Vestibular Rehabilitation

Author: Antonio Messina, Abdulazeez Alao

Abstract

Vestibular rehabilitation is a physiotherapeutic approach aimed at improving balance, reducing dizziness, and enhancing quality of life in patients affected by vestibular dysfunctions. It is grounded on the neurophysiological principle of central compensation, whereby the brain reorganizes sensory inputs from the vestibular, visual, and proprioceptive systems to restore postural control and gaze stability. The vestibular system, composed of semicircular canals, otolithic or- gans, and central pathways, is essential for spatial orientation and motor coordination; its impairment may lead to vertigo, instability, and functional limitations. Vestibular rehabilitation employs specific exercises designed to stimulate adaptation, substitution, and habituation processes, including gaze stabilization, balance retraining, and positional maneuvers for benign paroxysmal positional vertigo. These techniques enhance the efficiency of the vestibulo-ocular and vestibulo-spinal reflexes, facilitating neural plasticity and long-term recovery. In recent years, technological innovations such as virtual reality, biofeedback, and artificial intelligence have introduced new perspectives, allowing individualized treatment, objective progress monitoring, and improved patient adherence. Clinical evidence demonstrates significant reductions in dizziness severity, improvements in balance performance, and restoration of functional independence following structured rehabilitation programs. Despite its high efficacy, barriers such as limited accessibility, inconsistent adherence, and insufficient standardization of protocols remain challenges to wider implementation. Vestibular rehabilitation, therefore, represents an evolving, evidence-based, and patient-centered intervention that integrates neuroscience, technology, and physiotherapy to restore equilibrium, reduce disability, and promote active participation in daily life.