Vestibular rehabilitation

Domain IX · Biomedical, neuro & digital · Cawthorne, Cooksey · 1940

What it is

Vestibular rehabilitation (also called vestibular physical therapy, VPT, or vestibular rehabilitation therapy, VRT) is an exercise-based treatment for dizziness, imbalance, blurred vision on head movement and gaze or gait instability after damage to the balance system. It is delivered by registered…

Format

• Vestibular rehabilitation is an individually tailored programme, not a fixed protocol. The stages below describe the patient pathway, with the psychotherapist's role at each stage.
• History of onset and course.

Who practises it, and how they are trained or regulated

• Vestibular rehabilitation (also called vestibular physical therapy, VPT, or vestibular rehabilitation therapy, VRT) is an exercise-based treatment for dizziness, imbalance, blurred vision on head movement and gaze or gait instability after damage to the balance system. It is delivered by registered rehabilitation professionals: mainly specialist (vestibular) physiotherapists, and in some services audiologists. A…
• Who delivers it and regulation:
• UK: "Physiotherapist" and "Physical therapist" are protected titles regulated by the Health and Care Professions Council (HCPC). The HCPC list does not include "audiologist" as a title; it does include clinical scientists and hearing aid dispensers. How audiology vestibular practitioners are registered varies by role.

Evidence status, as the guide reports it

• The CPG recommends supervised therapy (strong evidence), taking patient preference into account.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• mixed messages; the client feeling passed between services; delays. Early treatment is advised.
• hopelessness about recovery, which EyeWiki also lists as a negative prognostic belief; withdrawal.
• contradictory messages between the professionals. Agree a shared formulation and shared wording with the team.
• re-emergence of avoidance after a setback; confusing a functional flare with a new problem. If unsure, seek medical review.
• using self-help instead of an assessment; unsupervised over-practice; the CPG preference for supervised therapy where available.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.