Dizziness and imbalance account for 5 to 10 percent of all doctors visits. Interpreting the term dizzy can be difficult because patients use this term to describe various sensations such as vertigo, lightheadedness and disequilibrium.

Vestibular pathology is one disorder that can be the source of dizziness and imbalance. Both central and peripheral disorders can produce decreased visual stabilization, gait dysfunction, and decreased postural and trunk stabilization.

Vestibular System Disorders:

  • Benign Paroxysmal Positional Vertigo
  • Vestibular Neuritis
  • Meniere’s Disease
  • Endoymphatic Hydrops
  • Bilateral Vestibular Disorders
  • And more…

Vestibular disorder symptoms can result in functional impairments and increased risk for falls!

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is the most common cause of vertigo. Otoconia floating in the endoltmph create a pressure or suction resulting in symptoms of vertigo.

The patient’s primary complaint is of brief periods of vertigo with rapid changes in head position. The episode lasts thirty seconds to two minutes. Recurrences can persist for years.

Physical therapy treatment is quick and effective for these patients. Treatment is dependent on the location of the loose otoconia and the patient’s abilities.

Vestibular Neuritis

This disorder is the second most common cause of vertigo. Symptoms manifest from a viral infection that can precede onset by two weeks. The infection results in unilateral vestibular paresis.

The patient’s primary complaint is prolonged severe rotational vertigo which worsens with head movement. This symptom can be very disabling and may be accompanied by nausea, nystagmus and imbalance. Neuritis usually affects those from 30 to 60 years of age.

Symptoms can resolve in 2-3 days, however; two out of three patients do not resolve spontaneously and need vestibular rehabilitation to compensate for a unilateral weakness. A weakness of as little as 1-2 percent can cause symptoms in some individuals.

Why Physical Therapy?

When a loss of paresis occurs in one vestibular nerve, the resting firing rate of the damaged ear does not match the normal ear. Although the vestibular system has little ability to repair itself, it can compensate for the mismatched signals being sent from the damaged and normal ears.

Physical therapy is designed to provide small, controlled movements and activities that promote dizziness and imbalance. Physical therapy is effective because treatment is customized to each patient based on their level of dysfunction. With symptom provocation, the patient develops compensatory strategies which resolve symptoms.

Groomer, G.L. (2002).
Vestibular Rehabilitation: A comprehensive clinical approach for positive functional outcomes. Kent, WA: North American Seminars, Inc.

Herdman, S.J. (2000).
Vestibular Rehabilitation (2nd ed.). Philadelphia: F.A. Davis Company.


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