Vestibular Rehabilitation Therapy

Vestibular rehabilitation is treatment for dizziness and vertigo, and for the loss of balance that often comes with them. It is not only for concussion: vestibular symptoms are not always part of a concussion, and most of the dizziness we treat has another cause. Dizziness can be sudden or long-standing, and it can come from the inner ear, from the brain, or from how the body and brain are handling movement.

Inner-ear (peripheral) disorders

These involve the inner ear or the vestibular nerve. The most common sudden cause is BPPV (benign paroxysmal positional vertigo), where crystals in the inner ear shift out of place and set off brief, intense spells of vertigo when you roll over, lie down or look up. We treat it with repositioning manoeuvres, a set series of head and body positions that guide the crystals back where they belong, and it often settles within a visit or two. Other inner-ear causes include vestibular neuritis, labyrinthitis, Ménière's disease and vestibular hypofunction, which we treat with gaze and balance exercises matched to the tests.

Central disorders

These involve the brainstem, the cerebellum or the brain's balance pathways: stroke, vestibular migraine, multiple sclerosis and other neurological conditions. They need a thorough assessment and a rehabilitation plan, and if they have not been diagnosed, a referral to your doctor or the emergency department first.

Functional and other causes

Dizziness after a concussion, dizziness from the neck (cervicogenic dizziness), motion sickness, visually induced dizziness and persistent postural-perceptual dizziness (PPPD) are treated with exercises matched to what sets them off. Every concussion assessment here includes a vestibular, eye-movement and neck screen, and your physiotherapist prescribes neck and vestibular exercises when the screen calls for them.

What to expect

We start with what the dizziness feels like, what brings it on and how it started, then test your balance, your eye movements with your head still and moving, your response to changes of position, and your neck. Treatment is mostly exercise: repositioning manoeuvres for BPPV, gaze and balance retraining, short repeated doses of the movements that set you off, and treatment of the neck when it is involved. If your symptoms do not fit an inner-ear, balance or neck pattern, we ask you to see a doctor or nurse practitioner.