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Vestibular Physiotherapy and Rehab in Coquitlam
Vertigo and Dizziness are some of the most common complaints seen by Medical Doctors. Vertigo is the sensation of world spinning around; dizziness is the sensation of being off-balance and “light headed”. While some of the reasons for such symptoms certainly do require medical treatment, some common conditions can greatly benefit from physiotherapy intervention.
Benign Paroxysmal Positional Vertigo (BPPV) results from calcium crystals (otoconia) displacement from their usual location in the vestibular system. These crystals migrate into one or more semi circular canals of the inner ear where they are not supposed to be. When the head moves into a certain position the crystals move and trigger nerves in the semi circular canal – this can cause the sensation of vertigo, nausea and involuntary eye movements (nystagmus). Patients will complain of vertigo being provoked by looking up or down, lying down too quickly and especially turning over in bed. The vertigo will be very strong, but will usually go away in less than 60 seconds.
Physiotherapist assessment of BPPV will include history taking and screening questions to confirm the diagnosis and rule out different neurological lesion. The Physiotherapist will then perform Dix-Hallpike and Head Roll tests to identify the involved semi circular canals. Based on the findings, the physiotherapist will perform a manoeuvre to reposition the crystals in the proper place (most common is Epley manoeuvre). The treatment is pain free and typically takes about 10 minutes. This treatment has a reported success rate of between 80% -94% with one treatment.
Vestibular rehabilitation focuses on reduction of symptoms of peripheral vestibular dysfunction such as dizziness, gaze disturbances and balance impairments. Chronic vestibular lesions can occur due to number of conditions including Vestibular Neuritis, Meniere’s disease and degeneration. The Physiotherapist will design and monitor a special exercise program to reduce symptoms associated with vestibular dysfunction. The exercises will include gaze stabilization exercises, habituation exercises (motion sensitivity reduction), static and dynamic balance exercises, and functional training. The treatment is available in our Port Coquitlam clinic, also serving Burnaby, Port Moody and Pitt Meadows.
*Please be aware that you may not be able to drive after your initial treatment*
The most common type of vertigo is BPPV; it is characterized by short lasting spells of acute vertigo, which leaves the patient dizzy,nauseated and generally not well for most of the day. The most characteristic sign of BPPV is that vertigo brought up by positional change such as laying down or turning in bed.
Skillful Vestibular Physiotherapist can diagnose it fairly easily by taking accurate history and performing few clinical tests. Visits to family doctor, specialists or emergency rarely needed and often expose patients to unnecessary tests such as x-rays or CT scans.
Most common treatment for BPPV is an Eppley Maneuver, painless manual therapy technique(some vertigo will happen during the maneuver). It is extremely effective, with success rates in the literature as high as 95%!! It must be noted that there are several variants of BPPV that require different treatments, usually with similar success rates. The key to successful treatment and full remission of vertigo is an accurate diagnosis .
Make sure you have somebody to drive you to treatment. Some may benefit from taking anti-nausea medications before treatment(consult your doctor if you have very strong nausea or vomiting).
Generally, it is advisable not to make fast movements with the head and to not lie down on involved side. Sleeping in more upright positioning can also be beneficial. Soft Neck Collar may be applied for 2 days in order to avoid head movements; however we rarely use this approach
No. Although success rates are very high, there are more resilient variants of BPPV(rare) that require more treatments. Occasionally, there is also a recurrence of BPPV. As with any medical condition, if there is no improvement after appropriate treatment a further medical investigation may be needed.
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