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Vestibular Rehabilitation:  Balance & dizziness disorders - assessment, diagnosis &treatment (summary of presentation)

This is a summary of a talk given by Susan Rankin, PT & Vestibular Rehab Specialist, at the July 11, 2002 meeting of the B.C. Balance and Dizziness Disorders Society (BADD) in Burnaby, BC, Canada.  [this page is republished in as a public service]

What is the Vestibular System?

The vestibular system is responsible for keeping us upright and balanced. The three main functions of the vestibular system are:

  1. Gaze stabilization
  2. Postural control
  3. Velocity reception

Where is the Vestibular System?

The vestibular system shares the inner ear with the hearing apparatus on both sides. It has two main parts:

  1. Three semicircular canals - fluid-filled tubes that correspond to head movements.
  2. Two Otoliths - the saccule and the utricle which sit at the end of the semicircular canals and are important in velocity reception.

Who can benefit from Vestibular Rehabilitation?

There are three groups of people that contact a physiotherapist for treatment.

Group 1:  Has a diagnosis and may have had testing done like calorics, or ENG. A physiotherapist with a special interest in vestibular rehabilitation would need to do an assessment to confirm the diagnosis and to guide the choice of treatment. Diagnoses might include BPPV, vestibular neuronitis, labyrinthitis, post car accident dizziness, Ramsay Hunt syndrome, Acoustic Neuroma removal and other traumas or tumours around the vestibular nerve.

Group 2:  Has a complaint of dizziness but has not been diagnosed or tested. This group is very carefully assessed in order to rule out other causes of dizziness prior to treatment. Assessment should be able to reproduce the dizziness complained about. Treatment is based on the results of the assessment.

Group 3:  People who have dizziness from another cause or who do not benefit from vestibular rehabilitation. This includes Menieres, progressive neurological disorders like cerebellar ataxia and cardio-vascular causes of dizziness.

What is Vestibular Rehabilitation?

The main premise of vestibular rehabilitation is that you must create dizziness in order to get rid of dizziness. This always comes as a surprise to people since most people will do anything not to feel dizzy. However, the less movement you have, the less improvement will happen. There are three main types of treatment that a physiotherapist can use after assessing your needs:

  1. Habituation exercises - Here the physiotherapist assesses what makes you dizzy and has you repeat those movements until they no longer create dizziness. This is a form of "brain training" that allows your brain to relearn how to interpret the signals it receives until it gets it right.
  2. Static and Dynamic balance exercises - Most people who have vestibular problems also experience balance problems. Exercises are graded to each individual's abilities and are progressed as there is improvement.
  3. Vestibular Ocular Exercises - Since visual stabilization is one of the functions of the vestibular system, these exercises help you to regain this function by combining head and eye movements in progressively more complicated combinations and positions.

For BPPV or Benign Paroxysmal Positional Vertigo, there is a very specific test and a highly effective maneuver that is done by a trained physiotherapist.

For more information or to be assessed by a physiotherapist contact BADD for a list of trained physiotherapists in your area.

Summary by Susan Rankin, P.T. & Vestibular Rehabilitation Specialist, of talk given on the July 11, 2002 meeting of BADD at Bonsor Community centre in Burnaby.

Susan Rankin can be reached at
5270 Schou St., Burnaby, BC, Canada V5G 4L1,
Tel/fax (604) 294-8778

Conclusions & comments
If you or a loved one has balance and dizziness problems that are ongoing, check with your medical doctor and consider asking if you may be a candidate for an assessment by a trained Vestibular Rehabilitation Specialist. 

Also look for a local self-help organzation as BC's Balance and Dizziness Disorder's Society, which serves the Greater Vancouver City area and also presents information on the web at  BC-BADD currently has a membership of over 300 (and growing).

As a former medical social worker and senior's quality of life consultant, I have found that doctors are often pleased to find a trained professional in the area of vestibular rehabilitation to help their patients... as one family doctor commented "... you would be surprised at how few rehab specialists (out there) have special training and experience in assessing and helping us [family doctor] in treating balance problems..." Neal Chan, MSW and BC-BADD Society supporter

More information
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See also
B.C. Balance & Dizziness Disorders Society - Vancouver

Susan Rankin, Physiotherapist gives talk to BC balance and dizziness disorders society, in Burnaby, Canada
see also

some general medical links