Stopping the spin of vertigo
A couple of years ago, I was diagnosed with an inner ear disorder called benign paroxysmal positional vertigo (BPPV), a long name for a condition that can cause a form of dizziness called vertigo.
It can occur when crystals (canaliths) in the inner ear that help maintain your sense of balance, become dislodged and move into the semicircular canals in your ears making your head sensitive to positional changes that make you feel dizzy, according to the National Institutes of Health.
It is one of the most uncomfortable feelings I have ever felt. It happened one morning when I rolled over in bed and the room began to spin. While the episode of vertigo only lasted a few seconds, the sensation of feeling off-balance and nauseous took three to four weeks to subside, and eventually subsided completely.
A few months ago, it happened again, and I spent days feeling out of balance and doing whatever I could to prevent the spinning from happening again. I began to walk with a lean toward my left side and not looking down to tie my sneakers or make sudden head movements because I was so fearful of another episode. As I spent more time developing habits of not moving my head up and down, or not reading because I got nauseous, I realized I needed help to regain my sense of balance in the world.
Physical Therapy
I finally went to my primary care physician and she prescribed vestibular physical therapy, a specific type of physical therapy to alleviate symptoms caused by vestibular disorders. These include vertigo, gaze instability and/or imbalance, according to the Vestibular Disorders Association.
John Corsino, PT, DPT, MBA, a physical therapist at Cape Cod Hospital, said that when patients come to the Emergency Department with symptoms of vertigo, or develop them as an inpatient, the physical therapists who have additional training with testing and treatment of vertigo will be contacted by the physician or staff. They can provide additional evaluation to help establish the cause of the patient’s symptoms.
The therapists can then perform specific tests to determine if the vertigo is the result of the following causes, according to Corsino:
- Decrease in function within the inner ear apparatus, resulting from either disruption of blood supply or inflammation which can sometimes occur following viruses or other illnesses.
- A stroke to the posterior part of the brain.
- A benign inner ear problem which can be identified and often resolved with physical testing and maneuvering.
“When a patient has persistent dizziness plus a certain type of abnormal eye movement, we use a set of tests called HINTS cluster (head impulse, nystagmus, which are rapid eye movements, and test of skew that can detect stroke)” said Corsino. “When used in the right clinical context, that cluster of tests allows the examiner to discern with a high degree of accuracy an inner ear problem from a posterior circulation stroke.”
The goal of the inhospital physical therapist is to figure out what may be causing the vertigo in the acute phase, said Corsino, and to offer treatment when the symptom’s source is something that can be treated with physical maneuvers.
“We can treat BPPV during the initial visit in the hospital and, for other types of dizziness for which different interventions like habituation exercises might be warranted, we will refer them to one of our five outpatient locations (for physical therapy).”
Goals of Treatment
“Initially, the goal of treatment for BPPV is a successful canalith repositioning which will move the debris in the semicircular canal out of the area where it is not supposed to be,” said Corsino. “We use an Epley maneuver or other maneuvers to facilitate the movement of the canalith and debris. We can repeat a provocation test after the treatment maneuver to determine if we have resolved the problem, which is rewarding to see. The techniques are very effective, there is robust evidence for their use, and we get good results when we need to use them in the hospital.”
Outpatient vestibular physical therapy can be ordered if there are residual symptoms of imbalance, dizziness or vision and can be individualized, according to the patient’s needs to help regain their abilities, said Corsino.
My outpatient vestibular physical therapy was created specifically for my needs and helped me regain my sense of balance and alleviate my symptoms. It wasn’t easy and I had to learn to trust my physical therapist that the exercises would help me even when I felt uncomfortable doing them.
“People don’t always associate these kinds of problems with physical therapy, but in more and more hospitals PTs are becoming useful resources for evaluating and sometimes for treating patients with acute dizziness.” said Corsino.
