Vestibular Issues in Physical Therapy

By: Jenna Buckwalter

Physical Therapy has increasingly become important in the treatment of vestibular issues, specifically Benign Paroxysmal Positional Vertigo. BPPV is caused by calcium crystals, called otoconia, that dislodge from their original position in the utricle, a structure in the ear, and travel to the semicircular canals. Here they disrupt the flow of fluid and cause dizziness or vertigo. Common symptoms of vertigo include dizziness, lightheadedness, unsteadiness, a loss of balance, blurred vision, nausea and/or vomiting. Furthermore, torsional movements of the eye called nystagmus may occur. These symptoms are usually brought on by position changes of the head such as lying down, bending over, nodding the head or shaking the head side to side. 

A physical therapist will determine the symptoms' origination point in your ear and canal systems by having you perform a series of movements. It is important for the physical therapist to perform this thorough examination of the patient, to determine if the reported signs and symptoms are from that of a vestibular origin, and not something more serious. Signs and symptoms that may suggest a more serious pathology include the 5 D’s: dizziness, dysarthria, dysphagia, diplopia or drop attacks. Additionally, different or sudden severe headaches, hearing loss, leg or arm weakness, numbness or tingling, and chest pain can all be signs of a more serious diagnosis. If physical therapy is unsuccessful in resolving a patient’s vertigo, or if the vertigo suddenly worsens with no explanation, further medical referral may be needed. 

Physical therapists may be recruited to treat other conditions with vestibular issues such as Meniere’s disease, MS, vestibular neuritis, labrinthitis, Parkinson’s disease and cervicogenic dizziness. One should always be informed of the patient’s constantly evolving status, and keep in mind the implications that these syndromes present to treatment. Although canal repositioning maneuvers are more than likely not implicated for these conditions, balance training and habituation exercises can be a very powerful tool to improve the quality of life for these patients. As it stands, BPPV is the most common vestibular issue treated by physical therapists. Please visit the following links for more about BPPV. 

http://www.tchain.com/otoneurology/disorders/bppv/bppv.html
http://www.mayoclinic.com/health/vertigo/DS00534/DSECTION=symptoms