Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-based Clinical Practice Guideline

Sep 5, 2026

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Uncompensated peripheral vestibular hypofunction causes postural instability, visual blurring during head movement, and persistent subjective dizziness and/or imbalance. A systematic review across five databases and additional relevant sources after 1985 identified 70 pertinent studies, including meta-analyses, systematic reviews, randomized controlled trials, and observational and case series evidence. Strong evidence supports vestibular physical therapy for unilateral and bilateral impairment with functional limitations. Strong evidence also discourages voluntary saccadic or smooth-pursuit eye movements as therapy components, while moderate evidence supports targeted exercise options aligned with patient preferences.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages78

Reading Time3 h 17 min

AccessFree to download

Abstract

Background

Methods

Results/Discussion

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-based Clinical Practice Guideline From the American Physical Therapy Association Neurology Section Authors: Courtney D. Hall, P.T. Ph. D. 1,2 ; Susan J. Herdman, P.T. Ph. D. , FAPTA 3 Susan L. Whitney, P.T. , ATC, Ph. D. , FAPTA4,5 ; Stephen P. Cass, M. D. , M. P. H.6 ; Richard A. Clendaniel, P.T. , Ph. D.7 ; Terry D. Fife, M. D. , FAAN, FANS8 ,9 Joseph M. Furman, M. D. , Ph. D.10 ; Thomas S. D. Getchius, B.A.11 ; Joel A. Goebel, M. D.12; Neil T. Shepard, Ph. D.13 Sheelah N. Woodhouse, P.T. , B.Sc. P.T. 14,15 1 Research Health Scientist, Auditory Vestibular Research Enhancement Award Program, Mountain Home VAMC, Mountain Home, TN 2 Associate Professor, Department of Physical Therapy, East Tennessee State University 3 Professor Emerita, Emory University School of Medicine, Atlanta, GA 4 Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 5 Professor, Otolaryngology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 6 Professor, Department of Otolaryngology, University of Colorado School of Medicine 7 Assistant Professor, Department of Community and Family Medicine, Doctor of Physical Therapy Division, Duke University Medical Center 8 Vice Chairman and Director, Balance Disorders and Vestibular Neurology, Barrow Neurological Institute 9 Professor of Neurology, University of Arizona College of Medicine 10 Professor, Department of Otolaryngology, University of Pittsburgh 11 Director, Clinical Practice, American Academy of Neurology, Minneapolis, MN 12 Professor and Vice Chairman, Director, Dizziness and Balance Center, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 13 Professor and Chair, Audiology and Director, Dizziness and Balance Disorders Program, Mayo Clinical School of Medicine, Rochester, MN 14 National Director of Vestibular Rehabilitation for LifeMark and Centric Health, Alberta, Canada 15 President, Vestibular Disorders Association, [vestibular.org](vestibular.org) [Financial disclosure/ COI](Financial disclosure/ COI) All members of the workgroup and advisory board submitted written conflict of interest forms and CVs which were evaluated by a member of the Neurology Section Clinical Practice Director (Beth Crowner, PT, DPT, NCS, MPPA) and found to be free of financial and intellectual conflict of interest. ACKNOWLEDGMENTS We are grateful to Jacob O’Dell, MS, SPT for countless hours of research and assistance with data management throughout this project. The academic librarians from East Tennessee State University (Richard Wallace, MSLS, EdD, AHIP; Nakia Woodward, MSIS, AHIP), Emory University (Amy Allison, MLS, AHIP), and University of Pittsburgh ( Linda Hartman, MLS, AHIP) performed the systematic literature searches. We gratefully acknowledge Thomas Getchius, Director, Clinical Practice at the American Academy of Neurology for his generosity in sharing his expertise and the American Academy of Neurology Clinical Practice Guideline Process Manual. John Engberg, PhD, who as our patient representative, provided valuable feedback to the process and content of the guideline. We are grateful to members of the Neurology Section and Vestibular Special Interest Group who volunteered their time and efforts to perform critical appraisals of the literature. The physical therapist critical appraisal team included: Carmen Abbott, Eric Anson, Kathy Brown, Lisa Brown, Janet Callahan, Diron Cassidy, Jennifer Christy, Pam Cornwell, Renee Crumley, Elizabeth Dannenbaum, Pamela Dunlap, Lisa Farrell, Julie Grove, John Heick, Janet Helminski, Lisa Heusel-Gillig, Janene Holmberg, Jennifer Kelly, Brooke Klatt, Jodi Krause, Karen Lambert, Rob Landel, Lara Martin, Joann Moriarty-Baron, Laura Morris, Chuck Plishka, Nora Riley, Britta Smith, Debbie Struiksma, Derek Steele, Brady Whetten, and Wendy Wood. We wou

FAQs

What clinical problems does uncompensated peripheral vestibular hypofunction cause?

It leads to postural instability, visual blurring with head movement, and subjective dizziness and/or imbalance.

How was the evidence gathered for this clinical practice guideline?

A systematic review searched five databases and additional sources for publications after 1985, including multiple study types in English.

What recommendations are supported by strong evidence for clinicians?

Clinicians should offer vestibular physical therapy for unilateral and bilateral hypofunction with related functional limitations, and should not include voluntary saccadic or smooth-pursuit eye movements as a component or alternative for gaze stability.

Sep 5, 2026

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