Vertigo, Balance and Gait

What is Vertigo?

It is often described as dizziness, sense of rotation, light headedness, spinning in the head, nausea, or trouble walking.

Benign paroxysmal positional vertigo, BPPV for short, is perhaps the most common cause of vertigo in adults. Fortunately, it is very simple disorder to manage. Symptoms remit with one treatment in more than 85% of cases.

Symptoms usually occur spontaneously in many patients, but may follow head trauma, labyrinthitis (inflammation in inner ear), or problems with the anterior vestibular artery.

Symptoms of BPPV:
Patients commonly report vertigo triggered by lying down, rolling over in bed, bending over, and looking up. Common situations in which vertigo is provoked include getting out of bed, gardening, washing hair, and going to the dentist. Sometimes, individuals report balance problems that may last for hours or days after the episodic vertigo has stopped.

Cause:
Collections of tiny crystals of calcium carbonate known as otoconia or otoliths lie in the labyrinth of the inner ear. In patients with BPPV, the otoconia are dislodged from their usual position within the utrticle and migrate into one of the semicircular canals. When the head is still, gravity causes the otoconia to clump and settle. When the head moves, the otoconia shift. This stimulates the cupula to send false signals to the brain, producing vertigo and triggering involuntary eye movements.

How Physical Therapy Can Help:

Your physical therapist will base your plan of care off of an evaluation, as well as your goals for recovery. The evaluation will consist of an interview, followed by a review of your medical history and tests and measures to properly diagnose the cause of vertigo. Specific treatments will depend on the cause of your vertigo. Your therapist’s main focus is to help you get moving again and manage the vertigo at the same time. Treatment may include specialized head and neck movements or other exercises to help eliminate your symptoms. Conditions such as benign paroxysmal positional vertigo have very specific tests and treatments.

If you have dizziness and balance problems after your vertigo has stopped, your physical therapist can develop a treatment plan that targets those problems. Your physical therapist will teach you strategies to help you cope with your symptoms such as:

  • habituation exercises
  • eye exercises that retrain the vestibular ocular reflex
  • balance retraining exercises
  • Vestibular rehabilitation may not work for everyone. In some cases medication or surgery is necessary. Vestibular rehabilitation is a great starting point that is drug-free and with a high success rate.