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Vestibular Rehab

What is Vestibular Rehabilitation Therapy?

Vestibular rehabilitation therapy, or VRT for short, is a type of physiotherapy that helps people who have problems with their balance and dizziness. It’s especially useful for those who experience dizziness or unsteadiness due to issues with their inner ear or other parts of the vestibular system, which is responsible for maintaining balance.

Here’s a breakdown of what VRT involves:


First, Dr Herdman will ask you questions about your symptoms and medical history. He will then examine you and assess your balance to try to understand what might be contributing to your dizziness or balance problems.

Customized Exercises:

Based on the assessment, Dr Herdman will create a personalized exercise program for you. These exercises are designed to help improve your balance and reduce dizziness. They can include movements like standing on a balance mat, walking in specific ways, or even just turning your head in certain directions.

Progressive training:

You’ll start with relatively easy exercises and gradually work your way up to more challenging ones as you get better. The idea is to slowly retrain your vestibular system to work properly.


During therapy, you’ll also learn about strategies to cope with dizziness in your daily life. This might include tips for how to move more safely or how to overcome avoidance of situations that trigger your dizziness

Monitoring and Adjustments:

Your progress will be regularly monitored, and Dr Herdman may adjust your exercises to make sure they’re helping you improve

The goal of vestibular rehabilitation therapy is to reduce dizziness, improve your balance, and enhance your overall quality of life. It’s a non-invasive and effective way to address vestibular problems and regain your sense of stability.

Who benefits

Vestibular rehabilitation therapy is a specialised form of treatment that helps people who experience dizziness or balance problems, especially when these issues are triggered by things like sudden movements or visual cues. This therapy is beneficial for individuals who feel unsteady, dizzy, or off-balance in situations such as when they turn their head quickly, look at moving objects, or change positions.

Benign Paroxysmal Positional Vertigo

BPPV (Benign Paroxysmal Positional Vertigo) is a common and treatable condition that causes brief episodes of intense dizziness, often triggered by simple head movements like rolling over in bed or tilting your head back to look up. It happens when tiny particles in your inner ear that help you balance get stuck in the wrong place. The dizziness can be very intense but typically only lasts for a short time during these specific movements. Fortunately, BPPV can often be fixed with simple manoeuvres performed by Dr Herdman in the clinic, helping those affected feel more stable and less dizzy.

Balance and Falls

As we age, our balance can decline, making us more prone to falls. Vestibular therapy focuses on strengthening the systems in the body that help us stay steady, like the inner ear and muscles. By doing these exercises, older adults can regain better balance and confidence in their movements, which in turn reduces their risk of falling and getting hurt.

Studies show that more than 50% of older adults who fall have vestibular impairment, but this usually goes undiagnosed. Timely receipt of vestibular physiotherapy can reduce the odds of falling by >80%! Managing the risk factors for falls (e.g. gait and balance problems) has wider benefits beyond falls prevention such as improved physical and mental health, functioning, and quality of life.

‘PPPD’ and Chronic Dizziness

Persistent Postural Perceptual Dizziness (PPPD) is a condition where someone feels dizzy and off-balance most of the time, even when they’re not moving or doing anything. People with PPPD often also have heightened sensitivity to their own movements or the environment around them. It’s like a feeling of unsteadiness that doesn’t go away.

It often starts after a triggering event like an inner ear infection or a head injury, which initially causes dizziness. But in some cases, even after the initial problem gets better, the brain keeps sending signals that don’t match reality, and make you feel dizzy. It’s like your body gets stuck in a pattern of dizziness. This happens because your brain and body didn’t adapt back to normal properly after the initial dizziness, and that’s why PPPD can persist. Treatment usually involves helping your brain re-learn how to balance correctly to reduce the ongoing dizziness.

Dr Herdman has pioneered a new therapeutic approach to PPPD, called ‘INVEST’, which helps to retrain your brain and body to feel more stable and less dizzy. It’s personalised to your specific needs, and it’s designed to give you the best chance at feeling better and getting back to your normal life.

Children with Balance Disorders

Children with vestibular disorders often have a remarkable ability to adapt and compensate for their balance problems quickly. However, children with vestibular dysfunction since or shortly after birth do not recover function without intervention. Likewise, some older children may still benefit from vestibular therapy. In recent years, investigations have shown that vestibular dysfunction is more common in children than previously thought, and can cause problems with motor development, balance and reading abilities.

It is important that the child is assessed by a paediatrician and audiovestibular physician before beginning vestibular rehabilitation. This is to exclude any genetic or developmental disorder. The dysfunction may be due to central or peripheral lesions, each with distinct presentation of symptoms and test results. For this reason, we would usually require a referral from a clinician before the first appointment.

Dr Herdman is qualified in both adult and paediatric vestibular rehabilitation, and established the first UK NHS paediatric vestibular therapy service. For children to benefit from vestibular rehabilitation, they should typically be older than 4 yrs. of age and able to follow instruction and direction.