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  • Dr. Sandra Tricomi, PT, Cert. MDT

Vestibular Physical Therapy for Vertigo

Dizziness is a common disorder that affects millions of people each year. Not all health care practitioners know how to effectively treat it. Many have a difficult time deciding where to refer patients for proper treatment.




Symptoms of dizziness include vertigo or a spinning sensation, light-headedness, visual disturbances, nausea, vomiting, decreased ability to concentrate, and decreased balance. These symptoms can impact daily life and cause secondary issues such as anxiety and depression. Patients frequently live with these symptoms for a long period of time; that often leads to an adapted lifestyle to avoid activities that bring on symptoms.


Anatomy of the Ear

In order for the body to feel balanced, the brain requires input from the eyes, ears, muscles and joints. The balance system is complex which makes diagnosis of dizziness difficult and it sometimes takes a team of medical specialists in order to find the correct problem. There are 3 parts of the ear; the outer ear, the middle ear, and the inner ear. When you have a true sense of vertigo where the world is spinning, the culprit is most likely the little tubes in the ear called the semicircular canals. These canals are located in the inner ear and it tells us what direction our head is rotating. When you bend forward, backward, turn, or bend these little tubes send powerful signals to the brain to let you know where your head is moving in space. The tubes are lined with hair cells called cilia, which are the receptors for balance. The tubes are also filled with fluid called endolymph. When your head moves, the fluid moves inside the tubes and stimulates the hair cells. This entire system is connected to your eyes, so that when you move your head one way your eyes move in the opposite direction.


What causes Vertigo?

Dizziness can be caused from many different things. One very common cause is Benign Paroxysmal Positional Vertigo or BPPV. This condition occurs when tiny crystals within your inner ear become loose and begin floating around your vestibular organ. When they begin moving, vertigo occurs which is a moderate to severe spinning sensation that can cause nausea, vomiting, and decreased balance. These sensations can be severe at first and then get better as the days go on. Treatment may be needed in order to resolve the symptoms.


Another cause of dizziness is orthostatic hypotension. This is also called low blood pressure. It occurs when you move from a lying down position to a sitting or standing position. The blood does not flow fast enough to the brain and dizziness is a result. An evaluation by your doctor is necessary so the right treatment can be implemented.


Migraines can also be a cause of your dizziness. Vestibular migraine is a very common central disorder, which means the cause is not due to a problem with your vestibular organs in the inner ear.


Vestibular migraine is a nervous system problem that causes dizziness in persons who suffer from migraine headaches or visual migraines. You may not always have a headache with this type of disorder but the dizziness persists. Symptoms include vertigo that can last minutes to days, decreased balance, nausea, visual disturbances, sensitivity to light, sounds, or smell, and also a history of motion sensitivity. Vestibular migraine can be difficult to diagnose but there commonly is a family history of migraines or a past history of migraines even if they occurred years ago. Treatment may include medication, Vestibular Rehabilitation Therapy (VRT), and diet changes to avoid triggers. Seeing the doctor or physical therapy specialist for proper diagnosis is the first step to resolving the symptoms.


Vestibular Neuritis causes moderate to severe dizziness that can last hours or days with moderate to severe nausea and vomiting and decreased balance. This condition involves damage to the nerve of the inner ear called the vestibulocochlear nerve. This nerve sends information about balance and head position from the inner ear to the brain. When this nerve is swollen or inflamed the information is disrupted and the brain does not interpret the data correctly and symptoms of sudden and severe dizziness or vertigo result. Vestibular Neuritis is most likely caused from a viral infection of the inner ear. Treatment can include medications to control symptoms and vestibular rehabilitation therapy.


Meniere’s syndrome is when there is a problem with the fluid balance regulating system in the inner ear. It usually occurs in one ear but both ears can be affected. Symptoms include episodes of dizziness, ringing in the ears, hearing loss, and nausea and vomiting. Treatment includes following a low salt diet and limiting caffeine and alcohol intake. Possible surgery and or vestibular rehabilitation therapy.


Physical Therapy Evaluation

Physical therapy for dizziness is called Vestibular Rehabilitation Therapy and is very beneficial for the recovery of vertigo and balance disorders. During the first visit, the physical therapy specialist will perform an evaluation to assess symptoms. They will perform an eye exam and a neurological exam to find out how well the eyes and ears are working together. An assessment of balance may also take place. As a result of the tests, the therapist will implement a specialized rehabilitation program that is tailored specifically for the patient so that the patient can recover as quickly as possible.


Treatment

The first goal of treatment is to decrease the intensity of dizziness as quickly as possible and to recover the balance and reduce the risk of falling. Dizziness may persist for a while even after starting treatment. This is normal and should decrease as treatment continues as long as the exercises are performed regularly. Exercises progress slowly depending on the patient and the severity of symptoms. Exercises incorporate a variety of eye movements, balance activities, and coordination exercises.


Prognosis

Within the first few weeks of treatment, symptoms of dizziness begin to lessen and function improves. Balance also begins to return. Each patient regains function differently and it depends on the specific diagnosis and severity of symptoms. Almost all patients see improvement within a few days to weeks.


If you have been suffering with dizziness, vertigo, decreased balance, and or nausea it may be a vestibular disorder that can be treated with vestibular rehabilitation therapy. Capital Region Physical Therapy has helped many patients that had vestibular symptoms lasting from days to many years. Give us a call today at 518-439-5006 for an evaluation and to start the road to recovery from your dizziness now.


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