By: Dr. Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN
Vertigo or dizziness refers to the sensation of spinning or disorientation that occurs as a result of a disturbance in a person's balance or equilibrium. It also may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. Vertigo usually occurs as a result of a disorder in the vestibular system. The vestibular system as a whole is a system of peripheral organs and central based neurons that your body uses to maintain its upright positioning and orientation in space. It is comprised of structures of the inner ear, the vestibular nerve, brainstem, and cerebellum. The vestibular system is responsible for integrating sensory information as the body or its surroundings move keeping objects in visual focus.
When the head moves, signals are transmitted to the labyrinth in the inner ear which is structure that is made up of three semicircular canals surrounded by fluid. The labyrinth then transmits movement information to the vestibular nerve which carries the information to the brainstem and cerebellum. The brainstem and cerebellum are areas of the brain that control balance, posture, and motor coordination. Disorders of the vestibular system can cause dizziness, vertigo, imbalance, hearing changes, nausea, fatigue, anxiety, and difficulty concentrating. These symptoms can potentially have devastating effects on a person's day-to-day functioning.
Vertigo is one of the most common health problems in adults. According to the National Institutes of Health (NIH), about 40% of people in the United States experience a feeling of dizziness at least once during their lifetime. There are two types of vestibular disorders, peripheral vestibular disorders and central vestibular disorders. The sudden onset of vertigo usually indicates a peripheral vestibular disorder. Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo. It usually lasts a few seconds to a few minutes and is intermittent, or comes and goes. It may include lightheadedness, imbalance, and nausea, and is usually the result of a change in position, such as rolling over in bed or getting out of bed. Benign Paroxysmal Positional Vertigo (BPPV) occurs when debris made up of calcium carbonate and protein, called otoliths or ear crystals, becomes displaced in the labyrinth portion of the inner ear. This displacement causes abnormal sensations when the head is moved in relation to gravity and is perceived by your brain as confusion or "Vertigo." Statistically BBPV accounts for 50% of the dizziness in individuals over the age of 65.
Vertigo caused by a central vestibular disorder usually develops gradually and may include symptoms such as; double vision, headache, lack of coordination, nausea and vomiting, and weakness. This is due to damage in the central or brain portion of the vestibular system. There are many causes of vertigo due to central vestibular disorders that may include; cardiovascular disorders, stroke, head trauma, migraine, multiple sclerosis, and tumors that may affect the central vestibular system.
It is important to diagnose the cause of vertigo, or dizziness, as quickly as possible to rule out serious conditions such as cardiovascular disease, stroke, hemorrhage, or tumor. Following a thorough examination your medical practitioner can make the appropriate diagnosis. Some important considerations to keep track of for your physician to assist with the proper diagnosis are; what triggers the vertigo, what symptoms occur, how long does the dizziness last, and what improves or worsens symptoms.
If your physician determines that your vertigo is peripheral and positionally based you may be referred to a physical therapist that is trained in a canalith repositioning maneuver. This is a maneuver in which a Physical Therapist trained in performing canalith repositioning techniques through changing your head position and orientation in space can reposition your displaced canaliths or ear stones helping to resolve your vertigo. With the correct diagnosis and the correct canalith repositioning technique positional based vertigo can be corrected in just a few treatments.
If your physician determines that you may be suffering from central vestibular dysfunction or if following a treatment for BPPV you still are suffering from residual imbalances, you may be referred by your physician to a Physical Therapist trained in vestibular rehabilitation therapy (VRT). Vestibular rehabilitation therapy is a type of physical therapy used to treat vertigo and imbalance. The goal of treatment is to minimize dizziness, improve balance, and prevent falls by restoring normal function of the vestibular system. In VRT, the patient performs exercises designed to allow the brain to adapt to and compensate for whatever is causing the vertigo. In most cases, patients visit the therapist and are instructed in custom-designed exercises to be performed at home, several times a day. As the patient progresses, difficulty of the exercises increases until the highest level of balance is attained, or until the vertigo resolves. Often, VRT is so successful that no other treatment is required.
Physical Therapy is a physician referred specialty. If your medical practitioner determines that you suffer from a form of vertigo they may discuss with you a referral to physical therapy for a canalith repositioning maneuver or vestibular rehabilitation therapy. All physical therapists are not trained in vestibular rehabilitation so it is important when referred by your physician you see a Physical Therapist that is adequately trained. For further information on this topic or if you would like to speak with someone who has experience and is trained in vestibular rehabilitation you can contact Brian P. Kinmartin PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN at Professional Rehabilitation Services in Pawleys Island, SC at (843) 235-0200.