Vertigo and Vestibular Rehabilitation
Nov 18, 2020
Vertigo, either from BPPV (Benign Paroxysmal Positional Vertigo) or as a result of vestibular dysfunction, is a very debilitating condition. People with vestibular disorders often experience problems with vertigo, dizziness, visual disturbance (nystagmus) and/or imbalance. Other symptoms that may also accompany the dizziness or spinning feeling are: nausea/vomiting, loss of concentration and fatigue, loss of hearing/ tinnitus, headache and /or neck pain and stiffness. These are secondary to the vestibular disorder.
Apart from the social and economic impact on the patient, one of the consequences of having a vestibular disorder, is that the symptoms often lead people to adopt a sedentary lifestyle in order to avoid bringing on, or worsening the dizziness and imbalance that occurs with movement. This in turn leads to decreased muscle strength and flexibility, increased joint stiffness and reduced stamina.
Vestibular Rehabilitation is a special form of therapy designed to alleviate the primary and secondary problems such as the dizziness associated with head movement, improve balance and thus improve function.
Therapists at Ramsay Health Plus Thirroul, located in Lawrence Hargrave Hospital, are trained in both assessment and treatment of vestibular disorders. Often, patients are assessed as having poor balance and are referred for general rehabilitation and reconditioning, when sometimes they have poor vestibular function. Once this is addressed, they go on to make a good recovery.
BPPV is the most common vertiginous disorder in the community:
- Symptoms – can be induced by a change in head position; e.g. turning over in bed, lying down in bed or after visits to the hairdresser/ dentist, looking up or stooping.
- Treatment with anti-nausea medication, e.g. Stemetil, whilst helpful, will only treat the nausea, not the primary condition.
- Whilst home treatment with modified manoeuvres can also help, it must be done with speed and often patients do not get correct positioning or speed to be effective.
- It can last for hours, days, months, years and can be recurrent.
- It can occur post head injury or an episode following vestibular neuritis/ period of bed rest
- 2.4% of the population may get one incident in their lifetime
- 9% of aged care residents have BPPV
- Affects mostly women aged > 50 years and it has been postulated that osteopaenia / osteoporosis may be a cause of otoconia (crystals deposited in the semicircular canals), in BPPV.
Assessment and treatment for BPPV can often resolve the signs and symptoms very quickly, so there is little need for patients to have to “put up with the vertigo”. Often they may only require 1-2 treatments. Assessment with the head positioning such as Dix-Hallpike or Supine head roll are performed to diagnose which canal is affected. Then the patient will need to have the CRM (canal repositioning manoeuvres) performed, such as Epley or Semont, (for the Posterior canalithiasis) or the BBQ roll or Gufoni CRM, for the rarer horizontal canal involvement.
Vestibular Rehabilitation training (VRT), for disorders such as vestibular neuritis, however can take longer for the compensatory changes to occur and thus bring about improvement. Compensation occurs for many naturally over time, however for patients whose symptoms do not reduce and continue to have difficulty with daily activities, then VRT can assist in the recovery by promoting compensation. Patients will be started on a programme of head and eye movements and balance exercises, and given these as a home exercise programme, with monitoring for a few weeks to months.
A summary of vestibular diagnosis and treatment options:
Cited Meniere’s Disease: BMJ 2014;349:g6544
Should the dizziness be assessed as cervicogenic in origin, rather than vestibular, that too can also be treated with mobilisation and exercise for the cervical spine.
At Ramsay Health Plus Thirroul, sessions are 45 minutes for the initial assessment and therapy, and 30 minutes for subsequent visits.
If you have a patient that you feel could benefit from treatment with our experienced therapists, an appointment can be made by calling Ramsay Health Plus Thirroul on 02 4268 9127.
Written by Virginia Rowland, Senior Physiotherapist at RHP Thirroul
Virginia Rowland is a senior physiotherapist at RHP, Lawrence Hargrave Hospital, Thirroul. She has a post graduate Diploma in Manipulative Physiotherapy, and is currently works with outpatients which has been her passion for the past 35 years. Virginia has had her own private practice in Nowra for 26 years, before moving to the Illawarra five years ago.
Whilst she has always had an interest in musculoskeletal assessment and treatment, especially vertebral work, she has been able to further her experience since moving up here, in the assessment and treatment of Vestibular Rehabilitation and Temporomandibular (TMJ) treatment techniques.
Ramsay Health Plus Thirroul
Phone: 02 4268 9127
Fax: 02 4268 9140