Vestibular and Balance Disorders - Rehabilitation Institute of Chicago

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Who We Treat

  • Vestibular Disorders


  • Only Hospital Ranked #1 in America by U.S. News & World Report since 1991
  • 800,000+ outpatient visits each year
  • 5,000+ inpatients treated each year, system-wide
  • 50+ sites of care throughout Illinois and Indiana
  • One of only 2% of hospitals to receive three consecutive Magnet Recognitions for Nursing Excellence.
  • 182-bed inpatient hospital in the heart of Chicago
  • Largest rehabilitation research center in the world
  • Only rehabilitation hospital with eight federally designated research centers
  • 370+ active research projects in neuroscience, bionics, robotics, and musculoskeletal medicine
  • Academic home of Physical Medicine & Rehabilitation Department, Northwestern University Feinberg School of Medicine

RIC Therapist with Vestibular Patient

Vestibular rehabilitation patient with RIC therapist

Vestibular Disorders Rehabilitation and 
Balance Retraining

Patients who come to the Rehabilitation Institute of Chicago (RIC) with a vestibular disorder may have a variety of symptoms. Common symptoms of a vestibular disorder include dizziness, vertigo, and imbalance. Patients may also experience nausea, hearing changes, anxiety, fatigue, and trouble concentrating.

Patients with a vestibular disorder receive a thorough evaluation to determine the problem and its effect on the patient's balance and quality of life.

There are several causes and types of vestibular disorders. The most commonly seen disorders at RIC include:

Benign Paroxysmal Positional Vertigo

Patient receiving treatment for benign paroxysmal positional vertigoBenign Paroxysmal Positional Vertigo (or BPPV for short) is one of the most common types of peripheral vertigo. Its cause is unknown, but it does become more common as we age. It may follow a head trauma, or may be idiopathic (that is, of unknown cause).

Symptoms are due to debris that has collected within a canal in the inner ear. The debris is made up of small calcium carbonate crystals often referred to as “ear rocks”. These crystals move through the canal as head position changes. This sends incorrect signaling to the brain producing the sensation of vertigo. Head positions and movements causing the feeling are often getting in or out of bed, bending over as to pick something up off the floor or tie shoes, or looking up when reaching for something overhead. Symptoms may not occur every time you do one of these, may occur with only one, or all of them.

Vestibular Neuritis and Labyrinthitis

Patient receiving treatment for benign paroxysmal positional vertigoVestibular neuritis and labyrinthitis are caused by irritation of the vestibular nerve in the inner ear due to infection. The infection is typically viral and can be preceded by a viral infection in the body such as the common cold. The infection can move to the inner ear and cause irritation of the vestibular nerve. Irritating the nerve often results in a sudden attack of vertigo and possibly nausea.

Symptoms are initially severe and can last for a period of 1–4 days, with gradual improvement over several weeks. For many people, symptoms will resolve on their own. For others, activities like driving, walking through the grocery store, crowds, malls, airports, or just down the street continue to cause dizziness and imbalance. These individuals may also notice difficulty concentrating, fuzzy vision, and symptoms worsening with fatigue.

BPPV and vestibular neuritis/labyrinthitis are the two most common vestibular disorders seen and treated at RIC. There are many other causes of dizziness and vertigo. It is important to see your physician to discuss your symptoms and receive a proper diagnosis prior to beginning vestibular rehabilitation.

Treatment through Vestibular Rehabilitation

Patient receiving treatment through vestibular rehabilitationThe treatment of a patient with an inner ear disorder focuses on determining a specific plan based on the individual diagnosis and symptoms. At RIC the patient will receive a thorough evaluation to determine this specific plan.

Vestibular Rehabilitation Therapy (VRT)

When the vestibular system has been affected due to one of the above conditions the brain cannot rely on the information it is receiving from the vestibular system. The patient's ability to maintain balance is now dependent on vision and signaling from muscles and joints. This can lead the patient to compensate for the change by avoiding various head positions and movements because these increase their symptoms. The avoidances help decrease the number of instances of dizziness and nausea but result in headache, muscle stiffness, fatigue, and decreased ability for the brain to adapt to the change in the vestibular system. Overall these avoidances make symptoms worse and increase the need for VRT. VRT includes:

  • Gaze Stabilization Exercises:

    Patient working on gaze stabilization exercisesWhen a patient has had vestibular neuritis or labyrinthitis the information the brain receives from the vestibular system has been changed. Adaptation exercise may be used in order to help the patient's brain adapt to new signaling from the affected vestibular system. Visual fixation on a target during head movement is a key gaze stabilization exercise given to assist in this retraining.

  • Balance Retraining Exercises:

    Patient working on balance retraining exercisesWhen the vestibular system has been affected by vestibular neuritis or labyrinthitis the nerve signaling related to balance and walking has also changed. When this occurs, balance training is also indicated. Balance retraining involves exercises designed to improve coordination of muscular responses as well as the organization of sensory information (eye sight, vestibular system) for balance control.

    In addition to a home program, patients are seen by the physical therapist one to two times each week for an average of four to six weeks. During this time progress is monitored, the home exercise program is modified, and specific balance retraining occurs.

  • Canal Repositioning Maneuvers:

    Vestibular Rehabilitation and Balance RetrainingWhen the patient has been affected by BPPV canal repositioning maneuvers are indicated. During the evaluation it will be determined what canal the debris lies in. Once the physical therapist has determined this, a canal repositioning maneuver will be used to dislodge or reposition the debris within the affected canal.

To schedule an appointment for a vestibular assessment call us at 312-238-1000.