Everything You Need to Know About Vestibular Therapy
Have you been feeling vertigo with rolling over, getting into bed or getting out of bed?
Have you had a sudden onset of dizziness and aren’t really sure who you should see about it?
Have you been told to do the Epley maneuver at home to treat vertigo by family, a friend, or your doctor but it hasn’t helped you to feel any better?
Maybe you’ve had someone tell you to see a vestibular physiotherapist so you want to know what is vestibular therapy and how to find a vestibular therapist near me?
This blog will go over what you need to know about vestibular therapy so that you feel confident reaching out to a vestibular therapist for help and what to expect when you get there!
I’ll cover the following topics:
What is vestibular therapy?
Vestibular therapy is known by a few names: vestibular rehabilitation, vestibular rehabilitation therapy (VRT), and vestibular physiotherapy. It is an area of rehabilitation that focuses on the assessment and treatment of many different diagnoses that lead to vertigo, dizziness, and balance disorders.
Depending on the condition being addressed, vestibular therapy could include:
treatment maneuvers to help resolve the condition present (in the case of benign paroxysmal positional vertigo)
manual therapy techniques (in the case of cervicogenic dizziness or post-concussion treatment)
an exercise program focused on addressing balance deficits, movement sensitivity (habituation), and/or retraining to improve function (adaptation)
What is a vestibular therapist?
A vestibular therapist is a healthcare provider that has taken additional training to learn about the assessment and treatment of peripheral vestibular (inner ear) disorders and central vestibular conditions (aka vestibular rehabilitation). Vestibular therapists (including vestibular physiotherapists) are skilled at taking the findings from a vestibular therapy assessment and using this to diagnose what is going on. They’ll work with you to get a plan together for the next best steps in helping you feel better.
Please note there are no minimum educational requirements for a healthcare provider to call themselves a vestibular therapist. When booking in with a vestibular therapist it is important to inquire about their training and how long they have been providing vestibular therapy services for especially if you’ve been having very complex symptoms.
At Wave Physiotherapy, Sharon-anne Graham is a vestibular physiotherapist that has been working with the vestibular population for over 7 years and has taken additional training in vestibular rehabilitation. Learn more about Sharon-anne.
What exactly is the vestibular system?
Typically when the vestibular system is mentioned most people are talking about the vestibulocochlear organ (aka the inner ear, labyrinth or peripheral vestibular system). The vestibulocochlear organ is located in the temporal bone and is made up of two parts: the hearing organ (the cochlea) and the vestibular organ (the semicircular canals and the vestibule). Each portion of the labyrinth has its own nerve output (aka the cochlear nerve and the vestibular nerve) which send information to the brain.
The vestibular organ has two types of sensors:
three semi-circular canals (anterior, posterior and horizontal) that sense rotational movement of the head
two otolithic organs (utricle and saccule) that sense linear movement of the head & gravitational forces
These sensors are unique in that they pick up when we are speeding up and slowing down (acceleration) but are at rest when we are still and when we are moving at a constant speed.
Information from the peripheral vestibular system is processed in numerous locations throughout the brain and this is considered the central vestibular system.
For more information on the peripheral nervous system check out this great article from VeDA.
How can I find a vestibular therapist near me?
If you’re looking for a vestibular therapist to see in person and you’re not local to Toronto, ON, a great resource for finding a healthcare practitioner is the Vestibular Disorders Association (VeDA) healthcare provider directory. The VeDA website also has a lot of great resources prepared by experts in the field, so be sure to check them out!
If you’re looking for a vestibular physiotherapist located in Toronto or the surrounding Greater Toronto Area, I would love to work with you at Wave Physiotherapy. You can learn more about me or even book a free consult call to see if working together would be a good fit!
If you’re looking for virtual vestibular physiotherapy care, I also provide online vestibular therapy appointments in Ontario. I would love to speak with you more about your needs, so don’t hesitate to reach out.
What are the common symptoms of a vestibular condition?
Each person with a vestibular condition will have a unique set of symptoms that they experience. Common symptoms the folks I see in my balance and dizziness clinic tell me about are:
A sense of spinning (vertigo). This may happen with moving in bed, position changes, or even happen when they are still.
Feeling you are moving relative to your environment at rest or during movement. This is often described as a feeling of rocking, swaying or shifting, or even feeling like you are on a boat.
Loss of balance with tasks you used to do without any issues issue. This may include putting on your socks and shoes, getting dressed without sitting down, having to reach for high or low targets, or washing your hair. Some people even tell me they’ve had multiple falls or trip while they are walking.
Headache, migraine, feeling lightheaded or feeling heavy headed
Eye (ocular) symptoms: eye fatigue, eye strain, light sensitivity, blurry, fuzzy or double vision, seeing things moving/bouncing in your vision, or even feeling like your eyes are moving
Ear (aural) symptoms: tinnitus (hearing ringing, buzzing, whooshing noises), ear pressure, ear pain, or ear fullness
Feeling like you could pass out
Nausea, vomiting, and digestive upset (including diarrhea and constipation).
Hot flashes, cold flashes, sweating, increased heart rate (heart racing), and increased respiration rate (feeling short of breath, shallow breathing or faster breathing rate).
Please note this is not an exhaustive list and you may have symptoms that are not listed above!
Who benefits from vestibular therapy?
Information from our inner ear is used along with information from our eyes (visual system) and skin, muscle and joint sensors (proprioceptive system) to give an accurate picture of where you are in space and maintain your balance. When the vestibular system isn’t working as it should, it can lead to the symptoms above and also make it difficult for you to keep your balance when you are still and moving. This can lead to an increased risk of falls, and more falls lead to an increased risk of other injuries.
Anyone experiencing symptoms of dizziness, vertigo, motion sensitivity, trouble with keeping their vision clear during movement, trouble with balance, and other symptoms listed above would benefit from a vestibular therapy consultation to see what may be causing their symptoms. Vestibular therapy treatment provides a way to address these symptoms in a conservative and holistic way. In most cases, prescribed medications are not needed to assist with your recovery.
Should any concerns be identified while in for vestibular therapy sessions, this will be relayed to your family doctor and/or referring specialist to ensure further testing and referrals are made.
What diagnoses are treated with vestibular therapy?
Vestibular therapy helps to reduce (and in many cases fully resolve) the symptoms you are experiencing due to a vestibular condition. Common vestibular diagnoses that are treated with vestibular therapy include:
Benign paroxysmal positional vertigo (BPPV)
Meniere’s disease
Enlarged aquaduct syndrome
Vestibular neuritis
Vestibular labyrinthitis
Mal deDebarquement syndrome (MdDS)
Vestibular migraine
Cervicogenic dizziness
Unilateral vestibular loss (UVL) also known as unilateral vestibular weakness or unilateral vestibular hypofunction
Bilateral vestibular loss (BVL) also known as bilateral vestibular weakness or bilateral vestibular hypofunction
Post-concussion syndrome
Sensorineural hearing loss with vestibular dysfunction (dizziness, balance loss, vertigo)
Cochlear implantation with post-surgery vestibular dysfunction (vertigo, balance loss, dizziness)
Visual vertigo (visually-induced dizziness)
At Wave Physiotherapy, I work with all of the vestibular diagnoses listed above. When booking a vestibular therapy appointment it is important to inquire if the treating therapist has experience with the diagnosis that you are seeking help for to ensure that their practice will be the best fit for your needs.
Please know this list is not exhaustive. If you have questions on whether vestibular therapy is appropriate for your specific medical diagnosis you can reach me using the information listed here.
How much does vestibular therapy cost?
At Wave Physiotherapy, vestibular therapy services are provided by Sharon-anne Graham, a registered physiotherapist. She attended Vestibular Rehabilitation: A Competency-Based Course hosted by Duke University and the American Physical Therapy Association (APTA) at the Emory Conference Center and Hotel in Atlanta GA, receiving her Certificate in Vestibular Rehabilitation in 2017. Following this, Sharon-anne has furthered her understanding of vestibular conditions through continuing education activities including journal clubs, conferences, and courses.
In Ontario, vestibular physiotherapy appointments are not covered by OHIP. At Wave Physiotherapy vestibular physiotherapy services for adults cost:
$165 for a 1 hour initial assessment appointment
$95 for a 30 minute treatment appointment
$125 for a 45 minute treatment appointment
The cost of vestibular physiotherapy appointments will vary depending on your location and I recommend calling around to locations that provide these services to get an idea of the expected cost of care.
How many vestibular therapy appointments are needed?
It is common for individuals with BPPV to require 2-4 treatment sessions, and individuals with a recent onset of vestibular neuritis to require vestibular therapy for 6-8 weeks to assist with recovery. That being said, the number of appointments that may be needed varies from individual to individual depending on that person’s symptomology, diagnosis, and pre-existing medical conditions. There are some individuals that require a shorter duration of vestibular therapy treatment and others that require longer.
What happens during a vestibular therapy assessment?
The vestibular therapy assessment is made up of a few components and each provides valuable insight into what’s causing the symptoms that you’ve been experiencing. Depending on the complexity of your symptoms and how you feel during the session, the assessment may need to be completed in more than one session.
The assessment session will be individualized for each person and may contain the following:
An in-depth review of your medical history: We’ll talk about your current symptoms and past medical history to get an idea of your overall health and potential pre-existing vestibular health issues. You’ll be asked questions to assist with ruling out specific diagnoses and to identify what may be useful to track to determine the results of treatment.
Movement screening of the head and neck: I’ll have you move your head and neck to assess the effect this has on your symptoms. You may be asked to hold or repeat a position to see if symptoms change in any way and you’ll be monitored closely during this.
Movement screening of the eyes: I’ll have you move your eyes during specific tests so I can see the effect this has on your symptoms. You may be asked to hold a position or repeat a test to see if symptoms change in any way and you’ll be monitored closely during this.
Specific testing of the vestibular system in room light conditions: Testing in room light conditions will involve moving the head and neck at slower and faster speeds with the eyes focused on a target to test the function of the vestibular system.
Testing of the vestibular system with infrared goggles: Video frenzel (aka infrared goggles) allow me to get a closeup video of the eye while your vision is removed. During this portion of the testing, I’ll have you move your eyes on camera, move the head and neck, and move into a few different positions to see what happens on camera. Testing may be symptom provoking so we’ll take everything at your pace and include breaks as you need them.
Balance testing: Depending on the results of testing so far, I may have you try a few different balance tests. This may include standing on a soft foam pad, closing the eyes, standing with one foot ahead of the other (tandem stance), and standing on one foot (single leg stance).
Gait testing: Walking (gait) tests allow me to test your dynamic balance and see your comfort with movement. Tests may include walking with the head to one side, looking up or down, looking side to side, turning on the spot, and placing the feet one ahead of the other (tandem gait).
I’ll take the information gathered during the physical vestibular assessment along with your history to identify what vestibular diagnosis is present so that you can be informed on your treatment options. We’ll discuss the best plan of care going forward and any follow-up questions you may have.
What is done for vestibular therapy treatment?
Vestibular therapy treatment sessions vary based on what is being treated and the symptoms that you’re experiencing. It’s common for most vestibular disorders to have an active home program that you’re working on regularly during your week. Treatment varies based on each person’s individual presentation.
Even if your symptoms are similar to those of a friend or family member, what helped them may not be what you need to feel better. Treatment recommendations are based on the results of the assessment session and what your goals with treatment are to ensure an individualized approach to care.
Treating BPPV with canalith repositioning maneuvers and canalith liberatory maneuvers
If benign positional paroxysmal vertigo (BPPV) is identified during the assessment session maneuvers will be used to help move the displaced inner ear crystals (otoconia) out of the semicircular canals. Getting these crystals out of the canals resolves the cause of your vertigo.
Common treatment techniques used in the clinic to resolve BPPV are:
Epley maneuver
Semont maneuver
BBQ roll maneuver (also known as the Lempert, Barbeque or Barbecue maneuver)
It is common to experience vertigo during these maneuvers as the source of your symptoms is being treated. Some people experience post-treatment symptoms including nausea, headache, and even dizziness, so I recommend you have a quiet day planned after BPPV treatment in case you need recovery time.
Vestibular therapy exercises
When your symptoms aren’t being caused by BPPV it’s common to be given a vestibular physiotherapy exercise program to work on at home. Click here for a list of diagnoses treated with vestibular rehabilitation. In many cases, a person with a vestibular disorder does not have full recovery of the inner ear. The goal with vestibular therapy is to retrain your brain to interpret information from the inner ear and use this along with information from your visual and proprioceptive (sensors in your muscles, joints, and skin) systems to help you recover function and get back to what you love again.
Your vestibular therapist will use your assessment findings and the activities that you’re having issues with to design a program that’s individualized to meet your needs. Vestibular therapy exercises typically focus on:
Decreasing motion and positional sensitivity with habituation exercises
Improving your ability to keep your eyes fixed on a target (gaze stability) while you are stationary and moving
Addressing balance and gait (walking) difficulties
Read more about the different types of vestibular therapy exercises (coming soon).
Do you have any resources that may help someone with a vestibular disorder?
Yes, there is a Wave Physiotherapy blog that has a number of articles written for the vestibular dysfunction population! Here are some of the more popular topics that I cover:
Additionally, I recommend checking out the articles at VeDA. They’re well-written and provide a lot of valuable information!
Updated: December 5, 2023
