Vertigo & Balance Correction

Vestibular Rehabilitation Therapy for BPPV

BPPV or Benign Paroxysmal Positional Vertigo is a disorder arising from the inner ear that causes repeated episodes of dizziness or a sensation of spinning caused by changes in the position of the head. It is the most common disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance. BPPV is benign, meaning that it is not life-threatening. BPPV produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly and with a change in head position.

Balance Correction

The average hospitalization cost for a fall injury is $35,000 and those who fall are two to three times more likely to fall again. Over half of older adults who previously had hip injuries will experience another fall within half of a year. Balance is an important aspect in preventing fall injuries. Balance training prevents falls by strengthening our perception and help position our bodies and get a sense of where we need to be without looking.


  • Vertigo: Spinning dizziness
  • Short duration (paroxysmal): Lasts only seconds to minute
  • Positional in onset: Induced by a change in position of body or head
  • Visual disturbance: It may be difficult to read or see during an attack due to associated nystagmus
  • Nausea and vomiting is uncommon but possible

Why Does BPPV Cause Vertigo?

The vestibular organs in each ear include the utricle, saccule, and three semicircular canals. The semicircular canals detect rotational movement. They are located at right angles to each other and are filled with a fluid called endolymph. When the head rotates, endolymphatic fluid lags behind because of inertia and exerts pressure against the cupula, the sensory receptor at the base of the canal. The receptor then sends impulses to the brain about the head’s movement.  BPPV occurs as a result of otoconia, tiny crystals of calcium carbonate that are a normal part of the inner ear’s anatomy, detaching from the otolithic membrane in the utricle and collecting in one of the semicircular canals. When the head is still, gravity causes the otoconia to clump and settle. When the head moves, the otoconia shift. This stimulates the cupula to send false signals to the brain, producing vertigo and triggering nystagmus (involuntary eye movements).

How We Treat BPPV with VRT


Vestibular therapy consists of the performance of an individualized group of exercises, designed to habituate excessive visual dependence or improve various balance strategies.

Vestibular Rehabilitation Therapy – VRT is an alternative form of treatment involving specific exercises designed to decrease dizziness, increase balance function, and increase general activity levels.  The exercise program is designed to promote central nervous system compensation for the inner ear and other balance deficits.

Why Does Vestibular Therapy Work?

Vestibular disorders affect the vestibule-ocular reflex, which controls eye movement and gaze stabilization during active head movement.  These disorders also affect the vestibulospinal reflex which influences postural stability.  Patients with vestibular disorders may present with defects in gaze stabilization and/or unsteadiness.  This usually occurs when they’re challenged by uneven surfaces, quick turns or with reduced vision.

vestibular_rehabGeneral Diagnoses Types

  • Benign Paroxysmal Positional Vertigo
  • Unilateral Peripheral Vestibular Loss
  • Bilateral Peripheral Vestibular Loss
  • Central Lesions
  • Balance Disorder
  • Gait Disturbance