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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.
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.
Vestibular 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.
What 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.
The 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.
Prehabilitation 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.
Referral 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.
What 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.
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.
Query for this technology: (TITLE:"Balance, dizziness and falls after cancer treatment" OR ABSTRACT:"Balance, dizziness and falls after cancer treatment") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Balance, dizziness and falls after cancer treatment, not a curated reading list.
Shares Where rehabilitation is commissioned, and who misses out, Cancer rehabilitation: the discipline that puts function back, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Where rehabilitation is commissioned, and who misses out, Cancer rehabilitation: the discipline that puts function back, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, The exercise prescription after cancer: the dose the guidelines state, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, The exercise prescription after cancer: the dose the guidelines state, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Where rehabilitation is commissioned, and who misses out, Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, The exercise prescription after cancer: the dose the guidelines state, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
Shares Hearing and tinnitus after platinum chemotherapy, Where rehabilitation is commissioned, and who misses out, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.