When asked what physical therapists do, most people would answer that physical therapists treat patients who have injuries to their muscles and bones. However, physical therapy can be used to treat a range of diseases, including dysfunctions of the vestibular system (the inner ear, eyes, and brain), which present with symptoms like dizziness.
Physical therapists can treat Vertigo, the most common vestibular dysfunction, with more than 90% success. Vertigo occurs in 20%-30% of the general population so this is a common issue.
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The vestibular organs of the inner ear provide the brain with information about changes in head movement. If the vestibular system is not functioning properly, dizziness, vertigo, imbalance, spatial disorientation, and other symptoms can result.
*Vestibular Disorders Association |
As an example, our patient Jane experienced a feeling of dizziness every morning when she got out of bed. The dizziness would return any time she would look up, which caused her to seek the advice of her regular physician. Her doctor recommended that she see a physical therapist, because physical therapists specialize in diagnosing diseases like Vertigo. Vertigo is a common problem of the vestibular system, the regulatory system that helps the body identify where it is in space, maintaining balance and remaining upright.
Common symptoms of Vertigo include:
- Dizziness
- Feeling “off-balance”
- Blurred vision
- Light-headedness
- Spinning sensations
- Nausea resulting from feeling as if the world around you is moving
- Unexplained loss of balance with position changes during functional activities
An evaluation is used to determine a course of treatment that would be specific to a patient like Jane’s needs. In our example, Jane’s dizziness lasts for 10 seconds, which led her physical therapist to perform tests to either confirm or eliminate the diagnosis of a specific type of benign positional Vertigo, called Byparoxismal Positional Vertigo (BPPV).
Tests in an evaluation can include:
- Looking up
- Maintaining a position until symptoms go away
- Positioning tests
- Moving the head and neck
- Dix-Hallpike test for the inner ear
- Berg Balance Scale
- To assess a patient’s balance, a scale known as the Berg Balance Scale can be performed by a physical therapist which will determine a person’s risk of falls. It has been shown that patients who participate in a vestibular rehabilitation program have shown a statistically significant decrease in their risk of falls in patients with balance deficits as determined by an increase in score on the Balance Berg Scale. (7) The higher the score, the better a persons balance.
In BPPV, calcium crystals called otoconia become dislodged from a sac in the inner ear called the maculae, and freely float in the semicircular canals that make up the inner ear. These canals are lined with hair follicles that send signals to the brain indicating the position of the head and body. When the otoconia become free-floating, they drift through the semicircular canal stimulating the hair follicles, to make the body believe the head is moving. This phenomenon can produce the sensation of dizziness.
Treatment for those who are experiencing dizziness can be as simple as repositioning maneuvers designed to eliminate the occurrence of vertigo with position changes, balance training to assist in preventing falls during daily activities, stretching and strengthening exercises designed to improve balance during standing and walking. Repositioning maneuvers have been documented to relieve the symptoms of 96% of patients suffering from Vertigo. Balance training can help patients suffering from Vertigo and other vestibular disorders to avoid falls, because patients who suffer from dizziness are 8 times more likely to experience falls.
Balance Activities:
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Vestibular Exercises:
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There are several parts of the vestibular system that when not functioning properly will cause patients to experience symptoms. Identifying the exact cause of symptoms expedites the recovery process.
The vestibular system includes:
- Semicircular canals – anterior, posterior, and horizontal canals respond to angular position changes of the head
- Otoliths – lined with hair particles that have spontaneous firing rates that respond to gravitational orientation changes
- Vestibular nerve – last link in the pathway ascending and descending into the vestibular nuclei
- Vestibular nucleus – located in the brain stem, provides information to the brain
- Labyrinthe and cochlea – help the inner ear maintain equilibrium for the body
Having an assessment performed by a licensed physical therapist can help you identify and overcome issues related to dysfunctions of the vestibular system.
Krysia Cierkowski, PT
Clinical Director
329 Culver Road, Monmouth Jct.
References
- Agrawal, Y. Archives of Internal Medicine, May 25, 2009; vol 169: pp 938-944.
- Dorigueto RS; Mazzetti KR; Gabilan YP; Gananca FF. Benign paroxysmal positional vertigo recurrence and persistence. Brazilian Journal Of Otorhinolaryngology [Braz J Otorhinolaryngol] 2009 Jul-Aug; Vol. 75 (4), pp. 565-72.
- Gans RE, Harrington-Gans PA. Treatment efficacy of benign paroxysmal positional vertigo (BPPV) with canalith repositioning maneuver and semont liberatory maneuver in 376 patients. Hearing Seminar 2002; 23(2): 129-142.
- Giray M; Kirazli Y; Karapolat H; Celebisoy N; Bilgen C; Kirazli T. Short-term effects of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction: a randomized controlled study. Archives Of Physical Medicine And Rehabilitation [Arch Phys Med Rehabil] 2009 Aug; Vol. 90 (8), pp. 1325-31.
- Ishiyama G. Imbalance and vertigo: the aging human vestibular periphery. Semin Neurology 2009, Nov; 29(5): 491-499.
- Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008 Nov; 14(6): 355-64.
- Macias JD, Massingale S, Gerkin RD. Otolaryngol Head Neck Surgery. 2005; 133(3): 323-325.
