Introduction:
Vertigo is rather a symptom than a condition that is characterized by dizziness. Patients often complain of heads spinning and dizziness; they are mostly caused by inner ear problems. Treatment for vertigo is based on the underlying cause of the symptom. Physical therapy can help in minimizing the symptoms of vertigo. This article will discuss the role of physiotherapy in treating vertigo in detail.
What Is Vertigo?
Vertigo occurs when there is an unpleasant disturbance to one’s own ability to maintain posture and orientation with respect to the surrounding environment. It is characterized by one’s own perception of movements such as rotation or swaying of their body or of the environment.
What Are the Types of Vertigo?
There are two types of vertigo:
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Central vertigo.
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Peripheral vertigo.
Peripheral Vertigo: The most common type of vertigo, Often caused by problems with the inner that is responsible for the balance of the body. The most common conditions of the inner ear that lead to peripheral vertigo are:
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Benign Paroxysmal positional vertigo.
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Vestibular neuritis.
Central vertigo: This type of vertigo is commonly caused by the presence of lesions in the vestibular pathway.
The common symptoms of vertigo include Loss of balance, ear fullness, headache, nausea, increased sweating, and hearing loss.
The clinician performs various tests to diagnose vertigo, such as:
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Fukuda Unterberger’s test.
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Romberg’s test.
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Head impulse test.
What Is the Role of Physiotherapy in Treating Vertigo?
Firstly, the clinician will thoroughly assess the patient with detailed history taking and physical examination. Once the clinician confirms the diagnosis, they are recommended to the physical therapist for performing a form of physical therapy called vestibular rehabilitation therapy. Physical therapy is performed on the patients only with a clear diagnosis of the underlying cause. A vestibular therapist can help in minimizing the symptoms of vertigo, such as imbalance. For example, in patients with 50 percent loss of hearing, the therapy concentrates on enhancing central compensation and rarely recovers almost 90% of the previous balance of the patient. The physical therapists also perform various maneuvers to dislodge the small calcium carbonate crystal from the semicircular canal of the inner ear in patients with Benign Paroxysmal positional vertigo. In patients with cervical vertigo, they perform neck mobilization techniques to increase the range of motion.
What Is Vestibular Rehabilitation Therapy?
It is a form of physical therapy involving an exercised based treatment program to improve the loss of balance and to reduce dizziness in patients with vertigo. The primary aims of vestibular rehabilitation therapy are:
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To reduce dizziness.
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To improve the sync between one’s head and eye movements (gaze instability).
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To improve the loss of balance.
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To reduce fall risks.
The vestibular system is the link between the inner ear and the brain that is responsible for maintaining balance. Normally in patients with vestibular disorders, the symptoms can be reduced, and functions can be improved through central compensation. This is achieved by training the brain to use other senses, such as visual and somatosensory, to substitute for vestibular dysfunction.
What Happens During Vestibular Rehabilitation Therapy?
The therapist will perform a comprehensive examination of the patient to address the individual's specific problems. Based on this examination conducted, the therapists developed an individualized exercise program for the patients. The principal exercise program involved in the therapy are
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Habituation exercise.
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Gaze stabilization.
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Balance training exercises.
Habituation Exercises: Habituation exercises are used to reduce dizziness in patients with provoked positioning vertigo. The physical therapist performs a motion sensitivity test to identify positions provoking the symptoms. This exercise works on reducing the magnitude of response by training the brain with repetitive exposures to vertigo-provoking movements. Over time, once central compensation is achieved through this exercise program, provoked vertigo slowly disappears.
Gaze Stabilization: Gaze instability in patients with vestibular disorders is due to reduced vestibular response to head movements. An error signal is induced by placing a retinal slip to improve the vestibular response. The retinal slip is induced by performing various head movements while keeping the visual target fixed. The common exercises used for enhancing gaze stability are:
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Head turns.
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Head trunk turns.
The exercises used in this therapy depend on the type of vestibular disorder and the severity of the condition.
Balance Training Exercises: The balance training exercises are used to improve the patient's postural stability to successfully perform their daily activities without the risk of falling. The therapist develops individualized exercises depending on each patient's symptoms. These exercises help in improving the posture and strength of the patient. Examples of balance training exercises are
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The Otago exercise program.
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Alternating knee lifts while walking.
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To stand and sit in a chair without using their hands.
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Perturbation-based balance exercises.
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Leg lifts while standing.
Other exercise program involved in vestibular rehabilitation therapy includes
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Visual tracking exercises.
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Convergence exercises for visual shifting.
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Gait and mobility exercises.
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Stretching and core strengthening exercises.
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Dual-task exercises.
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Postural training.
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Patient education on ergonomics.
What Is Canalith Repositioning?
The physical therapist performs canalith repositioning procedures in patients with Benign Paroxysmal positional vertigo (BPPV). This condition is an inner ear disorder that involves the displacement of calcium carbonate crystals, causing vertigo and dizziness. Vertigo normally results from head movement.
Canalith repositioning procedures are performed to displace the calcium carbonate crystals by performing various maneuvers to a part of the ear that does not cause dizziness. It involves moving the crystals from the inner ear's semicircular canals to the urticle. The therapist performs various positioning tests to assess the patient's symptoms of nystagmus (rapid and uncontrolled eye movement). Displacement of crystals in this condition tricks the brain into thinking of head-spinning, which results in rapid eye movements that are noticeable to other people. The commonly used manoeuvers in this procedure include,
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Epley maneuver.
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Semont maneuver.
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Foster maneuver.
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Gufoni maneuver.
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Brandt-Daroff exercise.
Conclusion:
Vertigo refers to dizziness or a feeling of head spinning. It is rather a symptom of an underlying condition than a disorder. Physical therapists play a huge role in treating patients with vertigo. The therapist performs a detailed assessment of the patient and develops an individualized exercise program for the specific patients based on their symptoms and underlying cause of vertigo. They either perform vestibular rehabilitation therapy or canalith repositioning procedures based on the patient's assessment and the type of vertigo. In patients with BPPV, there is a chance of vertigo recurrence, In that case, once the canalith repositioning is done, they are advised for therapy for habituation exercises and a balance training program.
