The Future of Vestibular Rehabilitation: Vestibular Rehabilitation from a Physical Therapist’s Perspective

Vestibular rehabilitation (VR) was first reported by S. T. Cawthorne and F.S. Cooksey in the 1940s. In the1990s, Susan Herdman began advocating the importance of individualized VR exercise program prescriptions by physical therapists. In recent years, the American Physical Therapy Association has issued and updated (2023) VR clinical practice guidelines, which was followed by Japan instituting the Japanese Society for Equilibrium Research in 2024. This article describes the widespread beneficial effects of physical therapy prescribed VR. Since 2021, Nagoya City University Hospital has been providing physical therapy at the request of the otolaryngology department and prescribed by a rehabilitation physician. Physical therapist-prescribed VR has been approved by the ethics committee and typically includes the following: 1) Gaze stability exercises; 2) Habituation exercises; and 3) Substitution exercises. These exercises are performed for up to 40 minutes per session. In addition to the physician’s diagnosis, determining the appropriate VR exercises requires listening to the patient’s complaints and development of an individualized VR program. Representative case examples of patients who have benefitted from VR prescribed by a physical therapist are included. Case1 describes the successful recovery of a patient with persistent postural-perceptual dizziness (PPPD) with the chief complaints of neck pain and dizziness. Case 2 describes the successful return to daily activities of a patient who had been suffering from dizziness for 10 years. Thus, physical therapist-prescribed VR can be highly effective for improving the symptom of dizziness and functional activity tolerance. Furthermore, research suggests that further effects of VR can be expected through incorporating on-demand training using mobile sensors and mobile applications, training in virtual environments using neuromodulation, development of vestibular implants, and robot-assisted gait training. Physical therapy education in VR has become essential, and medical fees for VR are important for successfully managing dizziness.