Vestibular Therapy

Premier Pulse     October 2026

by Madeline (Grace) Shell, PT, DPT

Dizziness is a prevalent and often debilitating symptom that many patients experience in their lifetime. Dizziness has many causes, including vestibular dysfunctions. If the vestibular system is involved, vestibular therapy may be able to help significantly with dizziness symptoms. Vestibular therapists are licensed physical therapists (PTs) who are trained to evaluate and treat the vestibular system through specific head, body, and eye movements.

Conditions that can be treated or managed with vestibular therapy:

  • BPPV (Benign Paroxysmal Positional Vertigo)
  • Vestibular Hypofunction
  • 3PD (Persistent Perceptual-Postural Dizziness)
  • Meniere's Disease
  • Vestibular Migraine
  • Mal de débarquement syndrome
  • Other vestibular dysfunctions

What happens during the evaluation:

  • Objective assessment including oculomotor exam, vitals assessment, positional testing, balance assessments, and screening of other systems’ red flags.
  • Patient education and administering tailored home exercises.

What to expect in treatment:

  • Treatment looks different for each patient depending on their specific deficits but may include:
    • Canalith repositioning maneuvers to treat BPPV.
    • A series of head, eye, and body movements called adaptation and habituation exercises to strengthen the vestibular system.
    • Balance training.
    • Education on managing chronic diseases, handling dizziness flare ups, and ways to avoid triggers.
  • In certain cases, such as BPPV, relief may be immediate. When therapy includes adaptation, habituation, and balance training, this can take a few weeks to a few months to see progress.

How to know if a patient would benefit from vestibular therapy:

  • If your patient is experiencing dizziness and/or balance deficits with head, eye, or body movements, they are generally appropriate for a vestibular evaluation.
  • If you suspect your patients' dizziness may be related to medication side effects, cardiac dysfunction, a neurological condition, or another systemic dysfunction, it is typically helpful to rule this out first before referring to therapy.

What to request on a referral:

  • A ‘Vestibular Therapy - Eval and Treat’ order is preferred to help prioritize your patient’s care.
  • A general PT order with attention to Vestibular Therapy can also be accepted
    • A few examples of codes that are accepted:
      • H81.1 Benign paroxysmal vertigo
      • H81.0 Ménière's disease
      • H81.39 Other peripheral vertigo
      • H81.9 Unspecified disorder of vestibular function
      • R42 Dizziness
      • Others

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