Over the past 6 years CardioFlex Therapy has successfully treated hundreds of vertigo patients, and assisted them in eliminating their dizziness. I want to share some concepts of how to use Vestibular Rehabilitation to get maximum results for Benign Paroxysmal Positional Vertigo (BPPV) patients.
Diagnosis
The first step in getting rid of dizziness begins with a solid diagnosis. Does the patient have a peripheral or a central problem? What causes the patient to get dizzy? Is there any spinning vertigo with the dizzy episodes? Patients that have Meniere’s Disease or other chronic conditions will get recurring bouts of dizziness, so helping them resolve each episode quickly will be the best case scenario for those individuals.
The first step in getting rid of dizziness begins with a solid diagnosis. Does the patient have a peripheral or a central problem? What causes the patient to get dizzy? Is there any spinning vertigo with the dizzy episodes? Patients that have Meniere’s Disease or other chronic conditions will get recurring bouts of dizziness, so helping them resolve each episode quickly will be the best case scenario for those individuals.
Central Vertigo involves brain and spinal cord lesions such as tumors, cysts, surgeries, scar tissue, and degeneration. Neuromuscular disorders such as Multiple Sclerosis, Ataxia, Stroke, & Parkinson’s Disease can affect the cerebellum in the brain, causing gait and balance disturbances as well as severe vertigo. Peripheral Vertigo is typically considered to be caused by anything not in the central nervous system (brain and spinal cord). Much of the time, Peripheral Vertigo is synonymous with Positional Vertigo (BPPV).
To truly diagnose the vertigo as peripheral, the patient must have a brain MRI to rule out central involvement. A Hallpike Dix test and a Supine Roll Test are performed to see if the patient has Positional Vertigo on the left side, the right side, both sides, or not at all. Positional Vertigo (BPPV) is caused by displaced otoconia, commonly called crystals, which tend to get stuck in the 3 semicircular canals. The Hallpike Dix Test will be positive if crystals are stuck in either the Anterior or Posterior canals. The Supine Roll Test will be positive if crystals are stuck in the Horizontal canals.
Eye tests need to be conducted with and without head movement to see if there is a visual sensory-in component. In other words, if a patient gets dizzy from visual tests with or without head movement, then there is probably a visual sensory-in pathway which can trigger the symptoms at any time, usually seen with severe vertigo. If the patient gets any nystagmus (spinning vertigo), then they have a sensory-out component through their eyes, and are more likely to have a sensory-in component as well.
Treatment
At CardioFlex, we believe in a concept that we call “Repetitive Maneuvers.” We believe that several maneuvers should be performed in each treatment session in order to clear the crystals out of the semicircular canals, and become free flowing like they were before getting stuck. There are several maneuvers that we like to use in our sessions to clear the crystals, such as the Brandt-Daroff Maneuver, the Semont Maneuver, Epley’s Maneuver, and the Barbeque Roll Maneuver.
At CardioFlex, we believe in a concept that we call “Repetitive Maneuvers.” We believe that several maneuvers should be performed in each treatment session in order to clear the crystals out of the semicircular canals, and become free flowing like they were before getting stuck. There are several maneuvers that we like to use in our sessions to clear the crystals, such as the Brandt-Daroff Maneuver, the Semont Maneuver, Epley’s Maneuver, and the Barbeque Roll Maneuver.
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