Vestibular Rehabilitation: Vertigo



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Benign Positional Vertigo (BPPV) is the most common cause of dizziness in people over the age of 50. This is one of many conditions that affects the vestibular system and results in dizziness. Inside the inner ear is an apparatus that contains otoconia (crystals). Under normal conditions the crystals are contained in the otolith organs (saccules and utricles). Under abnormal conditions the crystals are displaced into either the cupula or semicircular canals causing transient spinning or horizontal movement of objects in the room. In some cases individuals experience nausea, vomiting and persistent dizziness even beyond provocative positions. With the proper diagnosis BPPV is easily rectified with Canalith Repositioning Maneuvers.

Unilateral Vestibular Hypofunction occurs as a result of insult to the peripheral vestibular system which is made up of the labyrinth, and vestibular nerve. It occurs as a result of trauma, viral insult, decreased receptors or vascular events. The symptoms include blurred vision, postural instability, and dysequillibrium. Treatment includes gaze stabilization exercises, habituation exercises and balance training. Recovery usually occurs 6-8 weeks following initiation of exercises as instructed by a trained physical therapist.

Bilateral Vestibular Hypofunction mostly commonly occurs as a result of ototoxicity. One can acquire this from the use of antibiotics such as gentamicin and streptomycin. The antibiotics build up on the hair cells within the inner ear long after one stops consuming the medication. One can also develop Bilateral Vestibular Hypofunction from meningitis, autoimmune disorders, head trauma and tumors on cranial nerve VIII. The symptoms include dysequillibrium, decreased visual acuity with head movement, gait ataxia and blurred vision. Some impairments can be permanent. Treatment includes oculomotor exercises, gaze stabilization exercises, habituation exercises, balance and gait training. It may take up to 2 years for symptoms to resolve.

Central Vestibular involvement is the most severe vestibular pathology. It results in vertical nystagmus (pendular eye movement in a vertical fashion). People with central involvement will present with vertigo (an illusion of movement) that may never fully resolve. Central lesions that affect the vestibular nuclei will result in lateropulsion, head tilt and visual perception difficulties. Treatment includes habituation exercise, gait and balance training.