Dizziness and Vestibular Rehab at Home

How your balance system works

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), your sense of balance relies on signals sent to the brain by your eyes, your ears, and the muscles and touch sensors in your legs. The part of the inner ear that helps with balance is the vestibular system, a maze-like structure called the labyrinth.

Inside the labyrinth are three fluid-filled loops, the semicircular canals, that tell the brain when the head rotates, and other structures that sense straight-line movement and gravity. When you turn your head, fluid moves inside the canals and bends tiny hair cells, which send a nerve signal to the brain. The brain combines that signal with vision and body position to keep you steady and your vision clear while you move.

Why dizziness happens

The word “dizziness” means different things to different people, from a fleeting feeling of faintness to an intense spinning sensation. NIDCD reports that about 15 percent of American adults had a balance or dizziness problem in 2008, and the risk rises with age. Causes include:

Many balance disorders start suddenly with no obvious cause. Because the causes are so varied, a physician, often with an ear, nose and throat specialist (otolaryngologist) and an audiologist, should evaluate dizziness before therapy begins.

Common vestibular conditions

When to get help

• Seek prompt medical care for sudden hearing loss, new ringing in one ear, or dizziness after a head injury.
• See your physician for any new, recurring or worsening dizziness, falls, or unsteadiness, even if it comes and goes.
• Do not drive or climb ladders if you feel dizzy.
• Never stop or adjust a medicine on your own. Bring a full medicine list to your appointment.

How dizziness is evaluated

A physician may start by checking for other health conditions and medicines that cause dizziness. An otolaryngologist and audiologist may order hearing tests, eye-movement testing, positional tests, balance platform testing, or imaging, because the vestibular system is complex and several tests may be needed.

A physical therapist then assesses how your dizziness affects function: eye movements and gaze stability, positional testing for BPPV, balance, walking, and the situations that trigger symptoms. The results guide the exercises you are given and show whether you should be referred back to your physician.

How vestibular rehabilitation works

Vestibular rehabilitation is a form of exercise-based therapy. It uses the brain’s ability to adapt, so that it learns to use the signals it has, or to compensate for signals that are missing. Treatment depends on the cause.

• For BPPV, the American Academy of Otolaryngology–Head and Neck Surgery guideline recommends canalith repositioning, a sequence of head and body positions such as the Epley maneuver that moves the loose crystals out of the canal.
• For vestibular hypofunction, the American Physical Therapy Association’s clinical practice guideline recommends vestibular rehabilitation for adults with chronic peripheral vestibular hypofunction. It typically includes gaze stabilization exercises, balance training and walking practice.
• For other causes, therapy is tailored to what your physician finds, and may focus on balance, strength and confidence while the underlying condition is managed.

Exercises can feel uncomfortable because they deliberately provoke mild dizziness so the brain can adapt. A therapist sets the right dose and progresses it over time.

What physical and occupational therapy each do

Physical therapy: retraining balance and gaze

• Evaluation of dizziness triggers, eye movements, balance and walking
• Evaluation for positional vertigo (BPPV) and, when appropriate, treatment or referral
• Gaze stabilization and habituation exercises, progressed over time
• Balance and walking practice on varied surfaces and in different environments
• Fall-risk screening and prevention strategies
• A written home program, and guidance on when to check in with your physician

Occupational therapy: staying safe and active in daily life

• Strategies for bathing, dressing, cooking and other tasks when you feel dizzy
• Pacing and routines that reduce symptom flare-ups
• Home setup, including lighting, rails, and shower safety
• Equipment recommendations when needed
• Guidance on returning to work, hobbies and community activities

Supporting services

With your physician’s agreement, these can complement vestibular therapy.

What an ELEVATE home visit looks like

• Review: your symptoms, triggers, medicines and your doctors’ findings.
• Assessment: eye movements, positional testing, balance, walking and daily tasks.
• Home setup: lighting, stairs, bathroom and walkways.
• Plan: goals that matter to you and a written home program.
• Communication: progress shared with your physician as appropriate.

ELEVATE serves adults in Oakland and Macomb County, Michigan, with licensed physical and occupational therapists. See Payments & Insurance for details.

Questions families ask

Trusted resources for dizziness and vestibular disorders

These organizations are the leading sources of education and support for this condition. We are not affiliated with them.

Related guides

Browse every condition we treat on our Conditions We Treat page.

Sources and medical note

• National Institute on Deafness and Other Communication Disorders: Balance Disorders.
• Vestibular Disorders Association: What is Vestibular? and Support Group Directory.
• Hall CD et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline. Journal of Neurologic Physical Therapy, 2022 (APTA Academy of Neurologic PT).
• Bhattacharyya N et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery, 2017 (AAO-HNSF).

This page is educational and is not medical advice. It does not replace your physician’s care. Dizziness can have serious causes, so see your physician first. For sudden face drooping, arm weakness, trouble speaking, vision loss or a severe headache, call 911 immediately.