Vestibular Rehabilitation

Vestibular RehabilitationMost of us take for granted that good balance is essential for daily life, from getting out of bed to crossing the road. A healthy balance system uses information from the brain, inner ears, eyes, and joints, and enables people to see clearly when moving their head. However, dizziness can be incapacitating and deter many activities of daily living. Balance disorders and dizziness are a growing public health concern across all age groups. Prevalence increases with age and these disorders are some of the most common complaints reported to doctors by older patients.(1) Untreated, they result in worsening unsteadiness, loss of confidence and anxiety, difficulty with concentration and memory, inactivity, loss of independence, an increased risk of falls and costly falls-related injuries.(1,2)

What causes dizziness?

The most common type of treatable dizziness is a result of crystals that are dislodged and roam in the semi-circular canals of the inner ear.  This is the mechanical cause of benign positional paroxysmal vertigo (BPPV). This disorder of the inner ear causes episodes of intense dizziness on certain head movements. Other causes include infections of the inner ear, Meniere's Disease, aging of the inner ear, side effects from medication or alcohol, brain disorders such as stroke, concussion or cerebellar degeneration, cardiac problems and anxiety.

How can the dizziness be treated? What is vestibular rehabilitation?

Several of our physiotherapists are specially trained to thoroughly assess and treat conditions such as BPPV and other inner ear dysfunctions which can cause dizziness. We can provide relief through non-invasive treatment techniques that effectively remove dislodged crystals from the semi-circular canals of the inner ear.  Some of the more commonly used specific techniques include the Epley Maneuver, the Body Roll Maneuver, and the Modified Semont Maneuver. These techniques are extremely effective, and some studies indicate that the cure rate is as high as 97% within 3 treatments.

There are also specific home exercises we can give to strengthen the vestibular system for certain dizziness conditions. This process is referred to as vestibular rehabilitation. Some specific exercises we give generally involve movement of the eyes and head, exercises designed to improve strength of the ankles and lower extremities, and balance retraining exercises. There is also a large education component to our vestibular rehabilitation programs. We give advice on activity modification in order to reduce the risk for falling and to help gradually build the patient's confidence and functional level back to normal.


1. Iwasaki S and Yamasoba T, Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System, Aging and Disease vol 6, Number 1, February 2015. doi 10.114336/AD 2014.0128
2. Harun A et al Understanding the Experience of Age-related Vestibular Loss in Older Individuals: a Qualitative Study, Patient 2016 August: 9(4):303-309 doi 10.1007/s40271 – 015 -0156 – 6