Vestibular migraines
  • Persistent Postural-Perceptual Dizziness (3PD)

Treatment Techniques:

  • Canalith Repositioning Maneuver
    • Involves the therapist taking the patient through a series of head and body movements to reposition otoconia or “crystals” in the inner ear
    • Rates of resolution are well into the 90% range within 1-3 treatments (Parnes LS, et al. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003 169(7):681-693)
  • Exercise Program with an emphasis on repetition at home.   
    • Gaze stability exercises (keeping the eyes stable with head movements)
    • Oculomotor exercises (used in concussion or other central disorders)
    • Static and dynamic balance
    • Self-positioning techniques for BPPV
    • Habituation exercises (repeated exposure to stimuli causing dizziness)
  • Manual Therapy
    • To address cervical dysfunction, if indicated

If you are suffering from dizziness, vertigo, or imbalance, you should be assessed and treated (if indicated) by a Physical Therapist that is specialized in vestibular rehabilitation therapy.  Let us help you stop spinning and start living your best life.  Contact Lifeline Therapy today!

Our Vestibular Physical Therapist, Dr. Rachel Long, PT, DPT has over 10 years experience in vestibular rehabilitation therapy.  She obtained her APTA recognized vestibular competency in 2011 and continues to expand her skills and knowledge through continuing education and clinical experience.    


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