Tuesday, February 23, 2010

What is Vestibular Rehab?

By Mary Ann Gargano

When people think of physical therapy, most will think the usual: rehabilitation after shoulder or knee surgery, treatment for neck or low back pain, etc.  The general idea with physical therapy is to get the patient back to normal function.  However, most will not realize that Physical Therapists treat a vast patient population, including those with traumatic head injury, stroke, open heart surgery, various orthopedic disorders, and even Vestibular dysfunction.

Vertigo, (a sense of spinning/movement within a still environment), is characterized as a Vestibular disorder.  Our Vestibular System connects the workings of our inner ear and a specific part of our brain and helps us maintain our balance.  Vertigo is a very common complaint and can be the result of many different diagnoses.  A visit to a medical doctor is in order when someone is experiencing feelings of dizziness, or balance issues. Once a doctor determines whether the diagnosis is a Central Nervous System Disorder vs. a Peripheral Vestibular Disorder, he or she will usually prescribe medication and/or Physical Therapy. 

The most common Peripheral Vestibular Disorder, Benign Paroxysmal Positional Vertigo (BPPV), is a type of vertigo that is characterized by spells of vertigo that are of short duration (30-60 seconds), positionally induced (rolling, lying, getting out of bed, lying in a reclined chair, etc.), and commonly occur spontaneously.

The most common form of BPPV is Canalithiasis.  This is a condition where the canaliths (tiny particles of calcium carbonate) become dislodged from a part of the inner ear, and collect within the semi-circular canals, triggering false signals to the brain that your head is still moving even after it stops, causing dizziness and other symptoms. 

The type of therapy used for Canalithiasis is called CRP (Canalith Repositioning Procedure).  CRP was first described in 1992 by John M. Epley MD, and is referred to as the Epley Maneuver.  This therapy involves taking the patient through a series of head position changes that move the canaliths from the canal to the utricle.  The canaliths may then re-adhere to a special membrane, or possibly dissolve or break up, or move some place where they can’t cause symptoms.  The positions involve specifically patterned head and trunk movements and are performed while the doctor or therapist closely watches the patient for eye movements with each position change.  Once the canaliths are repositioned, the patient is offered special precautions in order to ensure that these particles remain in their new position.

The approximate cure rate for CRP is 80%.  The occurrence rate is low.  Usually one treatment is all that is necessary, but occasionally, additional treatments may be needed. Often times, symptoms of vertigo clear up on their own, and intervention is not necessary.

It is always recommended that the patient has had a recent physical examination, and up- to-date blood work, to help rule out other medical issues that may be contributing to their symptoms.

Our team of professionals, here at Advanced Wellness, is available to help with any questions or concerns you may have about your health.  If you are having problems with vertigo, please call us at 732-431-2155, to schedule an appointment for an evaluation.

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