REFERENCE · RECOVERY TECHNIQUE

Building a Vestibular Rehabilitation Plan That Fits You

When this may fit: When ongoing dizziness affects several parts of daily life and exercises need to match your assessed pattern. [Clinical rehabilitation with emerging PPPD evidence; no universal programme]

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For the Person With FND

A list of exercises can feel like another thing to get wrong when simply moving through the day is difficult. A vestibular rehabilitation plan starts by finding out what happens to you, then choosing a manageable way to work on something that matters.

What does vestibular rehabilitation mean?

The vestibular system includes balance sensors in the inner ears and their connections with the brain. The brain uses these signals alongside vision and information from muscles and joints to judge movement and position. Rehabilitation is a planned way of practising relevant movement and balance tasks. PPPD does not automatically mean an inner-ear sensor is damaged. [1]

A therapist may include head movement, balance, walking or visual tasks, but you do not need every exercise. “Individualized” means that the choice, support and amount change to fit your assessment—not that you must adjust an internet routine alone.

Making the plan concrete

Name one ordinary goal. Perhaps you want to turn towards someone at the table, reach the bathroom safely or use a screen for a short message.
Describe the difficulty. Is it rocking, spinning, faintness, blurred vision or loss of balance? Say when it happens and how long its effects last.
Ask for a demonstration and an accessible copy. The plan should specify the task, position, equipment, amount, stopping point and who to contact.
Agree how to judge the response. Consider the activity itself, falls or near-falls, symptoms later that day and the effect on other necessary tasks. Progression is a shared decision.

These planning examples are educational adaptations, not a trial protocol. A short supported activity can count as useful participation even when dizziness remains. [2][4]

If the plan is too much

Tell the therapist what happens rather than trying to meet the schedule at any cost. Severe or lasting worsening may call for a smaller task, another approach or reassessment of a coexisting condition. No fixed symptom increase is required to prove you are doing enough. Aids and help do not have to be withdrawn to show progress.

During a familiar flare

Use the agreed easier version, or pause practice if safe participation is not possible. Essential activities may need extra support. There is no missed-exercise debt to repay when the flare eases.

When to stop and seek assessment

Stop unsafe activity. Sudden or distinctly different dizziness with new weakness, double vision, speech trouble, inability to walk, severe headache, fainting or chest pain needs urgent assessment. Sudden hearing loss, head injury or persistent vomiting also needs prompt medical attention. Increasing falls or progressive loss of function warrants reassessment. Existing PPPD does not explain every new symptom. See the diagnostic and differential-assessment page.

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For Family, Friends, and Other Supporters

Ask which part of the plan the person wants help with: arranging space, keeping the written instructions nearby, transport or company. Avoid adding repetitions or evaluating effort. Describe practical problems to the therapist with the person’s permission.

During a familiar flare, follow the agreed support and safety plan. Ask before taking over. New or substantially different symptoms need their own assessment; an exercise should never delay that care.

For the Person With FND
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For Clinicians and the Care Team

Confirm Bárány criteria and identify active BPPV, vestibular hypofunction, migraine, orthostatic symptoms, medication effects and neurological causes. Select task-specific goals and examine gaze, balance, gait and visual-motion sensitivity as indicated. Semicircular canals signal angular head movement; otolith organs signal linear acceleration and gravity. Central vestibular pathways integrate these inputs with vision and somatosensation for gaze and postural control. PPPD does not by itself demonstrate peripheral loss; distinguish a functional formulation from an objectively identified vestibular deficit. Distinguish the diagnosis from any hypothesized sensory-weighting or threat mechanism. Rehabilitation response cannot establish PPPD. Track participation and delayed burden alongside symptom questionnaires; continuing access support remains appropriate.

Agree an accessible next step and review point. Consider meaningful activity, safety, access, effort and delayed effects alongside dizziness severity. Limited improvement is not grounds to withdraw assistance or infer lack of effort.

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Research and Sources

This page expands original entry 1, Individualized vestibular rehabilitation. Examples and practical prompts are educational adaptations, not patient quotations or a reproduced treatment protocol. Original-entry numbering does not imply thirteen independently validated treatments.

The 2025 review pooled eight studies and found improvement in dizziness-related handicap, with important heterogeneity and methodological limits. The 2023 Cochrane review admitted different comparators and longer follow-up, leaving only one small eligible study. These findings do not establish thirteen independent treatments. Package-level evidence cannot identify which exercise helped.

Citation	Source	What it supports and its limits	Figure
1	FND-CIT-0027 — Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research. 2017;27(4):191–208. DOI.	Diagnostic consensus; defines PPPD and differential assessment, not treatment efficacy.	—
2	FND-CIT-0038 — Li Y, Pei X, Ding R, et al. Effect of vestibular rehabilitation therapy in patients with persistent postural perceptual dizziness: a systematic review and meta-analysis. Frontiers in Neurology. 2025;16:1599201. DOI. Correction.	Heterogeneous rehabilitation studies; does not validate each exercise or a universal dose.	—
3	FND-CIT-0040 — Webster KE, Kamo T, Smith L, et al. Non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD). Cochrane Database of Systematic Reviews. 2023;3:CD015333. DOI.	Strict comparator and follow-up criteria left very limited evidence; not proof that rehabilitation cannot help.	—
4	FND-CIT-0196 — Neurosymptoms.org. Functional Dizziness (PPPD). Specialist patient information. Accessed September 22, 2026.	Specialist explanation and treatment context; not a controlled treatment trial.	—

Sources checked: September 22, 2026 · Vestibular, neurological, lived-experience and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
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