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What Can I Expect When I Go To Vestibular Rehabilitation Physical Therapy?

By Larry Grine, PT, MSPT, OCS, ATC, CSCS, CDN | March 20, 2023

The vestibular system plays a crucial role in maintaining our sense of spatial orientation and equilibrium, and damage or dysfunction in this system can lead to symptoms such as vertigo, dizziness, imbalance, a sense of feeling “off”, and nausea. Many patients who experience a vestibular crisis, or episode, can feel very anxious and significantly limited in their ability to do normal activities.


What is Vestibular Rehabilitation Therapy (VRT)?

Vestibular Rehabilitation Therapy is a type of physical therapy that aims to improve the function of the vestibular system, which is the part of the inner ear that helps control balance and eye movements. 

It involves a series of exercises and activities designed to help the brain and body adapt to changes in the vestibular system and improve overall balance and stability. The specific exercises used in vestibular rehabilitation will vary depending on the individual’s symptoms and underlying condition, but may include activities such as:

  • Eye Tracking Exercises – These exercises involve following a moving object with your eyes to improve visual tracking and reduce dizziness.
  • Balance Exercises – These exercises may involve standing on a foam pad or unstable surface while performing different movements to improve balance and stability.
  • Head Movement Exercises – These exercises involve moving the head in different directions to stimulate the vestibular system and reduce dizziness, vertigo, and/or the sensation of being off-balance.



Who Can Benefit from Vestibular Rehabilitation?

Vestibular rehabilitation can be beneficial for people with a wide range of vestibular disorders, including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere’s disease, post-concussion syndrome, a unilateral peripheral vestibular hypofunction, a bilateral vestibular hypofunction, and post-surgical recovery from an acoustic neuroma removal. It is typically performed under the guidance of a trained physical therapist and may take several weeks or months to complete, depending on the severity of the symptoms and the individual’s progress.


What can you expect from Vestibular Rehabilitation Physical Therapy?

If you are undergoing vestibular rehabilitation therapy, here are some things you can generally expect:

Initial Evaluation

Your physical therapist will first conduct a thorough evaluation to assess your vestibular function and identify any specific problems or areas of weakness. This will involve various tests, including assessments of balance, eye movements, head movements, and screening of the patient’s cranial nerves and neurological system.

Tailored Treatment Plan

Based on the results of your evaluation, your therapist will develop a customized treatment plan that includes specific exercises and activities to address your individual needs and goals.  Treatment for BPPV will most likely include:  Canalith Repositioning Maneuvers (Epley Maneuver), eye movement exercises, head movement exercises, and balance exercises.  Treatment for inner ear neurological involvement will include: eye movement exercises, head movement exercises, and balance exercises. 

Regular Therapy Sessions

You will typically attend regular therapy sessions, usually once or twice a week, where you will perform exercises designed to improve your vestibular function and reduce your symptoms. Your therapist will monitor your progress and adjust your treatment plan as needed.  If your diagnosis is benign paroxysmal positional vertigo your treatment sessions may be significantly less if the symptoms have resolved quickly.

Home Exercises

In addition to therapy sessions, you will be given exercises to perform at home to complement your therapy and speed up your progress.  Many exercises used to treat vestibular conditions require frequent and daily exercises to promote the necessary changes in the brain to provide an optimal recovery.  These may include balance exercises, eye tracking exercises, or head movement exercises.

Gradual Progress

Improving vestibular function and reducing symptoms can take time, and progress may be slow at first. However, with regular therapy and consistent effort, you should begin to see improvements over time; usually in several weeks.

Ongoing Maintenance

Even after completing vestibular rehabilitation therapy, you may need to continue certain exercises or make lifestyle adjustments to maintain your vestibular function and prevent symptoms from returning.

Overall, vestibular rehabilitation therapy is a structured, evidence-based approach to improving vestibular function and reducing symptoms related to balance and dizziness disorders. While it can require a significant investment of time and effort, many people find that it is an effective way to regain their quality of life and return to their normal activities.


How is success measured with Vestibular Rehabilitation?

Success with vestibular rehabilitation therapy is typically measured in a number of ways, including:

Reduction in Symptoms

One of the primary goals of vestibular rehabilitation is to reduce symptoms such as dizziness, vertigo, and imbalance. Success can also be measured by a reduction in the frequency, intensity, and duration of these symptoms over the course of treatment.

Improved Balance

Another key goal of vestibular rehabilitation is to improve balance and stability. Success can be measured by improvements in balance tests, such as the Romberg test or the Sensory Organization Test (SOT).

Increased Function

Success can also be measured by improvements in your ability to perform daily activities, such as walking, driving, and working. Many people find that vestibular rehabilitation helps them regain their independence and return to their normal activities.

Patient Specific Functional Scale (PSFS)

Upon beginning physical therapy patients can be given a PSFS form to list activities they specifically are currently not able to do as well as they would like and rate the degree of difficulty for those activities.  Changes and improvement in their ability to perform the specific activities they initially had difficulty with is a good indication of therapeutic change and improvement.

Patient Satisfaction

Success can also be measured by patient satisfaction with the treatment. If you feel that the therapy has helped you achieve your goals and improve your quality of life, that is a strong indication of success.

It’s important to note that success with vestibular rehabilitation can vary depending on the individual and the underlying condition. Some people may experience significant improvements in their symptoms and function, while others may have more modest gains. Your therapist will work with you to set realistic goals and track your progress over time.


What Certifications Or Training Is Required To Perform Vestibular Rehabilitation?

To perform vestibular rehabilitation, a healthcare professional typically needs specialized training and certification. The specific requirements may vary depending on the country or region, but in general, a therapist or healthcare provider who performs vestibular rehabilitation should have:

A Relevant Healthcare Degree

This could include a degree in physical therapy, occupational therapy, or audiology. Additional training in vestibular rehabilitation: A healthcare professional who wants to specialize in vestibular rehabilitation may need to complete additional training or coursework focused on this area.

Clinical Experience

Experience working with patients with vestibular disorders is important for developing the skills needed to provide effective vestibular rehabilitation.


There are several organizations that offer certification programs in vestibular rehabilitation, such as the American Physical Therapy Association (APTA), American Institute of Balance (AIB), Vestibular Disorders Association (VEDA), and also independent educational partners who provide Vestibular educational training courses and seminars.  Certification typically requires completing a certain number of hours of specialized training and passing a certification exam.

In addition to these formal requirements, a healthcare professional who performs vestibular rehabilitation should also have strong communication and interpersonal skills, as well as a patient-centered approach to care. They should be able to work collaboratively with other healthcare providers and be committed to ongoing learning and professional development.


How Do You Find A Qualified Healthcare Provider Who Is Trained To Provide Vestibular Rehabilitation?

Vestibular Disorders Association (VEDA) provides a healthcare provider listing for practitioners who treat Vestibular Disorders and have experience with Vestibular Rehabilitation.


Learn more about how VTFC can help you with Vestibular Rehabilitation Therapy
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About The Authors

Larry Grine, PT, MSPT, OCS, ATC, CSCS, CDN

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