Balance & Vestibular Wellness Training (BVWT) is a therapeutic, prehabilitative, and rehabilitative training program based on combining principles and exercises derived from Chinese internal martial and healing arts (Chi Kung, Meditation, Tai Chi Chuan, and Ba Gua Zhang) with the findings of scientific and medical research.

The program was developed by Bill Pagano, a former acoustic neuroma surgery patient and certified Tai Chi, Ba Gua and Meditation instructor with over 20 years of training.

BVWT is a dynamic continuum of instruction and training exercises. Each step builds upon the previous step, yet training can begin at any stage of the patient’s development. The program is uniquely customizable, and can be applied to fit the individual needs and abilities of each patient.

BVWT programs are designed and customized for:

  • Patients experiencing loss of balance and/or dizziness
  • Patients coping with the stresses of undergoing any major surgery
  • Patients recovering from surgical procedures that have temporarily or permanently impaired their vestibular function


Proprioception refers to the neurological systems which allow a person to be aware of the relative positions of the various parts of his or her body, as well as the the force used by the body to initiate and maintain movement of those parts.  It is based on the activity of proprioceptors, specialized neural structures in the body’s muscles and joints, which deliver this information to the brain.

A well functioning proprioception system has been shown to increase postural stability and counter the perception of dizziness. (1,2)  Tai Chi is known to enhance proprioception by a variety of mechanisms,(3, 4) and is considered by many to be better than traditional western Vestibular Rehabilitation at improving whole body stability and foot fall stability.(5)

Tai Chi is one of the Chinese Taoist internal martial arts, along with Chi Kung, Hsing I, Ba Gua, and Meditation. These arts all share a core group of basic principles.

By isolating the principles that best increase proprioceptive awareness and the recruitment of neural pathways, BVWT is more beneficial and more satisfying than traditional western vestibular rehabilitation methods in increasing stability and postural control, and decreasing effects of vertigo and dizziness in patients with impaired vestibular function.


  • Improved postural control
  • Reduced stress
  • Increased strength
  • Increased psychological resilience
  • Increased positive outlook
  • Increased energy and motivation
  • Lifelong techniques for coping with feelings of vertigo, stress, and lack of motivation.


  • Increase postural control and physical stability
  • Decrease stress levels to permit faster healing
  • Increase psychological resilience to promote faster recovery
  • Reduce physical symptoms and perception of dizziness and loss of balance
  • Increase physical strength, stability, and control
  • Provide methods for coping with tinnitus
  • Enhance daily experience and functioning, and overall well-being

BVWT helps recruit neural pathways, improving neuroplasticity to prepare the central nervous system to rely on “new” sensory input to control balance and coordination, as a replacement for lost or diminished vestibular input. The specialized training exercises of BVWT are designed to develop:

  • Proprioceptive awareness
  • Kinesthetic awareness
  • Joint position sense (JPS)
  • Joint stability
  • Control of vestibulo-spinal reflexes
  • Control of vestibulo-ocular reflex

VWT can be broken into four phases:

  • Prehabilitation
  • Post Diagnosis
  • Pre-surgery
  • Rehabilitation

The program is best started upon presentation of symptoms of loss of balance, even before a formal diagnosis is made. Upon diagnosis, the training can either be targeted to a recovery program, or a pre-surgical program. The last phase of the Balance & Vestibular Wellness Training program is post-surgical rehabilitation.

Pre-diagnosis (prehabilitation)
At the onset of symptoms of balance loss and/or dizziness, supervised therapeutic treatments are begun to give the patient a headstart in coping with these changes in their day to day lives. Homework, in the form of unsupervised exercises, is assigned to help the patient integrate techniques learned and prepare the patient to build on their foundation with new techniques added in subsequent sessions.

After the patient is diagnosed, specialized supervised training exercises, and homework, are provided to continue building on the foundations established in prehabilitation. These exercises will further increase stability and postural control based on the patient’s daily activity level and can lead into a program of continuing wellness education.

Personalized training is provided to reduce the physical, mental and emotional stresses of a diagnosis requiring surgery, to strengthen the patient prior to surgery, and to prepare the patient to quickly regain strength and postural control post-surgery. These exercises are designed to reduce stress and build strength and energy to prepare the patient for a successful surgical outcome while continuing to increase stability and postural control.

Post-surgical (rehabilitation)
Post-surgical rehabilitation should begin as soon as possible after surgery, as tolerated. Ideally, training will commence prior to the first walk, before being discharged from the hospital. Exercises will continue at a comfortable pace to help increase movement, reduce instability and build strength until the patient is ready to return to activity levels experienced prior to the surgery.

Continuing Wellness Education
In addition to the aforementioned benefits, VWT provides lifelong techniques to:

  • Lower blood pressure (6, 7)
  • Strengthen the immune system (7, 8, 9)
  • Increase strength and flexibility
  • Increase quality of life and participation in activities

With greatly increased physical intelligence, and emerging integration of mental, physical and emotional well-being, expanded homeostasis and maintenance is achieved. The BVWT “graduate” is well prepared for a healthy, active lifestyle, and poised to gain the greatest benefits from the study of Tai Chi or other healing or martial art.

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1.  Liu J, Wang XQ, Zheng JJ, Pan YJ, Hua YH, Zhao SM, Shen LY, Fan S, Zhong JG.,
Effects of Tai Chi versus Proprioception Exercise Program on Neuromuscular Function of the Ankle in Elderly People: A Randomized Controlled Trial.
Evid Based Complement Alternat Med. 2012;2012:265486.

2. Maciaszek J, Osinski W.
Effect of Tai Chi on body balance: randomized controlled trial in elderly men with dizziness.
Am J Chin Med. 2012;40(2):245-53.

3. Chen EW, Fu AS, Chan KM, Tsang WW.,
The effects of Tai Chi on the balance control of elderly persons with visual impairment: a randomised clinical trial.
Age Ageing. 2012 Mar;41(2):254-9

4. Li JX, Xu DQ, Hong Y,
Effects of 16-week Tai Chi intervention on postural stability and proprioception of knee and ankle in older people.
Age Ageing. 2008 Sep;37(5):575-8

5. McGibbon CA, Krebs DE, Wolf SL, Wayne PM, Scarborough DM, Parker SW.
Tai Chi and vestibular rehabilitation effects on gaze and whole-body stability
J Vestib Res. 2004;14(6):467-78.

6. Yeh GY, Wang C, Wayne PM, Phillips RS.
The effect of tai chi exercise on blood pressure: a systematic review.
Prev Cardiol. 2008 Spring;11(2):82-9.

7. Rogers CE, Larkey LK, Keller C.
A review of clinical trials of tai chi and qigong in older adults
West J Nurs Res. 2009 Mar;31(2):245-79. doi: 10.1177/0193945908327529.

8. Goon JA, Noor Aini AH, Musalmah M, Yasmin Anum MY, Wan Ngah WZ.
Long term Tai Chi exercise reduced DNA damage and increased lymphocyte apoptosis and proliferation in older adults.
Med J Malaysia. 2008 Oct;63(4):319-24.

9. Chiang J, Chen YY, Akiko T, Huang YC, Hsu ML, Jang TR, Chen YJ.
Tai Chi Chuan increases circulating myeloid dendritic cells.
Immunol Invest. 2010;39(8):863-73. doi: 10.3109/08820139.2010.503766. Epub 2010 Aug 18.

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