Vestibular Rehab

Connie Bonis-Smith, OTR/L
May 12
2 min read

The vestibular system includes the parts of the inner ear and brain that process sensory information involved with controlling balance and eye movements. If disease or injury damages these processing areas, vestibular disorders can result. Symptoms of chronic dizziness or imbalance can significantly impact a person’s ability to perform activities of daily living.

When the vestibular organs are damaged with disease or injury, the brain can no longer rely on them for accurate information about equilibrium and motion, often resulting in dizziness, vertigo, balance problems, and other symptoms.

Vestibular Rehabilitation Therapy (VRT) is an exercise-based program designed to promote central nervous system compensation for inner-ear deficits. The goal of VRT is to retrain the brain to recognize and process signals from the vestibular system in coordination with vision and proprioception. While VRT incorporates balance exercises, the focus is on sensory adaptation.

Feature	Traditional Balance	Vestibular Rehab
Focus	Stability and strength	Sensory and neurologic adaptation
Head Movement	Minimal	Essential and progressive
Symptom Provocation	Avoided	Purposeful and controlled
Diagnosis-Specific	No	Yes
Gaze Stabilization	No	Core Component

Core Exercise Categories

Gaze Stabilization
- VOR x1, VOR x2
- Near/far targets
- Progressed with speed, posture, and environment
Habituation Exercises
- Repeated exposure to symptom‑provoking movements
- Used for motion sensitivity and PPPD
Balance Training with Head Motion
- Static and dynamic balance with active head turns
- Sensory manipulation (eyes closed, reduced somatosensory input)
Functional Gait with Vestibular Demand
- Walking with head turns
- Dual‑task conditions
- Visual motion environments

Billing

Vestibular rehabilitation is most appropriately billed as Neuromuscular Re-Education (97112). For canalith repositioning (Epley maneuver, Semont maneuver) use CPT 95992