The vestibular system is a mammalian sensory system that plays a major role in balance, body position and spatial orientation. Many vestibular problems arise from the middle and inner ear and the peripheral receptor apparatus (commonly known as the vestibular apparatus, but also known as the peripheral vestibular apparatus, peripheral vestibular system or vestibular labyrinth).

The vestibular apparatus a set of sensory organs within the inner ear that converts head motions into neural information. In each ear, it includes the utricle, saccule, and three semicircular canals. When problems arise with the vestibular system, symptoms can include unsteadiness, dizziness, vertigo, hearing and vision problems as well as difficulty with concentration and memory. Patients with vestibular disorders are generally referred to physical therapists equipped to treat these disorders and help restore their balance and other vestibular functions by means of vestibular rehabilitation therapy.

According to Vestibular Disorders Association (VEDA), vestibular rehabilitation therapy (VRT) is an exercise-based program designed to promote central nervous system compensation for inner ear deficits. VRT can help with a variety of vestibular problems, including benign paroxysmal positional vertigo (BPPV) and the unilateral or bilateral vestibular hypofunction (reduced inner ear function on one or both sides) associated with Ménière’s disease, labyrinthitis, and vestibular neuritis. They also indicate that VRT can also help people with an acute or abrupt loss of vestibular function following surgery for vestibular problems.

When a patient comes in for a vestibular rehabilitation therapy consultation, they are thoroughly evaluated, which includes going over his/her medical history, as well as observing and measuring posture, balance and gait and how they compensate for poor balance. This evaluation may include eye-head coordination tests that measure how well a person’s eyes track a moving object with or without head movement and a questionnaire that measures the frequency and severity of symptoms and associated lifestyle changes.

Once the patient is evaluated, the therapist will develop an individualized treatment plan that includes specific, head, body and eye exercises to be performed in the therapy session and at home. These exercises help retrain the brain to recognize and process signals from the vestibular system and coordinate them with information from vision and proprioception.


Treatment may also include a repositioning procedure, commonly referred to as the Epley maneuver, which involves a series of specifically patterned head and trunk movements to move tiny displaced otoliths back to the utricle or to a place in the inner ear where they can’t cause symptoms. Otoliths help orient your body to the effects of motion and gravity. When these tiny crystals move from their normal location, it causes a form of dizziness called benign paroxysmal positional vertigo (BPPV), one of the most common vestibular disorders.

If you are experiencing vertigo, dizziness, headaches, balance problems or other symptoms that you may suspect are related to a vestibular problem, contact us to find out how you can be evaluated and treated.

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