Chapter 10
Vestibular Rehabilitation

Susan L. Whitney, PhD, PT, NCS, ATC
Assistant Professor in the Departments of Physical Therapy and Otolaryngology
University of Pittsburgh and the Centers for Rehab Services
Eye and Ear Institute, Pittsburgh, PA

Laura O. Morris, PT
Facility Director of Physical Therapy Services for the Centers for Rehab Services,
Eye and Ear Institute, Pittsburgh, PA

. . .There are many symptoms that can make you a good candidate for vestibular (balance) rehabilitation. It’s better to have dizziness that happens when you move or change position rather than to dizziness that is present all the time, even when you don’t move. Dizziness that occurs with a change of position often can be helped with vestibular rehabilitation. Constant dizziness symptoms are more difficult to improve, but a good rehabilitation program can make you stronger, improve your balance and make you less likely to fall.

Falling to the ground is a good reason to see a rehabilitation specialist about your balance. If you’re falling, especially without reason, you should see your doctor so that he/she is aware of your falling problem. Falls are seen with dizziness and balance problems, but should be checked by your doctor so that he or she can attempt to determine why you are falling. . .

If you’re seeing a physical or occupational therapist, they’ll ask you many questions about your prior medical conditions and your prior functional level. That’s really important so they know how active you were prior to developing your dizziness or balance problem.

The therapist will determine how well you can feel in your hands and your feet, the strength of your muscles, arms, legs and trunk, and also whether you have normal motion in your arms and legs.

Other aspects of the evaluation that are very important include assessing your balance. This is done in many different ways. Sometimes the therapist will have you stand on both feet, sometimes on one foot, and on different surfaces plus they will ask you to walk. Most people who have balance problems have much more difficulty walking than standing still. If you have more difficulty standing still, you need to very clearly explain this to the therapist and to your doctor. There are several conditions that specifically cause difficulty in standing still, including something called Mal de Debarquement and orthostatic hypotension.(also see These are unusual conditions, but the doctor and the therapist need to understand your complaint.

The therapist will ask you about your ability to do different tasks and whether specific movements make you dizzy. You will also be asked about whether you’ve fallen as a result of your dizziness or balance problem. Sometimes people fall because of their dizziness problem. If you have the feeling of spinning when you get out of bed, you have to be very careful so that you don’t fall. . .