Finding a provider of Vestibular Rehabilitation Therapy (VRT)

Timothy C. Hain, MD, Professor of Neurology, Otolaryngology, and Physical Therapy/Human Movement Science, Northwestern University Medical School, Chicago IL, USA.

Page last modified: July 30, 2022

Introduction

wild west

Vestibualar rehabilitation treatment (VRT) is an unregulated medical discipline, and there is a "wild wild west" situation. There are lots of options for providers as well as many pitfalls.

Groups that offer VRT include

So which one to choose ? Sorting this out can be complex.

If you think you might need vestibualar rehabilitation therapy (VRT), there are several methods of identifying a suitable person:

Qualifications of Individuals offering vestibular rehabilitation (VRT)

In recent years, at least in Chicago, Illinois, we have seen a gigantic upswing in individuals claiming expertise in the treatment of vertigo. Nearly every week, we get another circular, generally from a physical therapy practice, indicating a willingness to provide exercises to patients in an attempt to improve their balance. These circulars rarely indicate their source of expertise.

Lets take a careful look -- the common training situation for the groups that commonly offer VRT, counting only training post college, are as follows:

Group offering VRT Basic Residency/externship Fellowship Total training (years) and main area of expertise provided by training
Physical therapists and some occupational therapists 3 years Sometimes 1 year   3 (medical, orthopedic)
Audiologists 3 years 1 year   3 ( hearing and hearing aids)
Chiropractor 4 years 1 year internship   5 (orthopedic and spinal manipulation)
Otolaryngologist 4years 5 years 2 years 11 (medical, ear, other parts of head)
Neurologist 4 years 4 years 2 years 10 (medical, brain)

We will focus here on the differences between the non-physician and physician groups who claim expertise in VRT..

Generally speaking, none of the groups listed above get more than "basic" training in VRT in their professional school. Some get no training at all. VRT is a "hands on" activity - -and not something that you can learn solely out of a book. Thus, to be good at VRT, a degree is not enough, and everyone needs to get training.

There are two areas of knowledge needed for safe and effective VRT --

Detailed medical knowledge is mainly the province of physicians, who also have roughly 7 years more medical training than the other groups. None of the groups above are provided with detailed procedural knowledge at present, in their core professional education.

If one considers the dizziness/and balance training opportunities available this is limited to several possibilities:

So to summarize, most individuals who offer VRT, base this on a small amount of basic training given to them during their core education, and 1-3 days of post-graduate education. The providers who do VRT, have diverse amounts of education and understanding of the medical situation, and also varying abilities to troubleshoot problems.

How to determine the qualifications of a VRT provider

We think that the ideal VRT combination is a team including a suitably trained physician (preferably an otologist or neurologist) and a physical therapist. Note that these questions reflect Dr. Hain's biases, and are certainly personal opinions.

There are some that disagree.

Although we strongly favor the team approach, not everyone agrees. In fact, the team approach to patient care has been and is still under vigorous attack from the practice organization for physical therapists, the APTA -- Here, we quote a statement from the American Physical Therapy Association concerning "physician owned physical therapy services", written in 2003.

"Physical therapists (PTs) in private practice across the country are finding themselves confronted with one of the most serious threats they've ever faced. POPTS steal away their patients and virtually eliminate their ability to attract new clients. In many cases it cripples PTs' ability to carry on autonomously." (for full text,see this link to the APTA)

The audiology professional organization, ASHA, has similar comments:. Here we quote from their 2009 goal statement:

"Autonomy for audiologists. Promote audiologists' autonomy through direct patient access and comprehensive coverage of audiology services under Medicare"

What "direct patient access" means, is that audiologists could bill medicare for services to patients who have not been referred by a physician.To us, this seems to be about money for audiologists rather than improving patient care.

We think that there is an intrinsic conflict between autonomy and best patient care. We think that patient care comes first.

Our suggestions for the future

We would like to see VRT provided in a more standard way, by persons who can pass a test that establishes them to be safe and knowledable. Their knowledge should combine relevant medical knowledge as well as procedural knowledge.