Dizziness is a common symptom affecting approximately 30% of people over the age of 65. Vertigo is the most common form of dizziness. Although there are many causes of dizziness, true vertigo is usually due to an inner ear (vestibular) problem. The vestibular system provides the brain with information about changes in head movement. If this system is not working effectively, one may experience dizziness (lightheaded, floating, rocking sensation), vertigo, nausea, imbalance, spatial disorientation, visual disturbances, difficulty concentrating, headaches, and other symptoms.

 

There are vestibular and non-vestibular causes of dizziness. Some non-vestibular causes of dizziness include vision (new glasses, change in visual acuity, reduced vision due to cataracts, or adjusting to bifocals), decreased blood flow/oxygen to the brain/brain stem (orthostatic hypotension, dehydration, arteriosclerosis or osteoarthritis), nervous system disorders (peripheral neuropathy or a tumor located in brain stem or cerebellum), stress or fatigue (under these conditions, the brain stem functions less efficiently resulting in decreased automatic reflex control of balance), or medications.

 

The most common vestibular cause of dizziness is Benign Paroxysmal Positional Vertigo (BPPV). BPPV occurs when calcium carbonate particles (canaliths) in one part of the inner ear break off and float into one of the canals of the inner ear. This often results in vertigo during changes in head/body positions (lying down in bed, rolling over in bed, looking up to reach something on a high shelf, tilting back in dentist chair, etc.). Other vestibular causes of dizziness include:

 • Meniere’s Disease – vestibular disorder producing recurring symptoms of dizziness, imbalance and fluctuation in hearing as a result of abnormally large amounts of fluid collecting in the inner ear

• Labyrinthitis/Neuronitis – inflammation of the inner ear or the vestibulocochlear nerve often resulting in vertigo/dizziness, imbalance, and visual disturbances

• Vestibular Migraine – disorder usually associated with headaches, can also be associated with vertigo

• Acoustic Neuroma – a benign tumor affecting the vestibular portion of the eighth cranial nerve resulting in balance deficits and hearing loss.

 

Vestibular rehabilitation is an individualized exercise program designed by a specially trained physical therapist, usually in an outpatient setting, to help improve the interaction between the vestibular and visual systems during head movements, improve balance, and improve stability with walking. If the diagnosis is BPPV, the canalith repositioning maneuver can be used to move the canaliths to a part of the ear where they won’t cause vertigo. Another important part of vestibular rehabilitation is fall prevention. Vestibular and non-vestibular diagnoses can result in increased risk for falls. Learning to compensate for decreased visual and vestibular function, and decreased strength and sensation in feet/legs can help to improve an individual’s safety.

 

The duration of vestibular therapy varies depending on the diagnosis and severity of the symptoms. An individualized program and set of goals will be developed at the time of the evaluation. Treatments will consist of instruction in the specialized exercises and how to progress these exercises as they become easier. If the individual presents with BPPV, treatment can be in as little as 2 or 3 visits. 

 

Choosing the right outpatient rehabilitation facility is very important. Not all outpatient rehabilitation facilities offer vestibular rehabilitation. It is recommended that you call various facilities and ask if there is a specially trained vestibular therapist and advanced equipment for the assessment and treatment of vestibular patients. The Brooks Rehabilitation outpatient centers at Waterford Lakes in Orlando, Ormond Beach, and the Brooks Balance Center in Jacksonville all offer this specialized type of therapy using state-of-the-art equipment. 

 

Brooks Rehabilitation has been serving patients in Florida for more than 35 years. Along with a 143-bed physical rehabilitation hospital and a home health division in the Jacksonville area, Brooks has an extensive network of more than 25 outpatient centers, including five in the Orlando area, which offer physical, occupational and speech therapies to patients of all ages. More information on Brooks Rehabilitation can be found at BrooksRehab.org.

 

 

Brooks Rehabilitation - Waterford Lakes
801 Woodbury Road Ste 103 • Orlando, Florida 32828
(407) 373-6082