What is Benign Positional Vertigo?
Benign positional vertigo (BPPV) is characterized by spells of vertigo, lasting less than 1 minute that occurs when the patient moves the head into particular positions. Typically this occurs with looking up, lying down or rolling over in bed. This particular type of vertigo is caused by a problem with the balance system of the inner ear (the labyrinth). It is thought that debris (called canaliths or “ear rocks”) break off due to a jarring of the inner ear and subsequently collects in the inner ear.
How is it diagnosed?
The physical therapist evaluation to determine BPPV includes the Dizziness Handicap Inventory (DHI), subjective exam to qualify “dizziness” and performing the Dix Hallpike Test, to determine the side of involvement (confirmed by the observation of torsional nystagmus). This exam will differentiate BPPV from other disorders such as Disequilibrium, Meniere’s Disease and Vestibular Neuronitis. If indicated, further diagnostic testing can be ordered – such as an EMG or MRI.
How is it treated in Physical Therapy?
Physical maneuvers have proved helpful, such as Epley Maneuver / Canalith Repositioning Maneuvers (CRP), Brandt-Daroff Exercises, and Liberatory (Semont) Maneuver. Home instructions following Epley / CRP are stressed. Lastly, it is important to perform a complete assessment of the cervical and cranial base regions to identify any joint or soft tissue dysfunctions that may be contributing to the patient’s symptoms.
Are there any risks with this treatment?
Precautions, noted for the Epley and CRP procedure are high blood pressure, neck and/or back problems, and history of detached retina. A few patients may experience nausea while the canaliths are being repositioned. It is possible that short-term dizziness may occur right after the treatment, but there is usually immediate relief from the “spinning” sensation.
Is there rehabilitation treatment for other dizzy disorders?
Dysequilibrium, loss of balance from primary equilibrium sensory systems and/or the central relay system in the brain can be treated with Balance Retraining. Central Dizziness (change of blood flow within the brain), and Vestibulopathy (change in output of balance portions of the inner ear), can be effectively treated with Vestibular Rehabilitation.
What is Vestibular Rehabilitation?
VR is a combination of adaptation (i.e. gait with head movements), adaptation & substitution (i.e. standing ankle sways) and substitution (i.e. stepping patterns) along with BPPV treatment as appropriate.