Physiotherapy for Vestibular Rehabilitation
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is the most common cause of vertigo (Bhattacharyya, 2008). Symptom are induced by a change in head position: turning over in bed, lying down in bed, looking up, stooping, or any sudden change in head position. There is a wide spectrum of severity (Hornibrook, 2011).
Pathophysiology:
BPPV is a mechanical problem in the inner ear. It’s believed to occur when some of the calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the 3 fluid-filled semicircular canals. When enough of these particles accumulate in one of the canals they interfere with the normal fluid movement that these canals use to sense head motion, causing the inner ear to send false signals to the brain (Vestibular Disorders Association, 2015)
Fluid in the semi-circular canals does not normally react to gravity. However, the crystals do move with gravity, thereby moving the fluid when it normally would be still. When the fluid moves, nerve endings in the canal are excited and send a message to the brain that the head is moving, even though it isn’t. This false information does not match with what the other ear is sensing, with what the eyes are seeing, or with what the muscles and joints are doing, and this mismatched information is perceived by the brain as a spinning sensation, or vertigo, which normally lasts less than one minute. Between vertigo spells some people feel symptom-free, while others feel a mild sense of imbalance or disequilibrium.
(Vestibular Disorders Association, 2015)
Epidemiology and Causes:
BPPV is fairly common, with a lifetime prevalence of 2.4 percent (Von Brevern et al., 2007). It is thought to be extremely rare in children but can affect adults of any age, especially seniors. The vast majority of 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. (Shigeno, Ogita, & Funabiki, 2011).
Diagnosis:
Treatment:
Reoccurrence:
Unfortunately, BPPV is a condition that can re-occur periodically with long-term recurrence rates as high as 50% within 5 years (Fife et al., 2008), especially in those whose BPPV is related to trauma. If it seems to always reoccur in the same canal and if deemed safe, the therapist may teach the patient to perform the specific treatment maneuver on themselves.