VESTIBULAR

Vestibular Physiotherapy & Rehabilitation

Symptoms like vertigo (illusion of movement) and dizziness can relate to disturbances to the vestibular system. The vestibular apparatus is partly made of 5 sensory organs in the inner ear, called the 3 semicircular canals and the 2 otolith organs. Together they are responsible detecting angular acceleration and movement in 3 dimensional space. It then feeds closely into our balance system which is highly connected with our vision, hearing and brain activity through the cochlear and vestibular nerves.

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Vestibular disorders are often misdiagnosed and under-treated. This is because they share lots of overlapping symptoms, which can be difficult to analyse where there may be multiple contributing factors. They can also share symptoms with other conditions such as stroke and head or neck injury.

Some examples of Peripheral Vestibular Conditions

  • labrynthitis and vestibular neuritis
  • benign paroxsmal positional vertigo (BPPV)
  • Meniere’s diease
  • perilymph fistula
  • secondary endolymphatic hydrops
  • acoustic neuroma
  • vestibular migraine
  • enlarged vestibular aquaduct syndrome

Some of these conditions are managed alone by neurologists or specialists ENT doctors who can diagnose and treat these with medication. Others can be managed by neurological physiotherapy alone or in conjunction with medication depending on the severity of symptoms and the underlying cause.

Even a mild to moderate levels of dizziness can be hugely debilitating. Research has shown that many types of vestibular conditions benefit from vestibular rehabilitation.

What should I take note of?

There is a lot to learn about what is happening by asking some key questions. This includes asking yourself:

  • how long has this been happening for?
  • was it sudden or gradual?
  • how did it start?
  • perilymph fistula
  • how did it progress?
  • is it constant?
  • what were the circumstances in which this occurred?
  • was stress involved?
  • how well do you sleep?
  • have I changed my routine or diet recently?
  • have I taken hormonal supplements recently?
  • what other medical conditions are present?
  • have you had a history of cancer?
  • what medications are you on?
  • what triggers it?
  • how long do symptoms last for?
  • how frequent do they occur?
  • can you describe all your symptoms in your own words without using the word ‘dizzy’?

The last question is perhaps the most important question because determining what the full set of symptoms are really helps work out what is happening, and importantly WHERE it might be coming from. Getting a deep understanding of the problem is key to guiding diagnosis and therefore appropriate management, as the more complex ones usually require input from multiple health professionals.

What clinical tests can I expect?

Our therapists can perform clinical tests to help guide you towards a diagnosis:

These include:

  • observation of the static eye
  • observation of the facial muscles
  • observation of the eye when tracking a slow moving object
  • observation of the eye when tracking a fast moving object
  • vestibular ocular reflex (VOR) testing
  • head thrust test
  • dynamic visual acuity test
  • movement and positional testing
  • balance and walking assessments
  • examination of the neck, sensory systems, range of motion and coordination as needed

Some tests are more specific than others, but they all help form the clinical picture of the individual’s problem from an anatomical to a functional level. For the majority of cases, these assessments will be enough to formulate a working diagnosis.

It is also at this point where we must decide whether we need more information from further investigations, tests or another health professional’s input to confirm or deny anything ambiguous or suspiciously sinister.

Why an understanding of neurology is important here

There is a common misconception that vestibular disorders only relate to the vestibular apparatus. As you can classify vestibular disorders as peripheral (relating to the vestibular apparatus, the neck or some other body part) or central (relating to the brain). As a health professional trained in understanding neuroanatomy, we can begin to infer from clinical signs where the lesion might be.

For example, true centrally driven vertigo is the result of an imbalance of neural activity that can happen anywhere from the posterior cerebellum to the brain stem through to the labyrinth. If there are any of the classic 5 signs of sudden loss of posture, double vision, difficulty speaking, dizziness and clumsiness, then we would be highly suspicious of a posterior cerebellum lesion. Neurological signs affecting the cranial nerves would suggest brain stem involvement. Lesions above the posterior fossa usually result in lightheadedness and imbalance without any vertigo. Vertigo driven by peripheral conditions such as vestibular neuritis (which are usually one sided) can be picked up with a head thrust test.

Treatment and Vestibular Rehabilitation

With this thorough assessment and clinical reasoning, some cases of vestibular dysfunction can be treated conservatively and effectively within a few sessions. Once the underlying problem has been treated, home exercises can be done to control symptoms and improve balance in a graded manner so you return to your usual way of life. This is what vestibular rehabilitation is all about.

For more information and helpful advice, contact us today!