Vestibular disorders refer to a group of conditions that affect the vestibular system, which is responsible for maintaining balance, spatial orientation, and coordination of eye movements. The vestibular system comprises structures in the inner ear and the brain that work together to provide sensory information about head position, motion, and equilibrium.
When the vestibular system becomes disrupted, it can result in a variety of symptoms and conditions known as vestibular disorders. These disorders can have a significant impact on a person’s daily life, causing symptoms such as dizziness, vertigo (a spinning sensation), imbalance, nausea, and difficulty concentrating.
Physical therapy, particularly vestibular rehabilitation therapy (VRT), is strongly advised by therapists if you or someone you love suffers from a vestibular disorder.
What is Benign paroxysmal positional vertigo (BPPV)?
Benign paroxysmal positional vertigo (BPPV), the most frequent form of vertigo, is brought on by specific head movements such as tilting your head up or down, standing up from lying down, or turning over in bed. The inner ear consists of delicate semicircular canals that are filled with fluid, this fluid moves with your movements. However, sometimes microscopic calcium carbonate crystals get stuck in the semicircular canals. As a result, certain head movements can cause these loose crystals to stimulate the hair cells within the canals, leading to false signals being sent to the brain about the head’s position. This mismatch between the information received from the inner ears and other sensory systems is what causes the vertigo associated with BPPV.
While vertigo symptoms can be treated with medicine, the underlying cause is biomechanical and not addressed with medication. Vestibular rehabilitation maneuvers are helpful in this situation. The main goal is to redistribute the calcium carbonate crystals to their proper location in the inner ear.
The most common VRT Maneuver:
The Epley Maneuver
The Epley maneuver, is a therapeutic technique used to treat benign paroxysmal positional vertigo (BPPV). It is a way to reposition the displaced calcium carbonate crystals within the inner ear. The procedure involves a series of specific head and body movements that encourage the movement of the crystals.
Here is a step-by-step breakdown of the Epley maneuver:
- The patient begins by sitting upright on a bed with their legs extended.
- 2 pillows are placed at the patient’s upper back (not at head level).
- The patient’s head is turned 45 degrees towards the affected ear, the side where the vertigo is experienced.
- The patient is then laid down quickly, maintaining the head turned towards the affected ear and hanging over the edge of the pillows.
- The head is held in this position for about 1 minute, allowing time for the crystals to move within the semicircular canals.
- Next, the patient’s head is slowly turned 90 degrees in the opposite direction, so that the affected ear is now facing downwards.
- The head is maintained in this position for another 1 minute.
- The patient is then rolled onto their side, with the head still facing downwards, maintaining the 90-degree head turn. This position is held for another 1 minute.
- Finally, the patient sits up slowly, while keeping the head turned to the side.
The Epley maneuver aims to guide the crystals through the affected semicircular canal, back into the utricle, where they can no longer cause vertigo symptoms. It can be performed 2-3 times during a single session, if necessary.
Following the Epley maneuver, patients may experience a temporary increase in dizziness or vertigo, which usually subsides within a few minutes. The procedure has shown a high success rate in relieving BPPV symptoms, and patients often report a significant improvement after undergoing the maneuver.
Other Vestibular Disorders
It’s crucial to rule out other possible causes of your vestibular symptoms, such as Ménière’s disease, vestibular migraine, labyrinthitis, and vestibular neuritis. These conditions respond well to VRT exercises.
VRT frequently includes three types of exercises:
- Exercises to train balance.
- Exercises for gaze stabilization: Gaze stability exercises aim to improve the ability to maintain a steady gaze during head movements, helping individuals with vestibular disorders reduce dizziness and improve their visual stability.
- Exercises for habituation: Habituation exercises involve gradually exposing individuals to specific movements or stimuli that trigger their vestibular symptoms, with the goal of reducing sensitivity and promoting adaptation over time.
It’s crucial to remember that VRT is a method that gradually seeks to retrain the brain and vestibular system to aid in reducing the frequency and severity of vestibular symptoms. Vestibular symptoms should start to subside after three to six weeks of consistent VRT sessions. However, the length of physical therapy might differ based on a person’s unique circumstances, including the severity of their symptoms, general health, and compliance with their treatment plan.
Patients frequently report transitory increases in vestibular symptoms in the early stages of VRT. As the brain and vestibular system adapt, this is a typical reaction. Being patient and devoted to the VRT program is crucial. With regular exercise, these symptoms progressively go away, and patients start to see gains in their stability, balance, and general quality of life.
It is advised to get professional care from qualified physiotherapists with experience in vestibular rehabilitation therapy if you or someone you know is experiencing vestibular symptoms. They will do a thorough assessment, create a tailored treatment plan, and lead you through the exercises and techniques most suitable for your circumstance.
Remember that with the correct physiotherapy care, your vestibular symptoms can be managed and even beaten. You can take the first step towards improving your quality of life by contacting a professional today.
Contact Sheddon Physiotherapy and Sports Clinic for more details on physical therapy for vestibular disorders.