Physio Logic Vestibular Rehabilitation Specialist and Physical Therapist, Dr. Klaus Dobra, PT, DPT, CSCS, explains the causes, symptoms, and treatment of Vertigo and Vestibulopathy, by using Vestibular Rehabilitation.
Greetings from your friendly, neighborhood vestibular therapist! Today in Physical Therapy, we will be exploring the fundamental differences between the two most common abnormalities of the vestibular system, how to differentiate them, and what a course of rehab consists of in order to address those symptoms. Life will always have ups and downs, but that feeling should never be a literal sensation of being on a boat. So, let’s talk about dizziness!
Vertigo A.K.A. Benign Paroxysmal Positional Vertigo, or BPPV
One of the most common reasons people seek vestibular therapy is for the ever elusive, and always annoying, Benign Paroxysmal Positional Vertigo, or BPPV. This is one of my favorite conditions to treat because I look like a superhero by the end of the session! All jokes aside, this condition can be treated in five minutes and can alleviate sensations of vertigo and dizziness that many patients complain of having for years. YEARS! General symptoms consist of the room feeling like it spinning, much a like a carousel but far less fun. These symptoms are usually triggered by a particular positioning of the head. In most cases, people complain of vertigo when they lie their head down on a pillow to go to sleep.
The cause of this condition is of mechanical origin and is not pathological. Simply put, there is no damage to the inner ear! Within the labyrinth of the inner ear, calcium crystals called otoconia, which give us feedback on our position due to gravity, become dislodged from their usual position within their housing organ, the utricle. These crystals then migrate into one of the semicircular canals, more commonly the posterior canal, that give us feedback on our velocity through space. So, when the head moves, the crystals move through those canals and trick our brain into thinking we are moving! A cruel joke, no doubt. But, as mentioned, and because the problem is the result of something being where it should not be, it can be rectified by merely putting those structures back. So, within the span of five minutes, and the with the skillful head and body maneuvering from yours truly, the otoconia find their way home and the vertigo is resolved.
The other reason people seek vestibular rehab is for a true vestibulopathy. This entails actual physical or chemical damage to the vestibular system as result of damage to the organ itself, or from impaired neurological or vascular input to it. This usually presents in a variety of ways including, but not limited to, general dizziness at rest or with head turning, feelings of unsteadiness liking to being on a boat, or a sense of nausea similar to motions sickness. Unfortunately, no amount of skill in the world can resolved this in a matter of minutes. But, there is hope nonetheless! Through carefully chosen and specifically catered exercises based on the patients individual presentation, the vestibular system can be calibrated to once again give the individual an accurate sense of where they are in space and how they are moving through it. And you can get back to everything from walking down the street to base jumping.
The brain and body are a funny thing. They rely on this perfect sense of homeostasis, or balance, in order to function optimally. But, as we know and know well, the world is in an imperfect place, and we cannot always control the way we interact with it and how it will affect us. Alas, there are places and people that are there to help you get as close to perfect as you possibly can. So you may live, play, and thrive.