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: July 30, 2022

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.

Recent improvements to the process is to use the "VHIT" test to assess the degree to which compensation has occured. (Blodrow et al, 2014)

The following protocol is loosely based on Tee et al, 2005; The "Cawthorne Cooksey" exercises can also be followed.

Goals of VRT

• Increase gaze stability
• Reduce dizziness
• improve postural and gait stability
• improve independence in activities of daily living such as driving and shopping
• Increase cardiovascular conditioning

Procedures

General principles are that the activities should be a little difficult (i.e. provoke some mild dizziness), and also should be practiced in as many contexts (i.e. head positions, directions) as possible. If you do this under the direction of a physical therapist they will "progress" your exercises so they are always a little difficult for you, and also expand the exercises to include more contexts.

Some exercises, that are "unnatural" such as Treadmill walking, Elliptical training, Bicycle riding or swimming, don't train you for the "real world" very well because of what your body learns is often limited to the activity -- you can get really good at, lets say, Treadmill walking while watching TV and moving your head around, but it would be better to be walking outside.

Gaze stabilization exercises.

Gaze Stabilization Exercises -- this is one simple method for horizontal gaze stabization exercises. Follow the link for more methods.

 

Balance and gait training -- follow the link for more details.

 

Physical Conditioning

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

Alternatives: Some avocational activities such as Tai Chi are very good for vestibular rehabilitation. Yoga is also good for balance.

Also see the main page on 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.
• Blodow, A., et al. (2013). "Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders." Auris Nasus Larynx 40(4): 348-351.
• 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.