This study aims to evaluate the effects of an Ai Chi-based rehabilitation program on balance, dizziness severity, and quality of life in patients with unilateral peripheral vestibular hypofunction. Participants will be randomly assigned to either a control group receiving standard home-based vestibular rehabilitation exercises or an intervention group receiving additional Ai Chi sessions. The intervention will be conducted over a 4-week period with a total of 10 sessions under the supervision of a certified therapist.

Unilateral peripheral vestibular hypofunction is a clinical condition characterized by reduced vestibular function due to inner ear or vestibular nerve pathology. It presents with symptoms such as dizziness, imbalance, visual instability, and impaired postural control, significantly affecting functional independence and quality of life. Diagnosis is typically established by the otorhinolaryngology clinic and supported by vestibular function tests such as videonystagmography (VNG) and video head impulse testing (vHIT).

Vestibular rehabilitation is an evidence-based therapeutic approach aimed at promoting central compensation through mechanisms of adaptation, substitution, and habituation. These mechanisms contribute to the improvement of vestibulo-ocular reflex function, postural stability, and overall functional performance.

Ai Chi is an aquatic exercise program derived from Tai Chi and Qi Gong principles, consisting of slow, continuous, and controlled movements coordinated with breathing. The aquatic environment provides unique therapeutic properties such as buoyancy, hydrostatic pressure, and viscosity, allowing safe movement, reducing fall risk, and enhancing proprioceptive and sensory input. These features may support multisensory integration and facilitate central compensation in patients with vestibular dysfunction.

Although aquatic therapy has been increasingly used in rehabilitation, there is limited evidence regarding the effectiveness of Ai Chi specifically in patients with unilateral peripheral vestibular hypofunction. To the best of our knowledge, no randomized controlled study has specifically evaluated the effects of Ai Chi in this patient population.

In this randomized controlled study, participants will be allocated into two groups. Both groups will receive a standardized home-based vestibular rehabilitation program. In addition, the intervention group will participate in supervised Ai Chi sessions conducted in an aquatic environment over a 4-week period, consisting of a total of 10 sessions. All sessions will be delivered by a certified therapist, and adherence will be monitored using exercise logs.

Assessments will be performed at baseline, immediately after the intervention, and during the follow-up period by a blinded evaluator. The findings of this study are expected to contribute to the development of alternative rehabilitation strategies and provide additional evidence for the management of patients with vestibular disorders.

Inclusion Criteria:

• Age between 18 and 70 years
• Diagnosis of unilateral peripheral vestibular hypofunction
• Presence of dizziness symptoms for at least 3 months
• Ability to participate in Ai Chi and aquatic exercise program
• Berg Balance Scale score ≥21
• Willingness to participate in the study

Exclusion Criteria:

• Inability to complete assessment tests and questionnaires
• Severe systemic disease that may interfere with exercise participation
• Central vestibular disorders
• Berg Balance Scale score ≤20
• Severe visual or hearing impairment
• Initiation or change of psychiatric medication within the last 3 weeks
• Severe cardiopulmonary disease
• Contraindications to hydrotherapy, including water phobia, behavioral disorders, dyspnea at rest, incontinence, known chlorine allergy, open wounds, acute systemic illness, epilepsy, tracheostomy, permanent drainage devices, immunodeficiency, or known neurological disorders

Outcome assessments will be performed by a blinded evaluator who is unaware of group allocation.