{"entity":{"id":"rejuv-rehab-balance-vestibular","kind":"technology","name":"Balance, dizziness and falls after cancer treatment","aka":[],"tldr":"Surgery for a vestibular schwannoma removes the balance nerve on one side, and the brain has to learn to work without it. Vestibular rehabilitation is the physiotherapy that teaches it, and a systematic review of 23 studies graded every outcome as very low certainty. Referral is also the problem: in one centre 42 per cent of patients were referred and 36 per cent of those completed the programme.","summary":"Three different things cause unsteadiness after cancer treatment, and they need different treatments. Loss of the vestibular nerve, typically after surgery or radiotherapy for a vestibular schwannoma, removes half the balance input. Chemotherapy-induced peripheral neuropathy removes the sensation from the feet that the balance system depends on, and is covered in the wave one record on nerve damage. Weakness, fatigue and bone loss make a fall more likely and more serious, and are covered in the muscle and bone records.\n\nVestibular rehabilitation is the treatment for the first. It combines gaze stability exercises, habituation to provoking movements, balance training and gait training, and relies on central compensation: the brain reweighting vision and proprioception to replace the missing signal.\n\nWhat the evidence shows. A 2024 systematic review searched four databases and included 23 studies of vestibular physical therapy in people with vestibular schwannoma. Its summary is that the effect is uncertain: dizziness, static and dynamic balance and vestibular function all showed very low certainty on the standard grading approach. Multimodal programmes consistent with clinical practice guidelines showed potential for improvement, and single-modality interventions were mostly not significant.\n\nThe best individual trial is old and small. A randomised, assessor-blinded trial of 53 patients after acoustic neuroma surgery compared twelve weeks of customised vestibular rehabilitation with general instructions. Everyone improved in the first six weeks. Patients over 50 who received the customised programme did significantly better on standing balance, the timed up and go test and tandem gait, the effect persisted to twelve weeks and appeared on the dynamic gait index, and the over-50 rehabilitation group had better balance at twelve weeks than before their operation, a pattern still present at one year.\n\nPrehabilitation does not help here. A study of 52 patients having retrosigmoid removal compared a group who had the balance organ deliberately ablated with intratympanic gentamicin before surgery, plus training, with a group trained without ablation. Both improved significantly on subjective visual vertical, posturography and the balance confidence scale after surgery, and there was no significant difference between them. The authors conclude that intensive postoperative rehabilitation is the key factor and that prehabilitation did not speed recovery.\n\nReferral and attrition. A retrospective review of 145 patients at one institution found a referral rate for vestibular rehabilitation of 42.1 per cent, of whom 60.7 per cent attended at least once and 36.1 per cent completed with a formal discharge, an attrition rate of 40.5 per cent. Greater distance from a therapy site lowered the odds of completing (odds ratio 0.91 per unit, 0.85 to 0.97), and women, older patients and those travelling further had significantly higher attrition. A much larger database cohort of 6,431 patients found only 25.7 per cent attended at least one session after surgery.\n\nWhat comes back, and when: most of the improvement after a unilateral vestibular loss happens in the first six weeks and continues over months as compensation consolidates. Head movements remain uncomfortable for some people indefinitely, and walking in the dark or on uneven ground is usually the last thing to return.","status":"emerging","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Vestibular_rehabilitation","links":[{"label":"Vestibular rehabilitation: improving symptomatic and functional outcomes of persons with vestibular schwannoma: a systematic review (Phys Ther 2024)","url":"https://doi.org/10.1093/ptj/pzae085"},{"label":"The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection (Clin Rehabil 2008)","url":"https://doi.org/10.1177/0269215508089066"},{"label":"Evaluation of vestibular compensation by rehabilitation and prehabilitation after vestibular schwannoma surgery (Eur Arch Otorhinolaryngol 2019)","url":"https://doi.org/10.1007/s00405-019-05503-8"},{"label":"Barriers to vestibular rehabilitation in acoustic neuroma surgical patients (Otol Neurotol 2025)","url":"https://doi.org/10.1097/MAO.0000000000004613"}],"tags":["rejuvenation","survivorship","rehabilitation","evidence:insufficient"],"related":[],"cancers":["vestibular-schwannoma","head-and-neck","colorectal","multiple-myeloma"],"sections":["rejuvenation","supportive-care"],"technologies":["cipn-recovery-and-treatment","cancer-treatment-bone-loss","rejuv-rehab-cancer-rehabilitation","exercise-prescription-after-cancer","hearing-after-platinum-chemotherapy","rejuv-rehab-commissioning-inequity"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["peripheral-neuropathy","quality-of-life","late-effects"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Balance is computed from three inputs: the vestibular organs, vision and proprioception. Losing one permanently is tolerable because the brain can reweight the other two, but reweighting is driven by exposure to the error signal. Vestibular rehabilitation deliberately provokes that error, which is why the exercises are uncomfortable and why avoiding movement delays recovery.","strengths":["Multimodal programmes are recommended by vestibular practice guidelines","A randomised trial showed lasting benefit in patients over 50","Low risk, and needs no equipment"],"limitations":["Every outcome in the systematic review graded very low certainty","Fewer than half of eligible patients are referred, and many do not finish","Prehabilitation before vestibular nerve surgery did not speed recovery"]},"route":"/technologies/rejuv-rehab-balance-vestibular/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"},{"id":"vestibular-schwannoma","kind":"cancer","name":"Vestibular schwannoma (acoustic neuroma)","route":"/cancers/vestibular-schwannoma/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"cancer-treatment-bone-loss","kind":"technology","name":"Bone loss caused by cancer treatment, and what rebuilds it","route":"/technologies/cancer-treatment-bone-loss/"},{"id":"rejuv-rehab-cancer-rehabilitation","kind":"technology","name":"Cancer rehabilitation: the discipline that puts function back","route":"/technologies/rejuv-rehab-cancer-rehabilitation/"},{"id":"hearing-after-platinum-chemotherapy","kind":"technology","name":"Hearing and tinnitus after platinum chemotherapy","route":"/technologies/hearing-after-platinum-chemotherapy/"},{"id":"cipn-recovery-and-treatment","kind":"technology","name":"Nerve damage from chemotherapy: what recovers, and what helps","route":"/technologies/cipn-recovery-and-treatment/"},{"id":"exercise-prescription-after-cancer","kind":"technology","name":"The exercise prescription after cancer: the dose the guidelines state","route":"/technologies/exercise-prescription-after-cancer/"},{"id":"rejuv-rehab-commissioning-inequity","kind":"technology","name":"Where rehabilitation is commissioned, and who misses out","route":"/technologies/rejuv-rehab-commissioning-inequity/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"peripheral-neuropathy","kind":"term","name":"Peripheral neuropathy (chemotherapy-induced)","route":"/terms/peripheral-neuropathy/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}