Vestibular Rehabilitation and Vertigo

Vestibular Rehabilitation is a specific form of treatment for patients suffering from vertigo and dizziness. The most common cause of vertigo is known as Benign Paroxysmal Positional Vertigo or BPPV. BPPV accounts for 20-30% of all patients seen for vertigo (1). It occurs in adults of all ages, although it is more common among older individuals.

Patients with BPPV complain of vertigo and possibly nausea when bending forward, looking up, rolling over in bed and lying down. Once the symptoms of vertigo have stopped some patients report balance problems that may last for hours or days after the initial episode of vertigo.

BPPV is a biomechanical problem in which one or more of the semicircular canals of the inner ear is inappropriatley excited by loose pieces of calcium carbonate crytsals. BPPV begins for no known reason in the majority of patients but it may also follow head trauma or an inner ear infection.

BPPV is frequently a self-limiting disorder and will commonly resolve spontaneously. Since it is a biomechanical problem, antivertiginous drugs are often not helpful since these drugs cannot reposition loose crytals. However, after remission, recurrences can occur (estimated at approximately 40% of patients) and the condition may trouble patients for years. One study followed 50 patients with BPPV for a mean of 32 months and noted that the recurrence rate by 1 and 3 years was 18% and 30% respectively (2).

Physiotherapists treat a BPPV by using cannalith repositioning treatment (CRT). This involves moving the head of the patient in a very specific direction in a sequence aimed to reposition the loose crystals. The most commonly used technique is known as Epley maneuvre. This technique is highly effective. In one study the efficacy of CRT was reported as a remission rate of 88.2% with one treatment (3). In another study the effectivenes of CRT in a group of patients with chronic BPPV was assessed compared to an untreated control group. In this study, Wolf et al (1999) (4) found 93.5% of the patients treated with CRT responded positively versus 50% of the control group.

Physiotherapist Rob Willcott BSc Kin, BSc PT, CEP, MCPA is trained in Vestibular Rehabilitation and the CRT techniques described above. If interested in being treated please contact the clinic for an appointment. We ask that you have someone come with you for treatment since you may be dizzy following treatment and require a drive home. This is normal initially and will improve after a couple of treatments. When you are experiencing vertigo is the best time to be treated. This is the moment when the crytals are loose and can be repositioned for good.

Once your vertigo has been resolved you will be provided with home exercises to continue on your own. Often times there are deficits in balance if you have had this issue for a long time. We will design a specific exercise program for you to improve your vestibular system.

References:

1. Bloom J. Katsarkas A. Paroxysmal positional vertigo in the elderly. J Otolaryngol. 1989; 18: 96-98.

2. Swartz R et al. Treatment of vertigo. Am. Fam. Phys. 2005, Mar. 71(6).

3. Tusa RJ, Herdman SJ. Assessment and treatment of anterior canal benign paroxysmal positional vertigo using the canalith repositioning maneuvre. Am Acad Neurolgy Abstr Neurology. 1997; 48: A384.

4. Wolf M, Hertanu T, Novikov J, Kronengerg J. Epley's maneuvre for benign paroxysmal positional vertigo: A prospective study. Clin Otolaryngol. 1999; 24: 43-46.