Vestibular rehabilitation (VR, or vestibular rehabilitation therapy – VRT) is a specialized form of exercise and education used to treat vestibular disorders and their symptoms, which may include dizziness, vertigo, imbalance, postural issues, and/or unexplained falls.

Vestibular symptoms often result due to sensory mismatches between vision, the vestibular system (inner ear balance system), and joint proprioception (sense of joint position in space). Sometimes, vestibular symptoms are due to a mechanical issue in the inner ear (Benign Paroxysmal Positional Vertigo or BPPV), where tiny crystals that help sense gravity in the inner ear go in the wrong part of the inner ear. The treatment for BPPV should involve putting the crystals back where they belong with head and body movements (maneuvers) such as the Epley, followed sometimes by other vestibular rehabilitation strategies (see below) as needed.

🧠 Promoting central compensation – Central compensation occurs when the brain makes changes (neuroplasticity) to compensate for impaired vestibular input and/or to improve the ability to use non-damaged sensory inputs such as proprioception to orient oneself. This reweighting of sensory information can reduce dizziness and improve balance.

👁️ Improving gaze stability – The ability to keep one’s eyes fixed on an object, without that object getting blurry or double, while the head is moving is known as gaze stability. Certain types of vestibular rehabilitation exercises can promote gaze stability for some patients, depending on the root cause of the symptoms (pathology).

🌊 Reducing sensitivity to self and/or visual motion – Certain stimuli such as self-motion (e.g. bending down/coming up) or visual motion (such as watching a train speed past) can cause dizziness in some people. This is usually due to an issue known as visual vertigo or visual dependence. Sensitivity to self or visual motion may be reduced with gentle, repeated exposure to the challenging stimuli, in conjunction with certain cues such as increasing attention to proprioceptive input. Broadly, this is a form of central compensation.

⚖️ Enhancing effective balance strategies – Balance means the ability to maintain one’s body position safely, whether sitting, standing, walking, turning, or changing position. Balance training can involve many elements, depending on the individual’s exact cause of vestibular symptoms, their cognitive status, and their prior level of physical ability before the vestibular condition occurred. Options for training can include sensory reweighting (as described in the central compensation section above), strengthening key muscles such as at the core and hips, and recovery strategies such as stepping catch oneself after tripping.

Each patient’s program should be tailored to their symptoms, goals, and tolerance. Clinical practice guidelines recommend monitoring symptom provocation and avoiding excessive or prolonged exacerbation, as progressing exercises too quickly can interfere with compensation (Hall et al., 2022). Progression typically occurs when symptoms during or after exercises remain manageable and short-lived.

In addition to guideline-supported principles, clinical teaching and expert practice often use simple 0–10 symptom rating scales to track tolerance and guide progression. While this approach is common, specific numeric thresholds (e.g., limiting increases to ≤2 points) are not defined in published research or guidelines and instead reflect practical teaching strategies that should be applied with clinical judgment.