Vestibular Rehabilitation Therapy (VRT)
Vestibular Rehabilitation Therapy, or VRT, is a type of therapy that uses exercises to help with dizziness, vertigo, balance problems, and blurry vision when you move your head.
VRT is often used for inner ear problems and other conditions that affect balance. The goal is to help your brain and body adjust so you can move more comfortably and feel steadier in daily life.
Vestibular rehab starts with a detailed exam by a trained provider. This exam looks at how your inner ear, eyes, brain, and body work together to control balance and vision. Your provider may check your eye movements, balance, walking, neck movement, motion sensitivity, and whether certain movements or busy places make your symptoms worse. They may also screen for conditions like BPPV.
Based on your exam, your provider creates a treatment plan for your specific symptoms and diagnosis. Vestibular rehab is not one-size-fits-all.
Example of a VRT exercise
Your Program May Include:
- Gaze stabilization exercises
(keeping your eyes focused on a target while your head moves) - Eye movement exercises
(moving your eyes while your head stays still) - Balance and walking exercises
(such as standing on different surfaces, walking while turning your head, or changing directions) - Habituation exercises
(repeating movements that cause mild symptoms to reduce motion sensitivity over time) - Positional treatments
(specific maneuvers if BPPV is present) - Functional training
(practicing real-life activities like bending, reaching, or navigating busy environments) - Education and lifestyle guidance
(including pacing, activity progression, sleep, hydration, breathing strategies and managing triggers)
Sometimes the same movements that cause symptoms are used in treatment. This is intentional and helps your brain adapt and become less sensitive over time.
What Conditions is VRT Used for?
Vestibular rehabilitation may help when dizziness or imbalance is caused by problems with how the inner ear, eyes, brain, and body work together.
It is used to treat:
- BPPV, often along with specific repositioning maneuvers
- Inner ear weakness, such as vestibular neuritis, labyrinthitis, or bilateral vestibular hypofunction
- Dizziness or imbalance after a concussion
- Vestibular migraine, especially when motion or visual sensitivity is present
- Persistent Postural Perceptual Dizziness (PPPD), usually as part of a larger care plan
- Ménière’s disease, especially after or between attacks when imbalance remains
- General imbalance or fall risk, especially in older adults
Who Provides VRT?
Vestibular rehab is usually provided by a physical therapist (PT) with special training in dizziness and balance care. In some cases, an occupational therapist (OT) may also help with balance, safety, and daily activities. Your care team may also include an audiologist, ENT doctor, neurologist, or primary care provider. These providers may help with testing and diagnosis, while your therapist guides your exercise plan. Learn more about these clinicians.
Why Am I Having Vestibular Rehabilitation Therapy (VRT)?
You may be referred to VRT to:
- Reduce dizziness or vertigo
- Improve balance and walking
- Help your eyes stay steady when your head moves (so vision feels less “bouncy”)
- Lower your risk of falls
- Help you return to daily activities such as work, errands, and exercise
- Improve comfort and confidence with movement
Is VRT Safe?
Yes. Vestibular rehab is non-invasive. The main safety concern is fall risk. Your provider may ask you to do balance exercises near a counter, wall, or sturdy surface in order to keep you safe.
Some exercises may briefly cause:
- Dizziness
- Nausea
This can be expected. As you continue the exercises, symptoms often improve over time.
You can always:
- Take breaks
- Stop an exercise if needed
- Tell your provider how you are feeling
Will VRT Help?
Most people improve with vestibular rehab, but progress is different for everyone. Some people feel better in a few days. Others need several weeks. It is normal to have good days and bad days. Sometimes symptoms feel slightly worse at first while your brain adjusts to the exercises.
Some people also need other treatments along with VRT, such as:
- Migraine care
- Medication changes
- Treatment for anxiety
Before Your Appointment
Your provider may ask you to:
- Bring a list of your symptoms and triggers
- Bring results from hearing or balance tests (if you have them)
- Eat a light meal or snack before your visit
- Drink water before your visit
- Arrive early to complete paperwork
Do not stop medications unless your provider tells you to.
Should I Bring a Ride?
Most people feel okay to drive home after their visit.
However, some treatments can:
- Make you feel dizzy
- Cause brief nausea
- Make driving uncomfortable right away
If you can, bring someone to drive you home.
What Should I Wear and Bring?
What to Wear
- Comfortable clothes you can move in
- Flat, supportive shoes (such as sneakers)
- Glasses or hearing aids (if you use them)
What to Bring
- Photo ID
- Insurance card
- List of your medicines
- Glasses or hearing aids (if you use them)
- Any cane/walker you use
- Someone to drive you home (if needed)
Questions You May Want to Ask Your Provider
- What do you think is causing my dizziness or balance problem?
- What is the main goal of VRT for me?
- What home exercises should I do, and how often?
- Which symptoms are normal during rehab?
- How long might my rehab take?
- How will we measure progress?
- Is it safe for me to drive after sessions?
- What should I do at home to lower my fall risk?
- When should I call you between visits?
What Will Happen During VRT?
You may:
- Receive BPPV treatment, when needed, using repositioning maneuvers
- Do eye and head exercises while focusing on a target
- Practice balance activities, such as standing, stepping, or turning
- Walk while moving your head or changing direction
- Practice safe position changes, such as sitting, standing, bending, or getting in and out of bed
- Learn ways to lower your fall risk
- Receive a home exercise program
Treatment sessions usually last 30–60 minutes.
This is an example of how vestibular rehab exercises may progress over several visits. These exercises were chosen for this person’s specific symptoms, needs, and goals.
How May I Feel?
During or after treatment, you may feel:
- Dizziness or spinning
- Nausea
- Unsteady or “wobbly”
- Brief blurry vision during exercises
- Headache
- Tired or worn out
These symptoms are common and usually last only a short time. They also help your provider understand how your balance system is working.
When Will I Feel Results?
Some people notice small improvements after a few visits. Many people notice clearer improvement over several weeks with regular practice. Progress often happens step by step, not all at once.
After Vestibular Rehabilitation Therapy
How May I Feel?
Most people:
- Feel a little tired
- Feel slightly more dizzy for a short time
- Need a few minutes to rest before leaving
Some people may also have:
- Nausea
- Headache or brain fog
- Temporary unsteadiness
What Should I Do?
Follow any instructions from your provider closely for best results. After your visit:
- Stand up slowly
- Rest if you feel dizzy
- Drink water if you can
- Follow your home exercise plan
Home exercises are often the most important part of recovery. Stay active but move at a safe pace.
When Should I Call My Provider?
Contact your provider if you have:
- Symptoms that become much worse and do not improve with rest
- Vomiting that will not stop
- A fall or injury
- New weakness, numbness, trouble speaking, or trouble seeing
- Fainting or chest pain
- The worst headache you have ever had
Ask your clinician about any warning signs specific to your condition.
Key Points to Remember
- VRT is an exercise-based treatment for dizziness and balance problems.
- It is usually provided by a PT or OT with vestibular training.
- It’s common to feel some symptoms during exercises.
- Tell your provider how you feel and take breaks when needed.
- Home exercises are very important
- Progress can be uneven, but improvements matter.
- Always practice balance exercises near something sturdy for safety.
Additional Resources
- Vestibular Disorders Association (VeDA) – Vestibular Rehab Therapy
- Cleveland Clinic – Vestibular Rehab
- Healthline: Vestibular Therapy