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Stop the World from Spinning
Vestibular Therapy
By Lorienne Fisher, DPT
When sitting in your car, have you suddenly felt as though you were moving backward only to realize it was the car next to you moving forward? That disorientation is caused by a mismatch between the three systems our bodies use for balance — the inner ear (vestibular system) and sense of touch telling our brain we’re standing still while our vision system is saying we’re moving. While disturbing, most of us only experience this a few times in our lives.
Some people, however, experience this disorientation on a daily basis. They may also experience lightheadedness, dizziness, vertigo, nausea, and a sense of haziness or fogginess when trying to concentrate. People can have blurry or double vision and difficulty focusing when in motion from the mismatch of the systems that orients us in our environment. Many people complaining of dizziness or the other symptoms of vertigo are told they have to live with it or at best suppress it with medications. Fortunately, rehabilitation is available through physical therapy to help people to recover so that they can return to the normal activities.
The most frequent cause of dizziness or disorientation is an inner ear (vestibular) dysfunction in conjunction with a disruption of vision or poor sense of balance. While treatments for vision and balance issues can easily be obtained, treatment for the inner ear is often overlooked.
The best way to understand how to treat the inner ear is to first understand how it works. We receive information regarding gravity and head motion through a fluid filled organ in our inner ear. The main chamber of this organ contain crystals which move in relation to gravity and bend little hairs to tell us which way is down. From the main chamber, fluid moves through semi-circular canals which, again, bend little hairs when we move our head to tell us which direction we’re moving. (It’s this part that makes us dizzy when we spin our bodies around and around.) Our brains coordinate vestibular information with our other senses to allow us to adjust for uneven terrain or to stay upright on a moving surface such as on a bus, boat or escalator. Vestibular information is also used to coordinate eye and head motion to maintain focus on a moving object (or a still object when a person is moving such as scanning items on a grocery store shelf while walking down the isle).
Vestibular rehabilitation starts by determining whether a mechanical problem within the inner ear, itself is causing bad information to be sent or if the brain is not processing it correctly. This can be determined through a few simple tests by a physical therapist.
The easiest dysfunction to treat is a mechanical issue referred to as benign positional vertigo (BPPV). This is caused by the crystals migrating from the inner ear’s main chamber into the semicircular canals and altering the signal sent to the brain. A specific series of head positions performed with guidance from the physical therapist can coax the crystals back to their correct location. While movement of these crystals during the maneuver can be disconcerting, the treatment often resolves the symptoms completely in only one to three visits.
If the dysfunction is from the brain’s processing of the information, the treatment is three fold. First, functioning aspects of the vestibular system are strengthened with specific exercises such as eye and head motion. Second, the brain is trained to compensate for losses or information discrepancies through eye, head and body motion. And third, the sense of balance from our joints is strengthened to provide additional feedback to the brain to reorient the patient to their environment.
While BPPV treatment can seem “miraculous,” most vestibular rehabilitation is slow and often makes people feel worse before feeling better. The brain cannot be forced to suddenly change but must be gently conditioned. The endeavor, however, is rewarding with increased control, improved concentration, and a greater comfort level when in the community. There will also be decreased head and neck pain caused by the muscles attempt to restrict motion. The goal of vestibular rehabilitation is to restore a sense of control—control over one’s body, one’s environment and one’s life.
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