Vestibuläre Reha
Vestibular rehabilitation therapy
For reasons of readability, the generic masculine form is used and the simultaneous use of the male, female, and diverse (m/f/d) forms is omitted. Unless otherwise specified, the personal designations used in this patient information refer to all genders.
Most people benefit from movement therapy for balance disorders and dizziness. However, vestibular rehabilitation does not help with acute, active, recurrent, spontaneous attacks of vertigo - e.g. acute vestibular migraine or the early stages of Meniere's disease - because the brain cannot adapt to the changing nature of these disorders.
Summary
- Vestibular rehabilitation is an evidence-based and effective therapy for dizziness
- Vestibular rehabilitation strengthens the connection between the body, eyes, inner ear and brain.
- Symptoms are deliberately provoked in a safe and controlled environment to get the brain used to them.
- Goal: Improvement of quality of life, reduction of symptoms, improvement of overall function.
- Individually adapted rehabilitation programs are the most effective.
- The type, frequency and intensity of the exercises vary from person to person.
What is vestibular rehabilitation therapy?
Vestibular rehabilitation helps most patients by strengthening the connection between the body, eyes, inner ear, and brain. During vestibular rehabilitation, your symptoms are deliberately provoked in a safe and controlled way so that your brain can adapt to them. The overall goal is to improve your quality of life by helping you adapt to your disorder, reduce your symptoms, and improve your overall function. Research shows that rehabilitation programs are most effective when they are individually tailored. Therefore, apps and exercise brochures handed out by doctors or clinics, which are not personalized, are not very useful. The type, frequency, and intensity of effective exercises vary from person to person.
Which therapists carry out vestibular rehabilitation therapy?
Physiotherapists and occupational therapists can specialize in the assessment and treatment of vestibular disorders through intensive further training. The title 'vertigo and vestibular therapist' is not a regulated professional title in the DACH and BENELUX regions and vestibular rehabilitation is a specialized field..
The quality and quantity of training courses vary greatly and range from 1 to 2-day 'introductory' or online courses without practical exercises to more intensive competency-based courses with examinations. For example, the IVRT® training is 4 days, competency-based, with an exam and requires its specialized IVRT® dizziness and vestibular therapists to participate in refresher courses and advanced courses. The quality of the lecturers also varies greatly. While our lead lecturer has been working on the topic on a daily basis since 2012 and is a member of the renowned Bárány Society, there are unfortunately also lecturers who have only recently attended a course themselves or even just an online course without any practical practice.
You should therefore make sure to find out whether, and how well, the therapist is truly familiar with your type of disorder.
Reimbursement for vestibular rehabilitation varies greatly among health insurance providers in the DACH and Benelux regions. In Germany, Switzerland, and Belgium, costs are fully or largely covered by health insurance with a doctor’s prescription. In the Netherlands, coverage is often limited in the basic insurance package, so an additional insurance policy is needed for full reimbursement of physiotherapy. In Austria, the system is quite different: patients usually pay for therapy themselves or receive only a small reimbursement from health insurance. Of course, in Germany, Switzerland, and Belgium there are also therapists who do not work with health insurance providers and set their own conditions. Therefore, it is important to find out exactly how billing and reimbursement work in your country and with the therapist you choose.
The first visit includes a comprehensive examination that allows the therapist to design an appropriate rehabilitation program. Some dizziness and vestibular therapists use special goggles to carry out a more detailed examination.
Search our IVRT® therapist search for certified therapists with advanced training in vestibular rehabilitation.
The exercises should only cause a slight to moderate increase in dizziness for a few seconds. This short-term slight increase in symptoms helps the brain to make permanent changes to reduce dizziness in the long term. Gradually, your brain will adapt to the stimuli.
You have to be careful not to overdo it. It is not helpful to suppress your symptoms. Inform your therapist if you feel nauseous during the exercises, if you get a headache or if your symptoms do not return to their original level within 15-20 minutes. Your therapist will modify the exercises to make sure you tolerate them better. If you are doing an exercise and have no problems, the therapist will make your exercises more difficult.
Vestibular rehabilitation and balance exercises do not normally need to be continued indefinitely. Patients are advised to set goals for their rehabilitation program with their vestibular therapist . Once these goals have been achieved, a 'maintenance plan' can be drawn up. This involves finding a physical activity that is suitable for you and that continues to sufficiently stimulate and challenge the vestibular system. However, keep the exercises in mind in case the symptoms return.
If you do not notice any improvement despite ongoing vestibular rehabilitation and balance exercises, it may be that you have reached your limit (e.g. bilateraler Vestibulopathie) or your brain is not adapting adequately (see PPPD / Persistent Postural-Perceptual Dizziness).
Examples of vestibular rehabilitation exercises
Vestibular rehabilitation is tailored to your specific condition and symptoms. Some exercises are specific, for example, to reduce symptoms to certain movements or visual stimuli. Other exercises may relate to improving your participation in self-care, household chores, leisure activities, sports, driving or work.
A vestibular rehabilitation program may include the following:
- Eye-head coordination exercises
They help to coordinate the vestibulo-ocular reflex (VOR). A well-functioning VOR enables you to keep visual targets in view even when your head is moving. There are several types of eye-head coordination exercises. - Balance training
- Exercises to restore balance: These exercises are performed on different surfaces and with progressively narrower supports. They are helpful to improve stability and gait in activities of daily living and reduce the risk of falling.
o Balance exercises with eyes closed: These exercises help to reduce dependence on the eyes by 'forcing' the vestibular system to use more vestibular information.
o Walking training
For example, walking and moving the head, both on firm and unstable ground.
- Exercises to restore balance: These exercises are performed on different surfaces and with progressively narrower supports. They are helpful to improve stability and gait in activities of daily living and reduce the risk of falling.
- Habituation exercises
They serve to 'desensitize' the hypersensitivity of the nervous system. They help your brain to become accustomed to movements or situations that trigger dizziness in you. This is done through repeated, controlled exposure to the stimuli that trigger dizziness in you. - Learn and practise strategies
These will help you to deal with or avoid your symptoms. - Breathing and relaxation exercises
These exercises help to regulate the autonomic nervous system (the part of the nervous system that controls important involuntary functions).
What else can I do?
I don't have the opportunity to see a therapist - what can I do at home?
Vestibular rehabilitation and balance training are most effective when you follow a series of exercises tailored to your specific needs by a therapist. That's why we highly recommend our certified IVRT® therapists .
If - for whatever reason - you are unable to see a therapist, you can start by doing our Introductory exercises . We also offer you the opportunity to get telephone consultations from our vestibular rehabilitation experts so that you can increase these introductory exercises if you are making good progress. We are also currently working on offering individual online therapy. If you are interested, you can be put on the waiting list. Please send an email to info@ivrt.de with the subject 'Waiting list for online therapy' and your details (name, address and telephone number). We will contact you as soon as this project starts!