Physiotherapy for Vestibular Rehabilitation

Vestibular rehabilitation is a specialty area of physiotherapy that helps address the various problems caused by vestibular or inner ear disorders. Vestibular physiotherapists have done extra training about how the vestibular system works and approaches to assess and treat the multitude of different vestibular problems that can occur. Some vestibular problems can cause permanent deficits and therapy is designed to help your brain make neuroplastic changes (wire new connections) to adapt or compensate for the damage. Practice and repetition is crucial to drive neuroplasticity.

Therapy may take a variety of forms:

Gaze stabilisation exercises are used to improve the control of eye movements while the head is moving. These are particularly useful if something has made one of your vestibular systems weak. Exercises involve looking at a target and moving your head while keeping eyes still on the target. The speed of the head movement is increased as the exercise gets easier.

Habituation exercises are used to reduce your sensitivity to particular movements and environments. These involve repeated controlled exposure to stimuli that would usually provoke your dizziness so your brain can get used to it. Habituation may involve head movements, walking and moving, ball games and skills, or watching videos of moving environments.

Balance retraining is personalised to you from balance testing and your posturography results if we did that test. We assess your balance in terms of the different sensory inputs for balance: somatosensory from the feet and joints, vision from the eyes and vestibular from the inner ear. The brain should take all these inputs and integrate them with your balance responses to keep you upright and steady. Balance retraining can involve exercises with changing foot positions, changing surfaces, and also incorporate head and body movements.

Positional treatments may be used if you have Benign Positional Paroxysmal Vertigo (BPPV). This will usually be managed via the appropriate repositioning manoeuvre for which canal is affected. We will endeavour to teach you how to manage BPPV yourself if it is safe for you to do so.

Your therapy program will be personalised to your needs and may include elements from all of the above or different exercises if required. Sometimes we will refer you on if your problem is better addressed by a different sort of physiotherapist, such as a musculoskeletal physiotherapist if there are spinal or other muscle/joint problems.