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What is a vestibular disorder?
Your ability to balance depends on information from
three sources: vision, muscles and joints, and your vestibular system
or your inner ear. A problem with any of these will force you to develop
new patterns of movement that rely more heavily on the remaining sources.
The vestibular system receives input from a portion of your inner ear.
It tells your brain where your head is in space and how it is moving.
Your brain is then able to use this information to control your posture,
balance, and eye movement. If damage occurs in your inner ear or brain
you cannot rely on information from your vestibular system. Head movement
or changes in head position can cause imbalance, dizziness, blurred
vision, or nausea when a vestibular deficit is present. This leads you
to create strategies to carry out your normal daily activities without
head movements. For example, you may squat down to pick things up, never
lay on a particular side, or avoid looking up. Unfortunately, these
types of adaptations can cause headaches, neck ache, stiffness, fatigue,
and will ultimately make your vestibular symptoms worse.
In turn, you then become more reliant on vision and information from your
muscles and joints to maintain posture and balance. You may notice this
deficit when walking at night or in dimly lit areas, over gravel, soft
carpeting or grass, inclines, or any other uneven surface. Behaviors
may also include running your hand along the wall or holding on to furniture
when you walk. In addition, people with vestibular disorders may experience
motion sickness, difficulty walking in crowds, sensitivity to noise
and bright lights, inability to concentrate, trouble reading or speaking,
or a general loss of stamina. Ultimately, these symptoms can lead to
irritability, loss of self-esteem, or depression.
A number of vestibular disorders can develop if disease or injury damages
you inner ear or brain. The most commonly diagnosed are benign paroxysmal
positional vertigo (BPPV), Menier’s disease, labyrinthitis, vestibular
neuritis, end lymphatic hydrous, and perilymph fistula. Causes can be
any of the following; blows to the head, whiplash, ear infections or
inflammation of the inner ear, viruses, high doses of certain types
of antibiotics, or rarely a tumor. Decreased or blocked blood flow to
a particular portion of your brain can cause damage to your vestibular
system resulting in “central dizziness.” Depending on the etiology,
symptoms vary in onset, severity, and persistence.
How can physical therapy help?
Initially, your therapist will do a thorough exam focusing on eye control,
posture, balance, movement and compensatory strategies you may be displaying.
A treatment plan will then be developed based on your individual presentation
and needs. Treatment may include exercises focusing on eye control with
or without head movement, specific balance and gait training, repetitive
movement patterns, or positioning techniques for BPPV. Some exercises
may initially increase your symptoms, but if done correctly and faithfully,
dizziness, vertigo, nausea will decrease dramatically and may even disappear.
Vestibular exercises facilitate the body’s ability to compensate for
changes caused by vestibular loss.
Benign paroxysmal positional vertigo is a common cause for dizziness. It
is caused when, in the inner ear, calcium carbonate crystals, called
otoconia, are displaced from the utricle and travel into the semicircular
canals. This condition will cause rapid attacks of vertigo when the
person moves their head. They often report a severe spinning sensation
when lying down or rolling over. Symptoms typically only last seconds
and are intermittent. They may also experience a sense of imbalance
or floating when they are walking. Treatment for this includes the PT
taking the patient through a series of positions in attempt to roll
the otoconia out of the semi-circular canals. This technique has proven
highly effective in as few as one or two treatments in most cases.
How do I get started?
If you are experiencing any of the symptoms above or have concerns about
your vestibular health please consult your physician. After an examination
he or she may refer you to an Ear Nose and Throat doctor for further
testing or suggest physical therapy as a treatment. Please feel free
to suggest this option or call us with questions!
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