There is no question that vestibular rehabilitation therapy is the best way to manage most causes of vertigo, dizziness and imbalance. The downside is that there are very few trained specialists in this field competent in diagnosing these disorders and formulating appropriate treatment applications. This field is mostly the domain of the chiropractic neurologist, and there remain very few doctors sub-specialized in this field, especially in NJ. Further, just because a therapist of sorts offers vestibular rehabilitation therapy, it does not mean that it will be done correctly. My office sees a myriad of individuals with these conditions. Several have somehow managed to find a therapist who performs some variation of vestibular rehabilitation therapy. All have failed because the therapy provided was a “canned” approach, and was not formulated specific to the patient being treated. I find that canned treatment approaches, especially pertaining to vestibular rehabilitation therapy, are destined to fail. Treatment protocols must be specifically designed for the patient being managed. If this is not the case, some patients will improve, some will stay the same, and some will worsen.  You can look at an analogy of physical fitness.  If you want to get into shape and hire a trainer, if the trainer says on day one, ok, were going to start with bench pressing 200 lbs., you can see how that will end up for someone who cannot physically do that.  The same thing happens when you exceed someone’s functional capacity with rehabilitation.