Vertigo is a vestibular dysfunction disorder, which presents as an illusion of movement. It results in the illusion of rotatory movement due to the altered alignment of the body in space. Vertigo involves the auditory and the vestibular apparatus or their central connections transmitted through the VIIIth cranial nerve. Patients' descriptions of the symptoms may include that they see the environment moving or they sense the environment moving around them, often described as dizziness due to the movement of the head.
Types of Vertigo
Vertigo, as a vestibular disorder, is of 2 types - Central Vertigo and Peripheral Vertigo. Central Vertigo predominantly affects second-order neurons to the Oculomotor nuclei, brainstem, cerebellum, temporal lobe of the cortex. Peripheral Vertigo is caused due to the affection of the part of the inner ear that is responsible for balance, that is the Vestibular Labyrinth or the semicircular canals or the Vestibular nerve.
Causes of Vertigo
Causes of Vertigo are multiple and depend on which part of the vestibular apparatus is affected. Some of the causes are trauma, infection, Benign Positional Vertigo (BPPV), Ménière's disease, drugs, cerebellopontine angle tumors, etc.
The most common cause of vertigo is Benign Positional Vertigo (BPPV). The pathophysiology of BPPV involves the dislodgement of otoconia (Calcium Carbonate Crystals) from the utricle to the posterior part of the semicircular canals. The dislodged otoconia settle down in the endolymph of the semicircular canal with gravity’s force, which causes the fake sensation of spinning as the person changes the position of the head. BPPV is self-limiting as it presents as attacks which are episodic associated with the change of the head position.
Vestibular Rehabilitation
Vestibular rehabilitation (VRT) or Balance training may be helpful for patients suffering from vertigo. Vestibular Rehab promotes vestibular adaptation and substitution. Rehabilitation of Vertigo involves goals such as
- To improve gaze stability
- To re-educate the patient to rely on joint and position sense
- To improve balance
- To enhance postural stability
- To improve the quality of daily living.
Gaze Stability Exercises
Gaze stability exercises include relaxation of the head, neck, and shoulders in a relaxed position and to look at a stationary object without the involvement of the movement of the head. This exercise can be progressed where the patient’s eye follows the object when it is moved slowly.
Further progression may involve the movement of the head along with the object. Treatment techniques like Canalith Repositioning Maneuver (CRM), Liberatory Maneuver, and Brandt-Daroff exercises are also incorporated in the rehabilitation or vertigo.
Balance Training
Balance training starts from standing with feet shoulder feet apart, arms across the chest progressing to bringing feet closer, with closed eyes, standing on uneven surfaces. To practice ankle sways in anteroposterior directions progressing to circular motions. Walk and move the head from side to side, up and down progressing to walk backward. Balance exercises also include standing on a wobble board, single-leg stance, walking in a darker environment may challenge the patient in different stages of vertigo rehabilitation.
Conclusion
The role of Physiotherapy in managing the symptoms of vertigo is essential in addition to medical interventions. Various case studies that are published say that VRT has proven to be effective in managing the symptoms of Vertigo and it has also led to the improvement of gait and the overall quality of life of vertigo patients.