In the United States nearly 50% of adults will experience vertigo at least once in their lives. Individuals with vertigo often describe their symptoms as dizziness, they will feel a sensation of being in motion or spinning while they are completely stationary. Lightheadedness can sometimes be confused with vertigo however, this is not the same thing. People who experience vertigo will feel as though their world is spinning around them.
There are two types of vertigo people can experience, central and peripheral vertigo. Central vertigo stems from damage in either the cerebellum which is located in the back portion of the brain or from the brain stem. Peripheral vertigo is caused by a problem in the vestibular system that helps to control our balance. The most common type of peripheral vertigo is called Benign Paroxysmal Positional Vertigo (BPPV).
What is BPPV?
BPPV is a non life-threatening, sudden, brief spell of dizziness that is triggered by a change in position or sudden movements. This occurs when the calcium carbonate crystals, also known as otoconia, that are normally embedded in gel within 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, this causes the inner ear to send false signals to the brain.
How can BPPV affect you?
When these false signals are sent to the brain it can cause a false sensation of movement. This sensation will most typically occur with positional changes such as looking up, bending down, or rolling over while in bed. This condition becomes progressively more common in adults older than 40 years of age and is found to be more common with women. While there is no known cause for BPPV, head injuries, certain illnesses, and infection can occasionally increase the chances of disrupting the calcium carbonate crystals causing them to migrate to the semicircular canals. Every person with BPPV can have slightly different symptoms however, the most common are dizziness, nausea, vomiting, and unsteadiness.
How is BPPV treated?
There are a few ways BPPV can be treated, all of which a physical therapist or physical therapist assistant can do.Testing for BPPV can tell the therapist which canal the crystals are in.The Dix Hallpike Test is used first to determine if the crystals are in the anterior or posterior canals. Most commonly these crystals are found in posterior canals. If the Dix Hallpike Test is positive the therapist's goal will be to help move these crystals back into the utricle where they belong. This is done by what's known as the Epley maneuver. This maneuver involves a series of quick and specific head movements as shown in the picture below. If the Dix Hallpike Test is negative it is still possible that the crystals are in the horizontal canals. This is determined by something called the roll test. If this test is positive the therapist will treat it by using the BBQ roll which will also allow those crystals to return to the utricle within the inner ear.
Treatment for this usually only takes one or two sessions for symptoms to subside. This treatment has a 85% success rate on the first session and a 95% success rate on the second session. There are post treatment precautions that the therapist treating you will go over after the treatment is complete however, these precautions are only applicable through the rest of the day. When waking up the next day you should feel good as new!
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