Vestibular Balance Rehabilitation

Each year over 10 million people visit a physician due to dizziness. A common cause of dizziness and balance problems is associated with the vestibular system. The vestibular system is part of the inner ear and brain. It helps control balance and coordinate eye movements. Vestibular rehabilitation addresses dizziness and impaired balance caused by diseases or injuries affecting the vestibular or inner ear balance system.

The Saint Luke’s Vestibular Balance Rehabilitation team consists of therapists with specialized training in treating vestibular and balance disorders. Our team has many years of experience working to improve the lives of patients with these disorders. The therapists will work closely with you—and with your doctors— to provide comprehensive and coordinated care.

About the Vestibular Balance Rehabilitation Program

Vestibular rehabilitation addresses dizziness and impaired balance caused by diseases or injuries affecting the vestibular or inner ear balance system. It is an exercise based program developed by physical therapists specially trained to assess and treat vestibular disorders. The physical therapist will evaluate several aspects of overall balance function, including oculomotor function and response to position changes.

Based on diagnosis, treatment options include:

  • Manual repositioning maneuvers for BPPV
  • Balance and gait training focused on proper integration of balance strategies
  • Motion tolerance exercises for dizziness
  • Gaze stabilization and visual eye movement training
  • Computerized analysis of sensory and motor integration for the balance system
  • Individualized home exercise program instruction and progression
  • Strength, flexibility, and endurance training

An individualized program will be designed to address your specific deficits. Treatments are typically one to two times a week for six to eight weeks. This varies based on diagnosis and response to treatment. Some patients will only need to be seen for three or less total treatments.

Our program features the Neurocom SMART Balance Master System. This state-of-the-art sensory and motor training system provides objective data for retraining balance control. The therapists use this information to design an effective training program focused on your functional limitations.

The Neurocom SMART Balance Master System
The Neurocom SMART Balance Master System

What is vestibular balance disorder?

Dizziness and a spinning sensation (vertigo) are symptoms of a vestibular balance disorder. Balance disorders can occur at any age. But they are most common as you get older.

Your ear is a complex system of bone and cartilage. Within it is a network of canals. These are called semicircular canals. The canals are filled with fluid. The position of the fluid changes with movement. A sensor in the ear then sends the information to your brain to add to your sense of balance. These and other delicate pieces make up the vestibular system.

Certain things can affect the signals from any of the parts of the vestibular system, causing symptoms.

What causes vestibular balance disorders?

Common causes of vestibular balance disorders include:

  • Medicines
  • Infection of the middle ear
  • Inner ear problems, such as poor circulation in the ear
  • Calcium debris in your semicircular canals
  • Problems rooted in your brain, such as traumatic brain injury

What are the symptoms of vestibular balance disorders?

The symptoms of a vestibular balance disorder include:

  • Dizziness
  • Feeling off-balance
  • Feeling as if you are floating or as if the world is spinning
  • Blurred vision
  • Disorientation
  • Falling or stumbling

Less common symptoms include:

  • Nausea
  • Diarrhea
  • Vomiting
  • Anxiety
  • Fear
  • Changes in your heart's rhythm

How is a vestibular balance disorder diagnosed?

You may need to work with an ear, nose, and throat specialist (ENT or otolaryngologist). Many conditions can make you feel dizzy and lightheaded. Part of the diagnosis may include ruling out other causes. After your health history is reviewed, you may need the following tests:

  • Hearing exam
  • Vision exam
  • Blood tests
  • Imaging tests of the head and brain
  • Clinical tests of balance
  • Look at your posture and movement, using a structured exam called a posturography
  • ENG (electronystagmography) and VNG (videonystagmography). These are tests that record eye movements. They can help your healthcare provider find the cause of your disorder. Your vision system is a major part of your sense of balance. The ENG uses electrodes to watch eye movement. The VNG uses video cameras.

How is a vestibular balance disorder treated?

Treatment will depend on the cause of your balance disorder and may include:

  • Treating any underlying causes. Depending on the cause, you may need antibiotics or antifungal treatments. These can treat ear infections that are causing your balance disorder.
  • Changes in lifestyle. You may be able to ease some symptoms with changes in diet and activity. This includes quitting smoking or staying away from nicotine.
  • Epley maneuver (canalith repositioning maneuvers). These are a specialized series of head and chest movements. The goal is to reposition particles in your semicircular canals so that they don’t set off symptoms.
  • Surgery. When medicine and other therapies can't control your symptoms, you may need surgery. The procedure depends on the underlying cause of the disorder. The goal is to stabilize and fix inner ear function.
  • Rehabilitation. If you struggle with vestibular balance disorders, you may need vestibular rehabilitation or balance retraining therapy. This helps you move through your day safely. A rehab specialist will help you learn how to cope with dizziness in your daily life. You may need to learn better safety strategies and make adjustments for:
    • Going up and down stairs
    • Driving (ask your healthcare provider when it will be safe for you to drive)
    • Walking, bending over, and exercising
    • Using the bathroom
    • Organizing your home to make it safer, such as tightening handrails
    • Changing your shoes or clothing, such as wearing low-heeled shoes
    • Changing your daily habits, such as planning your day so that you won't be walking in the dark
    • Learning how to use a cane or walker 

What are possible complications of vestibular balance disorders?

Possible complications include:

  • Injury from falling 
  • Anxiety and depression
  • Reduced quality of life
  • Discomfort

Living with a vestibular balance disorder

The symptoms of vestibular balance disorder can interfere with regular daily activities and your ability to drive, work, or enjoy recreation activities. This can cause depression and frustration. Counseling can help you learn to cope with the disorder and how it affects your lifestyle.

When should I call my healthcare provider?

Most people have felt lightheaded or dizzy once in a while. But call your healthcare provider if these sensations get worse, happen often, or affect your quality of life.

Key points about vestibular balance disorders

  • Vestibular balance disorders can affect your balance and make you feel disoriented.
  • Common causes include inner ear problems, medicines, infections, and traumatic brain injury.
  • These disorders can occur at any age. But they are most common as you get older.
  • Treatment depends on the underlying cause and can include medicine, rehabilitation, and lifestyle changes.  You may need surgery for symptoms that don't go away with other treatments.
  • Talk with your healthcare provider if you have symptoms of vertigo, dizziness, or hearing changes. These can mean you have a vestibular balance disorder.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.