What We Learned at the Midwest Vestibular Symposium 2026

Dizziness, vertigo, balance problems, and concussion-related symptoms can be incredibly complex for both patients and healthcare providers. At the 2026 Midwest Vestibular Symposium, vestibular specialists from across the country gathered to discuss the latest research, treatment strategies, and clinical advancements in vestibular rehabilitation.

One of the biggest themes throughout the conference was that successful treatment requires looking at the whole person. Vestibular disorders are rarely straightforward, and symptoms often involve overlapping systems including the inner ear, vision, cervical spine, balance control, and nervous system regulation. The symposium reinforced the importance of individualized care, interdisciplinary collaboration, and improving patient access to vestibular specialists.

Here are some of the biggest takeaways we learned from this year’s symposium and how they can help patients struggling with dizziness, concussion symptoms, balance disorders, and persistent motion sensitivity.

1. We Can Improve Access to Care

   • Despite advancements in vestibular rehabilitation and knowledge of vestibular disorders, it can still be challenging for patients to access proper care.  In physical therapy, vestibular specialists can help close this gap by offering rehabilitation services via telehealth. Telehealth is an excellent option for individuals with dizziness who are:  far from a clinic, do not have flexibiltiy in their schedule to commute to a clinic, become too symptomatic and dizzy in a vehicle, or who are unable to drive themselves.  Research shows that for individuals with good safety awareness and practices, that telehealth for conditions such as BPPV, Vestibular Migraine, Meniere’s and even PPPD is highly effective. 

2. It is Essential to Not Ignore the Neck

   • The cervical spine (neck) can be a primary driver of dizziness symptoms following concussion and whiplash injuries.  Most often, changes in proprioception (how position of head is reported to the brain) is the reason why.  The neck also helps with postural control of the body and eye stability/motor control.  Therefore, symptoms from the neck can be quite similar to those caused by vestibular disorders.  Changes in the neck can result in a sensory mismatch with other sensory contributors to balance (like vision and vestibular input) and cause dizziness.  We should be testing the neck directly to determine if the cervical spine is a driver behind dizziness symptoms based on pt history and presentation.  Follow dizziness exercise guidelines by not pushing too far into symptoms, as that can result in a setback and reduced tolerance of exercises.

3. PPPD – Persistent Postural Perceptual Dizziness – Is Treatable With the Right Combination of Interventions Specific to the Patient

   • Following a vestibular or traumatic event, PPPD is a sense of dizziness that occurs and lasts 3 months or longer.  Symptoms are present particularly while someone is moving.  Successful treatment requires a comprehensive approach that considers all of the sensory input needed for successful balance (vision, vestibular, somatosensory), and includes a focus on that as part of the rehabilitation process.

4. Vision has an important role in vestibular rehabilitation

   • Vision is, essentially, a third of the sensory input required for balance and postural stability.  The eyes have connections via reflexes with the vestibular system and cervical spine.  These reflexes help to coordinate the motor (movement) output of the eyes, including tasks such as smooth pursuits (tracking a moving object with just the eyes), saccades (rapidly looking back and forth between targets), accommodation (keeping an image clear on one eye as it moves toward/away from you), and vergence (keeps an image single on the retina as it moves toward you).  Because of the relationship between the eyes and the inner ear, vestibular disorders can have a huge impact on vision, and vice versa.  Not only is it important to ensure these relationships are functioning properly, but it is important to ensure that the musculature and orientation of the eye is also within normal parameters.  Dysfunction anywhere along this system can create and contribute to perceptions of dizziness.

5. The diagnoses used in PT do not have to match the script

   • Common medical diagnoses may not match the diagnoses written by a physical therapist on an evaluation, and that is to be expected.  Medical diagnoses describe the origin of pathology that is affecting a system of the human body.  When an individual goes to physical therapy, the PT is looking at how that particular medical diagnosis impacts the quality of movement and function of that individual.  In terms of balance and stability, there are advancements coming in the classification of movement dysfunctions affecting these systems to be more specific in terms of a medical diagnoses affect on static postural control (keeping balance when not moving), anticipatory postural control (adaptations we make when we think our balance will be challenged), and reactive postural control (how we move and stay steady after our stability has been challenged).  Developing these movement dysfunction categories will allow PTs to clearly explain to others specific balance dysfunctions, as well as understanding other’s documentation more clearly.

6. Determining a Vestibular Diagnosis is Complex

   • When we evaluate someone with complaints of dizziness in a physical therapy setting, the information provided by the patient is essential to arrive at 2-3 potential diagnoses to rule out.  Many patients present like an onion, and it takes time to get through all of the layers ot the dysfunction to determine the root cause.  When diagnostic testing is often “normal”, determining a vestibular diagnosis can be a frustrating process for the patient.  A vestibular PT must continue to question the exams used, the results of the test, and the “why” behind it.  By continuing to sift through the layers of dizziness, it is possible to determine the cause of the symptoms.

7. PT Should Be The First Stop for Many Things

   • Physical Therapists are often the last healthcare providers a patient will see along their journey.  However, PT’s are qualified to move up on that list and have a greater role as a primary care provider.  People can make PT’s their first stop when they have things like musculoskeletal problems, dizziness, or are interested in wellness.