Vestibular Rehabilitation Therapy (VRT) for Unilateral Vestibular Loss

This page is intended to be a reference for physical therapists who are providing physical therapy.

Timothy C. Hain, MD Page last modified: May 3, 2011

VRT has been generally shown to be helpful in recovery from unilateral loss, such as for vestibular neuritis or acoustic neuroma (Strupp et al. 1998; Herdman et al. 2003; Krebs et al. 2003; Badke et al. 2004; Cohen et al. 2004; Topuz et al. 2004; Hall et al, 2004; Enticott et al, 2005). An extensive metanalysis was done by the Cochrane Library in 2011, who concluded that VRT is effective for unilateral vestibular damage (Hillier and McDonnell, 2011). This entire document is available online.

The following protocol is loosely based on Tee et al, 2005;

Goals of VRT

Increase gaze stability
Reduce symptoms of dizziness
improve postural and gait stability
improve independence in ADL such as driving and shopping
Increase cardiovascular conditioning

Procedures

Persons with UL will generally improve by themselves given sufficient time, but the process can be sped up by VRT.

Also see the main page on VRT. and Prehab VRT.

References:

Badke, M. B., et al. (2004). "Outcomes after rehabilitation for adults with balance dysfunction." Arch Phys Med Rehabil 85(2): 227-33.
Enticott, J. C., J. O'Leary S, et al. (2005). "Effects of vestibulo-ocular reflex exercises on vestibular compensation after vestibular schwannoma surgery." Otol Neurotol26(2): 265-9.
Fujino A and others. Vestibular training for benign paroxysmal positional vertigo. Arch Otolaryngol HNS 1994:120:497-504.
Hall CD, Schubert MC, Herdman SJ. Prediction of fall risk reduction as measured by dynamic gait index in individuals with unilateral vestibular hypofunction. Otology and Neurotology, 25: 746-751, 2004
Herdman, S. J., et al. (2003). "Recovery of dynamic visual acuity in unilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg 129(8): 819-24.
Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction( Review). The Cochrane Library 2011, issue 2.
Horak FB et al. Effects of vestibular rehabilitation on dizziness and imbalance. Otol HNS 1992:106-175
Jacob RG, Whitney SL, Detweilder A, Shostak G, Furman JM. Vestibular rehabilitation for patients with agoraphobia and vestibular dysfunction: A pilot study. Anxiety Disorders 15(2001) 131-146.
Strupp, M., et al. (1998). "Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis." Neurology 51(3): 838-44.
Tee LH, Chee NWC. Vestibular rehabilitation for the Dizzy Patient. Ann Acad Med Singapore 2005:34:289-94
Topuz, O., et al. (2004). "Efficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction." Clin Rehabil 18(1): 76-83.

Vestibular Rehabilitation (VRT)