physiotherapy treatment for BPPV vertigo

Vertigo, Vestibular Rehabilitation Therapy

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Vestibular Rehabilitation Therapy (VRT) is an exercise-based program for reducing the symptoms of disequilibrium and dizziness associated with vestibular problems like vertigo. ReLiva Physiotherapy provides vestibular rehabilitation with a neuro-otological approach for managing such symptoms at its clinics in Navi Mumbai and Thane.

VRT is an alternative treatment involving specific exercises that can eliminate or significantly reduce symptoms of vertigo by promoting central nervous system compensation for inner-ear deficits. The program is designed to achieve these goals:

  • 1. Decrease dizziness and visual symptoms.
  • 2. Increase balance and walking functions.
  • 3. Increase general activity levels.

Typically the VRT would include:

1. Canalith repositioning maneuver/ Epley maneuver:

Designed for inner ear condition known as Benign Paroxysmal Positioning Vertigo (BPPV). This condition occurs when crystals in inner ear gets dislodged and float in the ear canal. Canalith repositioning maneuvers are very effective in case of BPPV and may require only couple of sessions.

2. Vestibular retraining:

This program would typically include exercises for improving coordination of eye and head movements, balance retraining and desensitization of the vestibular system. This part of the therapy would typically require 8 - 12 sessions. In some cases where significant balance and walking training is required it may require many more sessions.

3. Self Exercise Program:

We educate our clients on the exercises they need to continue to manage their symptoms by themselves at home and continued improvement in fitness and endurance. Person entering a vestibular rehabilitation program needs to undergo a detailed assessment prior to starting the program because not all dizziness is caused by vestibular deficits.

Many times, vertigo is felt due to cervical spondylosis for which a different treatment program is prescribed

What is Vertigo ?

Vertigo is a more like a symptom, rather than a condition itself. It is the sensation that you, or the environment around you, is moving or spinning.

Typically you would feel a loss of balance (which can make it difficult to stand or walk), nauseous and dizzy. Basically the feelings of unsteadiness; wooziness (swimming feeling in head); lightheadedness; feelings of passing out; and sensations of moving, spinning, floating, swaying, tilting, or whirling. These sensations can occur when standing still, lying down or when changing positions.

Feeling of vertigo at times can develop suddenly and may last for a few seconds, or it may last longer. Severe vertigo can lead to constant symptoms which could make normal life very difficult.

What causes Vertigo ?

Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain.

Vertigo, dizziness and imbalance are the frequent symptoms in patients who suffer trauma to the head, neck or craniovertebral junction and can result in peripheral or central vestibular dysfunction.

Once trauma, infection, injury or other underlying causes are ruled out, doctors typically zero in on a diagnosis of either Meniere's disease or Benign Paroxysmal Positional Vertigo (BPPV). These two otherwise benign conditions are the leading causes of vertigo, with a fifth of all cases attributed to BPPV.

Both Meniere's and BPPV result from disorders of the inner ear, which contains the body's balance mechanism. Their causes are not known (they are not caused by injury or infection), but the disturbances affect the sense of equilibrium

What is the recovery Vertigo patient can expect with Vestibular Rehabilitation ?

As per Cleveland Clinic, in most cases, if patients continue to perform the exercises they have learned, balance and dizziness problems decrease significantly or completely disappear.  Read More

Vestibular Disorder Association, USA, says that vestibular rehabilitation can be effective in improving symptoms related to many vestibular (inner ear/balance) disorders.  Read More

Expected vestibular rehabilitation outcomes include:

  • Decreased fall risk
  • Decreased dizziness symptoms
  • Improved balance
  • Improved ability to stabilize vision/gaze
  • Increased body strength
  • Return to prior level of movement/function
  • Increase in confidence in ability to maintain balance
  • Improved neck motion, reduced symptoms

How Common is Vertigo ?

As per Medscape, the overall incidence of dizziness, vertigo, and imbalance is 5-10%, and it reaches 40% in patients older than 40 years. The incidence of falling is 25% in subjects older than 65 years. A report reviewing presentation to US emergency departments (EDs) from 1995 through 2004 indicated that vertigo and dizziness accounted for 2.5% of presentations. The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million.

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