Vestibular rehab

Vestibular rehabilitation therapy

For reasons of better readability, the generic masculine is used and the simultaneous use of the language forms male, female and diverse (m/f/d) is dispensed with. Unless otherwise indicated, 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

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 becomes accustomed to them. The overall goal is to improve your quality of life by getting used to your disorder, reducing your symptoms and improving your overall function. Research shows that rehabilitation programs are most effective when they are personalized. Therefore, apps and exercise booklets handed out by doctors/clinics that are not customized are not 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® advanced training is 4 days, competency-based, with an exam and requires its specialized IVRT® dizziness and vestibular therapists to participate in refresher courses and in-depth 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 find out very well whether and how well the therapist is really familiar with your type of disorder.

The reimbursement of vestibular rehabilitation by health insurance companies varies greatly in the DACH and BENELUX regions. While in Germany, Switzerland and Belgium the costs are covered in full or for the most part by health insurance companies with a doctor's prescription, in the Netherlands it is often included to a limited extent in the basic offer of health insurance companies. In the Netherlands, supplementary insurance must therefore be taken out for full physiotherapy reimbursement. The system is very different in Austria, where you usually pay for the therapy yourself or only receive a small portion of the reimbursement from the health insurance companies. Of course, there are also therapists in Germany, Switzerland and Belgium who do not cooperate with the health insurance companies and set their own conditions. You should therefore find out exactly how billing and reimbursement works in your country or with your chosen therapist.

The first visit includes a comprehensive examination that allows the therapist to create an appropriate rehabilitation program. Some vertigo and vestibular therapists use special glasses to perform a more thorough 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 the limit (e.g. bilateral vestibulopathy) or your brain is not adapting adequately (see functional vertigo / PPPD).

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
    • Balance recovery exercises: 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 Gait training
      For example, walking and moving the head, both on firm and unstable ground.
  • 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® therap ists.

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 advice from our vestibular rehabilitation experts over the phone 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!

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