Vertigo 4th level (1)

1. Overview of Vertigo

  • Definition: Vertigo is characterized by the sensation of movement, whether it's oneself or surrounding objects, leading to feelings of spinning or swaying and an overall sense of imbalance.

  • Etiology/Causes: Vertigo often stems from inner ear issues; common causes include:

    • Benign Paroxysmal Positional Vertigo (BPPV): Calcium particle clumping in inner ear canals leading to sudden vertigo during head movement; often age-related.

    • Meniere's Disease: Inner ear disorder from fluid buildup and changing pressure, causing episodes of vertigo, tinnitus, and hearing loss.

    • Vestibular Neuritis or Labyrinthitis: Viral infection causing inflammation in the inner ear, affecting balance.

    • Other Causes:

      • Head or neck injuries

      • Brain problems (e.g., stroke, tumor)

      • Certain ototoxic medications

      • Migraine headaches

2. Clinical Features of Vertigo

  • Symptoms:

    • Spinning, tilting, swaying sensations

    • Imbalance, pulled toward one direction

    • Nausea and vomiting

    • Abnormal eye movements (nystagmus)

    • Headaches, sweating

    • Ringing in the ears and potential hearing loss

3. Types of Vertigo

3.1 Peripheral Vertigo

  • Symptoms include:

    • Mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, and ear fullness/pain.

    • Associated with internal auditory canal lesions possible facial weakness.

    • Typically improves within days to weeks.

3.2 Central Vertigo

  • Arises from injuries to the CNS balance centers (brainstem or cerebellum).

  • Often presents with less intense movement sensations and nausea, but may have neurologic deficits (e.g., slurred speech, double vision, and pathological nystagmus).

  • Can result in disequilibrium, a sensation of being off balance.

4. Role of Physical Therapy in Recovery

4.1 Treatment Goals

  • Decrease patient’s symptoms and subjective complaints.

  • Enhance gaze stabilization.

  • Improve functional balance skills and overall mobility.

  • Ensure patient safety during ambulation and activity.

  • Gain patient compliance and motivation.

  • Clarify treatment goals and implications of exercise.

  • Minimize symptoms through tailored exercise programs.

  • Empower patients with control over their rehabilitation process.

4.2 Treatment Approaches

Acute Phase

  • Encourage brief periods of activity followed by rest.

  • Gradually allow head movements while increasing visual stimulation.

  • Incorporate gentle head movements and VOR (Vestibular-Ocular Reflex) adaptation.

  • Progress activities from sitting to standing as tolerated.

  • Avoid bending over activities during this phase.

Post-Acute Program

  • Encourage head movements and visual focus during exercise.

  • Maximize adaptation of gaze stability and VOR.

  • Implement balance and gait activities, integrating various tasks.

  • Include community re-integration and walking programs.

  • Address any musculoskeletal issues during therapy.

4.3 Vestibular Rehabilitation Techniques

  • Habituation Exercises: To decrease dizziness with repeated exposure.

  • Gaze Stabilization: To improve visual focus stability during head movements.

  • Balancing Exercises: To enhance overall stability.

5. Specific Exercises for Recovery

5.1 Brandt-Daroff Exercises

  • Sequence of head turns and lying positions to relieve BPPV symptoms.

5.2 Semont Exercises

  • Rapid head turning and positional changes designed to dislodge calcium crystals impacting balance.

5.3 Epley Exercises

  • A series of specific head movements intended to alleviate BPPV symptoms by reorienting calcium crystals.

5.4 Foster Exercises

  • Exercises performed on hands and knees, involving head positions to reduce dizziness.

5.5 Cawthorne Exercises

  • Head and eye movements to promote engagement and balance coordination.