Vestibular Physiotherapy

March 14, 2022

What is vestibular physiotherapy?

Vestibular physiotherapy is a specialised area of physiotherapy which focuses on the way the balance systems work together. In particular, this includes the visual, vestibular, and somatosensory balance systems. When one system does not work properly, a person may experience dizziness, vertigo, imbalance, or falls. And these physical impairments can lead to adverse effects on a person’s ability to safely and efficiently complete their usual activities of daily living and participate in the community.

What types of conditions do people experience that vestibular physiotherapy can be helpful for?

Age related vestibular changes ‘presbyvestibulopathy’ (Whitney, 2014).
Benign paroxysmal positional vertigo (BPPV) (Bhattacharyya et al., 2017).
Migraine related vertigo (Alghadir & Answer, 2018).
Meniere’s disease (van Esch et al., 2017).
Vestibular neuritis and labyrinthitis (Hall et al., 2016).
Vestibular schwannoma (Hruba et al., 2019; Mann & Gouveris, 2009).
Dizziness of central origin (neurological dizziness) (Brant & Dieterich, 2017; Tramontano et al., 2021).
Persistent concussive symptoms (Ellis et al., 2015).
Chronic forms of dizziness (Popkirov et al., 2018; Dai et al., 2014; Trinidade, & Goebel, 2018).
Functional neurological disorders (Nielsen et al., 2014).

In which settings do vestibular physiotherapists work?

Emergency departments.
Acute hospitals.
Inpatient rehabilitation programs.
Day rehabilitation programs.
Dedicated outpatient clinics within hospital.
Community health programs.
Private practice.

How can vestibular physiotherapy help people achieve their goals?

If you are working with a person that is experiencing vertigo, dizziness, imbalance, or falls, consider referral to a vestibular physiotherapist. Vestibular physiotherapists will complete a comprehensive assessment of the balance systems and develop a holistic, person centred, goal-oriented management plan (Whitney et al., 2017). Vestibular physiotherapists value interdisciplinary communication and collaboration with health professionals from a range of disciplines, in order to best support people to achieve their goals in a realistic, and timely manner (Spiegel et al., 2017).

About the author:

Heather Tolhoek is a vestibular physiotherapist located on the Sunshine Coast, Australia. Currently working within the Ramsay Health Care team’s vestibular clinic and day rehabilitation programs.

References:

Alghadir, A. H., & Answer, S. (2018). Effects of vestibular rehabilitation in the management of a vestibular migraine: a review. Frontiers of Neurology, 9(440), 1-9. doi: 10.3389/fneur.2018.00440

Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., Holmberg, J. M., Mahoney, K., Hollingsworth, D. B., Roberts, R., Seidman, M. D., Prasaad Steiner, R. W., Tsai, B., Voelker, C. C. J., Waguespack, R. W., & Corrigan, M. D. (2017). Clinical practice guideline: benign paroxysmal positional vertigo (update). American Academy of Otolaryngology – Head and Neck Surgery, 156(3S), S1-S47. doi: 10.1177/0194599816689667

Brant, T., & Dieterich, M. (2017). The dizzy patient: don’t forget disorders of the central vestibular system. Nature Review Neurology, 13, 352-364. doi: 10.1038/nrneurol.2017.58

Dai, M., Cohen, B., Smouha, E., & Cho, C. (2014). Readaptation of the vestibulo-ocular reflex relieves the mal de debarquement syndrome. Frontiers in Neurology, 5(124), 1-6). doi: 10.3389/fneur.2014.00124

Ellis, M. J., Leddy, J. J., Willer, B. (2015). Physiological, vestibulo-ocular, and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment. Brain injury, 29(2), 238-248. doi: 10.3109/02699052.2014.965207

Hall, C.D., Herdman, S. J., Whitney, S. L., Cass, S. P., Clendaniel, R. A., Fife, T. D., Furman, J. M., Getchius, T. S. D., Goebel, J. A., Shepard, N. T., & Woodhouse, S. N. (2016). Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence based clinical practice guideline. American Physical Therapy Association, 40, 124- 155. doi: 10.1097/NPT.0000000000000120

Hruba, S., Chovanec, M., Cada, Z., Balatkova, Z., Fik, Z., Slaby, K., Zverina, E., Betka, J., Plzak, J., & Cakrt, O. (2019). The evaluation of vestibular compensation by vestibular rehabilitation and pre-habilitation in short-term post-surgical period in patients following surgical treatment of vestibular schwannoma. European Archives of Oto-Rhino-Laryngology, 276, 2681-2689. doi: 10.1007/s00405-019-05503-8

Mann, W., & Gouveris, H. T. (2009). Diagnosis and therapy of vestibular schwannoma. Expert Review of Neurotherapeutics, 9(8), 1219-1232. http://ezproxy.acu.edu.au/login?url=http://www.tandfonline.com/doi/abs/10.1586/ern.09.66

Nielsen, G., Stone, J., Matthews, A., Brown, M., Sparkes, C., Farmer, R., Masterton, L., Duncan, L., Winters, A., Daniell, L., Lumsden, C., Carson, A., David, A. S., & Edwards, M. (2014). Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery, & Psychiatry, 86, 1113-1119. doi: 10.1136/jnnp-2014-309255

Popkirov, S., Stone, J., & Holle-Lee, D. (2018). Treatment of persistent postural-perceptual dizziness (PPPD) and related disorders. Current Treatment Options in Neurology, 20(12), 50. https://doi-org.ezproxy1.acu.edu.au/10.1007/s11940-018-0535-0

Spiegel, R., Rust, H., Baumann, T., Friedrich, H., Sutter, R., Göldlin, M., Rosin, C., Müri, R., Mantokoudis, G., Bingisser, R., Strupp, M., & Kalla, R. (2017). Treatment of dizziness: an interdisciplinary update. Swiss Medical Weekly, 147, w14566. https://doi-org.ezproxy1.acu.edu.au/10.4414/smw.2017.14566

Tramontano, M., Russo, V., Spitoni, G. F., Ciancarelli, I., Paolucci, S., Manzari, L., & Morone, G. (2021). Efficacy of vestibular rehabilitation in patients with neurologic disorders: a systematic review. Archives of Physical Medicine and Rehabilitation, 102, 10379-1389, https://doi.org/10.1016/j.apmr.2020.11.017

Trinidade, A., & Goebel, J. A. (2018). Persistent postural-perceptual dizziness-a systematic review of the literature for the balance specialist. Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 39(10), 1291–1303. https://doi-org.ezproxy1.acu.edu.au/10.1097/MAO.0000000000002010

van Esch, B. F., van der Scheer-Horst, E. S., van der Zaag-Loonen, H. J., Bruintjes, T. D., & van Benthem, P. P. G. (2017). The effect of vestibular rehabilitation in patients with Ménière’s disease: a systematic review. Otolaryngology–Head and Neck Surgery, 156(3), 426–434. https://doi.org/10.1177/0194599816678386

Whitney, S.L. (2014) Physical therapy management of the older person with vestibular dysfunction. In S. Herdman & R. Clendaniel (Eds.), Vestibular Rehabilitation (4th Ed., pp. 480-503). F.A.Davis Company. ISBN:978-0-8036-3970-6

Whitney, S. L., Alghadir, A. H., & Answer, S. (2016). Recent evidence about the effectiveness of vestibular rehabilitation. Current Treatment Options in Neurology, 18(13), 1-15. doi: 10.1007/s11940-016-0395-4

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