Should You Try Vestibular Rehabilitation Therapy for Your Dizziness or Vertigo?

Feelings of dizziness, vertigo, and loss of balance are more common than most people realize; 42% of the United States population (ninety million people) experience this at least once during their lifetime, and for many the situation becomes chronic. In the elderly, dizziness is the most common reason that people over seventy five visit a doctor, and for people over sixty five, falls resulting from a loss of balance are the number one cause of serious injury and death.

Approximately three-fourths of these cases of loss of balance and dizziness are caused by peripheral vestibular disorders that affect the inner and middle ear, such as labyrinthitis, perilymphatic fistula, vestibular neuritis, acoustic neuroma, benign paroxysmal positional vertigo (BPPV) and Ménière’s disease. These disorders cause abnormalities in the delicate areas of the inner ear that disrupt our ability to maintain and control our sense of balance. Although most cases of chronic vertigo and dizziness occur in adults, the condition can affect children suffering from it even more, because they are so active that a lack of balance can prevent them from engaging in sports or other activities.

These conditions can be treated with drugs and surgery, but there is another treatment methodology that uses physical therapy to stimulate and retrain the vestibular system and provide relief – Vestibular Rehabilitation Therapy (VRT). Vestibular Rehabilitation Therapy exercises are prescribed individually for each patient’s specific symptoms and often involve the use of eye exercises, head movements and gait training designed to improve patients’ gaze and stability. VRT cites its goals as seeking to improve balance, decrease the experience of dizziness, improve patients’ stability when moving or walking, improve coordination, minimize falls, and reduce anxiety.

For many people suffering from bilateral or unilateral vestibular loss and the conditions described above, Vestibular Rehabilitation Therapy has often been shown to be effective in reducing their symptoms. Several studies have confirmed VRT’s effectiveness in patients who did not respond to other treatment methodologies. On the other hand, VRT is not as likely to be beneficial if the underlying cause of vertigo or dizziness is due to transient ischemic attacks (TIA), anxiety or depression, reactions to medications, migraine headaches or low blood pressure.

Because the specific exercises in a regimen of VRT vary according to the patient’s symptoms and conditions, it is not easy to give an overview of them. But most of the exercises involve therapist-led movements of the head and body to help your brain and body retrain themselves to compensate for the erroneous information they are receiving from their inner ear, and thus regain control over their balance and equilibrium. Consult a balance specialist if you have experienced vertigo or dizziness for long periods of time, and if an inner ear cause of the problem is indicated, ask for more information about Vestibular Rehabilitation Therapy. You may also want to contact the Vestibular Disorders Association and take advantage of many of their short publications and resource materials.

What Is It and How Is It Treated

Vertigo – a perception of movement in which the individual or the individual’s surroundings seem to spin and move – is, generally an unpleasant event. The feelings of vertigo occasionally include dizziness, spinning or falling. Any time vertigo impacts balance, it can lead to falls and accidental injuries – especially in older adults. More serious cases may also trigger nausea, vomiting, migraine headaches, fainting and visual irregularities called nystagmus.

There can be many causes for vertigo, but one kind of it – benign paroxysmal positional vertigo, or BPPV – relates to hearing. BPPV occurs from calcium crystals that form naturally known as otoliths or otoconia, which in most people cause no problems. In benign paroxysmal positional vertigo, the crystals travel from their normal locations into the semicircular canals of the inner ear. When this occurs, and the individual with BPPV changes the orientation of their head relative to gravity, these crystals move around, resulting in an abnormal displacement of endolymph fluid, which leads to vertigo.

Everyday actions such as tilting your head, looking up and down or rolling over in bed can bring about the benign paroxysmal positional vertigo. The vertigo sensation comes on very suddenly and has a short duration. These symptoms can be made worse by lack of sleep, anxiety, or changes in barometric pressure, such as occur before rain or snow. The condition can manifest itself at any age, but it most commonly appears in people over age 60. The initial trigger for the benign paroxysmal positional vertigo is typically difficult to determine. A sudden blow to the head (for example in an automobile accident) is among the more well-known causes.

Benign paroxysmal positional vertigo is different from other forms of dizziness or vertigo because the episodes are transient (typically under a minute), and because it is always triggered by head movements. Vertigo specialists may diagnose it by having the patient rest on their back and then tilt their head to one side or over the edge of the examination table. Additional tests which can be used to diagnose benign paroxysmal positional vertigo include videonystagmography or electronystagmography, which test for abnormal eye movement, and magnetic resonance imaging (MRI), whose primary role is to eliminate other potential causes, such as brain abnormalities or tumors.

There is no full cure for benign paroxysmal positional vertigo, but it can be effectively treated using canalith repositioning (either the Semont maneuver or the Epley maneuver), both of which use bodily movements to shift the crystals to a position in which they no longer cause trouble.Surgical treatment is an option in the exceptional cases in which these treatments are ineffective. See your health care provider if you have felt symptoms which sound as if they could be related to BPPV, especially if they persist for more than a week.

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