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Vertigo & Vestibular Rehabilitation - What to do when the world is spinning.


Vertigo is characterised by a false sensation of movement of the body or its surroundings, commonly described as spinning, whirling, or a tilting sensation.

It is a symptom of a vestibular condition and the cause of it can either be ‘central’ or ‘peripheral’. Central vestibular conditions originate from within the brain, brain-stem or cerebellum, and peripheral vestibular conditions commonly originate from the inner ear and surrounding nerves. Vertigo can often be accompanied by various other symptoms, including dizziness, nausea, or imbalance.

What is the vestibular system?

The vestibular system is a sensory system in the body that contributes to our sense of balance, spatial orientation, and coordination of movement. It is primarily located within the inner ear, and works in conjunction with the proprioceptive (sensory input from muscles and joints) and visual systems to maintain equilibrium. The mismatch in signals from the inner ear to the brain can disrupt this equilibrium and cause the sensation of vertigo.


Vestibular Conditions

There are a number of vestibular conditions, some more common than others, that can affect the vestibular system. These are some, but not all, that may cause vertigo.

  1. Benign Paroxysmal Positional Vertigo (BPPV): Is caused by the displacement of small calcium crystals (canaliths) within the inner ear. It results in brief episodes of intense vertigo triggered by certain head movements. It is a common vestibular condition and can respond very well to treatment, such as the Epley manoeuvre.

  2. Vestibular Neuritis: Is an inflammation of the vestibular nerve, usually caused by a viral infection. It leads to sudden, severe vertigo that can last for days or weeks, often accompanied by imbalance and difficulty walking.

  3. Labyrinthitis: Is another form of inner ear inflammation, often resulting from a viral or bacterial infection. It causes vertigo, hearing loss, and sometimes ringing in the ears (tinnitus).

  4. Ménière's Disease: Is a rare and chronic condition characterised by recurrent episodes of vertigo, fluctuating hearing loss, tinnitus (ringing in the ears), and a feeling of fullness or pressure in the affected ear. It is believed to be related to fluid buildup in the inner ear.

  5. Vestibular Migraine: Is a type of migraine headache that includes vestibular symptoms such as vertigo, dizziness, and imbalance. These symptoms may occur with or without the typical headache pain and visual disturbances associated with migraines.

Vestibular rehabilitation


It is important to understand that different vestibular conditions require different types of treatment. If you are experiencing any of these symptoms mentioned above we encourage you to consult with a practitioner trained in vestibular assessment and rehabilitation.

The aim of vestibular rehabilitation is to reduce symptoms, improve balance and enhance functional abilities. Here are some common techniques used;

  1. Canalith Repositioning Procedures: This technique is primarily used for benign paroxysmal positional vertigo (BPPV). It involves specific head and body movements to reposition displaced calcium crystals (canaliths) within the inner ear. This form of physical treatment can have rapid effects on vertigo symptoms.

  2. Vestibular Rehabilitation Exercises: These exercises are designed to improve the function of the vestibular system and enhance balance. They may include eye movements, head movements, and balance exercises tailored to the individual's needs.

  3. Gaze Stabilization Exercises: These exercises focus on improving the ability to keep the eyes fixed on a target while the head is in motion. They help reduce dizziness and improve visual stability during everyday activities.

  4. Balance Training: Balance exercises play a crucial role in addressing balance deficits associated with vertigo. Therapists employ various techniques, such as standing on unstable surfaces, to challenge and improve balance control.

  5. Treatment of the neck and back: Sometimes tight muscles and joints of the neck and back can exacerbate the symptoms of vertigo, particularly from the upper neck levels.

  6. Education and Lifestyle Modifications: Education on strategies to manage vertigo symptoms, including tips for minimising triggers and adapting daily activities to improve safety and prevent falls.

Referral

In some cases a referral to a neurologist and liaising with your GP may be required for further investigation and medical intervention such as scans, use of medication, and blood tests. If this is the case, we will discuss the process and what to expect.

Summary

There are many types of vestibular conditions, some more common than others. We know that these can be debilitating and are not something you should put up with! If you or someone you know is struggling with vertigo please reach out to us. After a thorough assessment, we will make a treatment plan specific to your needs with the goal of improving symptoms, and getting you back to your best self.


At Balance Health we have Physiotherapists Tim Tracy and Kara Cassells, trained to provide vestibular assessment and rehabilitation

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