Vestibular rehabilitation

Vestibular rehabilitation exercises are useful for patients with vestibular hypofunction, particularly when one sided. Typical symptoms of a unilateral vestibular hypofunction are a general unsteadiness, tending to veer to one side and the sensation that you get when you come off a boat (Mal de debarquement). Conditions where this is likely to be the case include labyrinthitis/vestibular neuronitis after the acute vertigo where patients feel generally unsteady, and Meniere’s disease between the attack of acute vertigo or once the vertigo has burnt itself out.

These symptoms of a general unsteadiness should not be treated with betahistine or prochlorperazine. Other medication such as sedatives and alcohol can also contribute to these symptoms and should be avoided if possible. In cases where the dizziness is multi-factorial it is still worth trying vestibular rehabilitation exercises if there is felt to be a significant vestibular component although the overall benefit will be less.

Vestibular rehabilitation exercises are NOT helpful for acute vertigo such as BPPV. BPPV should either be treated with the Epley manoeuvre or Brandt-Darrof exercises.

The gold standard for vestibular rehabilitation is physiotherapy led vestibular rehabilitation, but this is resource intensive and not always readily available.

Patients can be given the following information sheets on vestibular rehabilitation

Balance training

Controlling your balance symptoms.

Vestibular rehabilitation works by helping the contra-lateral vestibular system and the central pathways compensate for the vestibular hypofunction in the affected ear. It is common for the exercises to make patients feel dizzy at the time and this can even be considered a good sign providing supporting evidence that the problem is a vestibular issue. Baring this in mind it is important to emphasise the importance to patients of making sure that they are safe doing the exercises and do not put themselves at risk of a fall particularly for patients with multi-factorial balance problems.