Vestibular Physiotherapy
Do you sometimes experience a spinning sensation, dizziness, or imbalance?
Specialized physiotherapy assessment and treatment techniques can help resolve or improve your symptoms so that you can participate in the things you love to do!
What is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo. Simply put, it means non-life threatening, sudden brief spells of a false spinning sensation brought on by position changes.
BPPV is quite common, with an estimated incidence of 107 per 100,000 per year and a lifetime prevalence of 2.4 percent. Most cases occur for no apparent reason, with many people describing that they simply went to get out of bed one morning and the room started to spin. However, associations have been made with trauma, migraine, inner ear infection or disease, diabetes, osteoporosis, intubation (presumably due to prolonged time lying in bed) and reduced blood flow. There may also be a correlation with one’s preferred sleep side.
Specialized physiotherapy assessment and treatment techniques can help resolve or improve your symptoms so that you can participate in the things you love to do!
What is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo. Simply put, it means non-life threatening, sudden brief spells of a false spinning sensation brought on by position changes.
BPPV is quite common, with an estimated incidence of 107 per 100,000 per year and a lifetime prevalence of 2.4 percent. Most cases occur for no apparent reason, with many people describing that they simply went to get out of bed one morning and the room started to spin. However, associations have been made with trauma, migraine, inner ear infection or disease, diabetes, osteoporosis, intubation (presumably due to prolonged time lying in bed) and reduced blood flow. There may also be a correlation with one’s preferred sleep side.
BPPV is a mechanical problem in the inner ear, occurring when crystals (otoconia) that are normally embedded in the Utricle of the inner ear, migrate into one or more of the 3 fluid-filled semicircular canals. This can interfere with the fluid motion in the canal which detects head motion, sending incorrect signals to the brain. When this information does not agree with what the vestibular system in the other ear is sensing, or what the eyes are seeing or the body feeling, this is perceived by the brain as a spinning sensation or vertigo, which usually lasts less than a minute. Between episodes, some people are symptom free, and some may experience mild disequilibrium or imbalance.
What symptoms are associated with BPPV?
BPPV may be suspected if you have symptoms such as vertigo triggered by rolling over in bed, getting in and out of bed, tipping your head to look upward, bending over, and quick head movements. Your family doctor may be familiar with treatment of the most common form of BPPV, but not with some of the rarer variants.
How is BPPV diagnosed?
Medical imaging is not useful to diagnose BPPV. The diagnosis of BPPV is made by moving the patient into a position that makes the dislodged crystals move within a canal, resulting in an error signal that causes the eyes to move in a very specific pattern, called “nystagmus”. The dislodged crystals make the brain think a person is moving when they are not, and it mistakenly causes the eyes to move, making it look like the room is spinning. The nature and direction of the nystagmus allows a trained practitioner to identify which ear the displaced crystals are in, and which canal they have moved into.
Infrared Video Goggles allow for observing the eyes in the dark (removing the ability to focus on a target), enlarge the eyes on a screen for easier viewing, and record the eye movements for repeated playback. We utilize these goggles at Elevate Physiotherapy to aid in providing an accurate diagnosis, which in turn can improve treatment outcomes.
How is BPPV treated?
The treatment is specific for each variant of BPPV. In most cases, BPPV can be corrected mechanically. Once your Physiotherapist knows which canal the crystals are in and what variant you have, they can then take you through the appropriate treatment maneuver, using gravity to guide the crystals back to the chamber where they should be.
Before testing or treating for BPPV, your Physiotherapist will perform a careful neurological scan, evaluation of the neck, and other safety-related tests to determine if certain elements of the procedure need to be modified or avoided.
How successful is treatment for BPPV?
Studies have shown that resolution is well into the 90% range in 1-3 treatments. More rare forms can be a little more stubborn, and it is possible to have more than one canal involved, in which case your vestibular physiotherapist would have to correct them one at a time. You may be advised to avoid certain head positions for a short time after treatment.
Unfortunately, BPPV is a condition that can re-occur periodically. Recurrence rates are as high as 50% within 5 years, especially in those whose BPPV is related to trauma. If it seems to always reoccur in the same canal, and if deemed safe, your therapist may teach you or a family member to perform the maneuver at home.
In some cases, symptoms tend to decline over time as the brain slowly adjusts to the abnormal signal it is receiving, or because the condition spontaneously resolves. However, with a health care professional who is appropriately trained in the assessment and treatment of BPPV, most patients are pleased that their problem can easily be correct so that their world can stop spinning.
What symptoms are associated with BPPV?
BPPV may be suspected if you have symptoms such as vertigo triggered by rolling over in bed, getting in and out of bed, tipping your head to look upward, bending over, and quick head movements. Your family doctor may be familiar with treatment of the most common form of BPPV, but not with some of the rarer variants.
How is BPPV diagnosed?
Medical imaging is not useful to diagnose BPPV. The diagnosis of BPPV is made by moving the patient into a position that makes the dislodged crystals move within a canal, resulting in an error signal that causes the eyes to move in a very specific pattern, called “nystagmus”. The dislodged crystals make the brain think a person is moving when they are not, and it mistakenly causes the eyes to move, making it look like the room is spinning. The nature and direction of the nystagmus allows a trained practitioner to identify which ear the displaced crystals are in, and which canal they have moved into.
Infrared Video Goggles allow for observing the eyes in the dark (removing the ability to focus on a target), enlarge the eyes on a screen for easier viewing, and record the eye movements for repeated playback. We utilize these goggles at Elevate Physiotherapy to aid in providing an accurate diagnosis, which in turn can improve treatment outcomes.
How is BPPV treated?
The treatment is specific for each variant of BPPV. In most cases, BPPV can be corrected mechanically. Once your Physiotherapist knows which canal the crystals are in and what variant you have, they can then take you through the appropriate treatment maneuver, using gravity to guide the crystals back to the chamber where they should be.
Before testing or treating for BPPV, your Physiotherapist will perform a careful neurological scan, evaluation of the neck, and other safety-related tests to determine if certain elements of the procedure need to be modified or avoided.
How successful is treatment for BPPV?
Studies have shown that resolution is well into the 90% range in 1-3 treatments. More rare forms can be a little more stubborn, and it is possible to have more than one canal involved, in which case your vestibular physiotherapist would have to correct them one at a time. You may be advised to avoid certain head positions for a short time after treatment.
Unfortunately, BPPV is a condition that can re-occur periodically. Recurrence rates are as high as 50% within 5 years, especially in those whose BPPV is related to trauma. If it seems to always reoccur in the same canal, and if deemed safe, your therapist may teach you or a family member to perform the maneuver at home.
In some cases, symptoms tend to decline over time as the brain slowly adjusts to the abnormal signal it is receiving, or because the condition spontaneously resolves. However, with a health care professional who is appropriately trained in the assessment and treatment of BPPV, most patients are pleased that their problem can easily be correct so that their world can stop spinning.
Infrared Video Goggles allow for observing the eyes in the dark (removing the ability to focus on a target), enlarge the eyes on a screen for easier viewing, and record the eye movements for repeated playback. We utilize these goggles at Elevate Physiotherapy to aid in providing an accurate diagnosis, which in turn can improve treatment outcomes.
If you would like to know more about our vestibular rehabilitation services, or to speak to a physiotherapist, please call the clinic at 519 719 1782.
For more information about Vestibular Disorders, their management, and to find further support, visit:
Vestibular Disorders Association (VeDA)
Balance and Dizziness Canada
Sources:
VEDA (Vestbular Disorders Association): https://vestibular.org/article/what-is-vestibular/causes-of-dizziness/
VEDA (Vestbular Disorders Association): https://vestibular.org/article/what-is-vestibular/causes-of-dizziness/
Elevate Physiotherapy London Ontario
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