Vestibular Rehabilitation Therapy (VRT) for Unilateral Vestibular Loss
This page is intended to be a reference for physical therapists
who are providing physical therapy.
Timothy C. Hain,
Page last modified:
December 13, 2015
VRT has been generally shown to be helpful in recovery from unilateral loss, such as for vestibular neuritis or acoustic neuroma (Strupp et al. 1998; Herdman et al. 2003; Krebs et al. 2003; Badke et al. 2004; Cohen et al. 2004; Topuz et al. 2004; Hall et al, 2004; Enticott et al, 2005). An extensive metanalysis was done by the Cochrane Library in 2011, who concluded that VRT is effective for unilateral vestibular damage (Hillier and McDonnell, 2011). This entire document is available online.
Recent improvements to the process is to use the "VHIT" test to assess the degree to which compensation has occured. (Blodrow et al, 2014)
The following protocol is loosely based on Tee et al, 2005;
Goals of VRT
- Increase gaze stability
- Reduce dizziness
- improve postural and gait stability
- improve independence in activities of daily living such as driving and shopping
- Increase cardiovascular conditioning
Persons with unilateral vestibular loss will generally improve by themselves given sufficient time, but the process can be sped up by VRT.
Also see the main page on VRT and Prehab VRT.
- Badke, M. B., et al. (2004). "Outcomes after rehabilitation for adults
with balance dysfunction." Arch Phys Med Rehabil 85(2): 227-33.
- Enticott, J. C., J. O'Leary S, et al. (2005). "Effects of vestibulo-ocular reflex exercises on vestibular compensation after vestibular schwannoma surgery." Otol Neurotol26(2): 265-9.
- Blodow, A., et al. (2013). "Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders." Auris Nasus Larynx 40(4): 348-351.
- Fujino A and others. Vestibular training for benign paroxysmal positional
vertigo. Arch Otolaryngol HNS 1994:120:497-504.
- Hall CD, Schubert MC, Herdman SJ. Prediction of fall risk reduction as measured
by dynamic gait index in individuals with unilateral vestibular hypofunction.
Otology and Neurotology, 25: 746-751, 2004
- Herdman, S. J., et al. (2003). "Recovery of dynamic visual acuity in
unilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg
- Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction( Review). The Cochrane Library 2011, issue 2.
- Horak FB et al. Effects of vestibular rehabilitation on dizziness and imbalance.
Otol HNS 1992:106-175
- Jacob RG, Whitney SL, Detweilder A, Shostak G, Furman JM. Vestibular rehabilitation
for patients with agoraphobia and vestibular dysfunction: A pilot study. Anxiety
Disorders 15(2001) 131-146.
- Strupp, M., et al. (1998). "Vestibular exercises improve central vestibulospinal
compensation after vestibular neuritis." Neurology 51(3): 838-44.
- Tee LH, Chee NWC. Vestibular rehabilitation for the Dizzy Patient. Ann Acad Med Singapore 2005:34:289-94
- Topuz, O., et al. (2004). "Efficacy of vestibular rehabilitation on
chronic unilateral vestibular dysfunction." Clin Rehabil 18(1): 76-83.
Vestibular Rehabilitation (VRT)