Which exercise should I do

if I have my rocks loose (BPPV)?  I recently had a client come in who woke up spinning when she rolled over in bed.  One of her health care providers taught her the Epley Maneuver to do for both ears and so she tried these "exercises."   As a result, she felt no relief and became more nauseated.

Upon examination, I discovered one possible reason the Epley Manuever did not not work: the calcium crystals were loose in the lateral canal instead of the posterior canal.  The Epley Maneuver is for the posterior canal and the 360 degree/270 degree rolls are for the lateral canal.  After two 360 degree rolls and one 270 degree roll, her otoconia appeared to be in place.

Treatment for BPPV is most successful when prescribed and completed by a health care provider trained in determining which canal requires repositioning.  There are different maneuvers that should be performed and the direction in which the maneuver is performed will depend upon the side in which the BPPV is located.

Pseudo-spontaneous nystagmus...again

I recently worked with another individual who had pseudo-spontaneous nystagmus.  Spontaneous nystagmus test with fixation blocked revealed a second degree left beat nystagmus.  Vibration increased the spontaneous nystagmus in the same direction.  Flexing the head 30 degrees abated the nystagmus and flexing 60 degrees created a very slow right beat nystagmus.  It turned out to be left lateral canal cupulolithiasis that converted to canalithiasis fairly easily.  On the same day following the treatment, the spontaneous nystagmus/second degree nystagmus was gone and vibration did not provoke the left beat nystagmus again.

Motion sickness

with inner ear problems can be a double whammy for people.  I always keep in mind that, to the brain, spinning on a merry-go-round or battling spinning from an inner ear problem can be perceived as the same activity.  We always have to proceed more slowly with individuals who have a history of motion sickness in addition to inner ear problems.  Nausea takes a long time to go away once stimulated.

Without our video eye movement recorder

I would not know what I know today and I would have missed finding problems that my clients have had.  Several times room light testing has revealed nothing, but when fixation is blocked, I find nystagmus.  Without having this technology, I would miss problems clients may have.    In addition, vestibular specialists using this technology are learning more about why people become dizzy.  For instance, we are learning lateral canal and multi-canal BPPV is more common than we once thought.  This helps people who are battling dizziness to find  more complete relief.

The rules have changed

for BPPV.  Now that we know pseudo-spontaneous can be caused by lateral canal BPPV, the spells can last minutes to hours while holding still.  Perhaps we will find BPPV is the cause of more vertigo than we once thought.

Pseudo-spontaneous nystagmus

fascinates me.  I had an individual with lateral canal cupulolithiasis the other day.  He was constantly feeling things moving.  I thought for sure he had a hypofunction, but when I put the lenses on him and had him flex his head the nystagmus reversed directions.  He had ageotropic nystagmus in the roll test positions.  I did a series of lateral canal cupulolithiasis and canalithiasis maneuvers, forced positioning with vibration and gave him forced positioning for home.  He returned with no nystagmus at all and was no longer dizzy.

Is dizziness really unpredictable?

That depends.  If a person has BPPV, the spells are very predictable.  They will tend to occur when a person gets in and out of bed, rolls over, tilts their head back or bends over.   Once the problem goes away, it is difficult to predict when it will return.  Migraine dizziness can sometimes be predictable because of an aura that occurs prior to the spell.  The dizziness following a Migraine is usually aggravated by motion which makes it predictable.  Menieres type dizziness may be predictable based upon the type of diet the person had a few days prior.  After the Menieres attack, the spells that follow are usually motion provoked which makes them predictable. In summary, the first attack of dizziness is usually unpredictable, but the following spells are usually more predictable.  Vestibular rehab can help an individual determine when their spells are predictable.

Is the hardest thing on a person's nerves

dizziness?  I have heard it said that it is and I think it could very well be.  Every day I see several people who are battling the sense of being out of control through over 100 different sensations they have called dizziness.  Many feel the toughest aspect about dealing with dizziness is the way it is so unpredictable.  Vestibular rehab is valuable because it can teach people which kinds of dizziness are predictable and how to better manage the problem.

Two different inner ear problems

for one person is fairly common.  I am reminded of this because of the number of clients I have been working this week who have a history of BPPV (rocks loose) and a vestibular hypofunction.  In these cases, I work hard trying to teach my clients how to tell the difference between the two problems.  Once my clients realize their dizziness can have a few different causes (sometimes from the same organ) they are on their way to a more complete recovery.

But... I was told I don't have an inner ear problem!

Another benefit of vestibular rehabilitation is that the vestibular rehab specialist will, often times, be able to examine the client with dizziness on "dizzy days".  Too often, people are told there is nothing wrong with their inner ears for the following reason: the day their inner ears were tested was on a day when they were not dizzy and the problem, at that moment, was stable.  Health care providers trained in using a video eye movement recorder can usually get a person with dizziness in quickly to see them and it sometimes only takes a few moments with a few simple tests to determine the presence of a vestibular problem on a "dizzy day".

What are the benefits of vestibular rehabilitation?

The most obvious benefit I see daily is that many people experience significant relief from their dizziness quickly. Health care providers who specialize in vestibular rehab are able to help determine the presence of a vestibular problem and provide individuals with education regarding why they are dizzy and how they can receive help.

What is vestibular rehabilitation?

Vestibular rehab is therapy aimed directly at improving the functional relationship between the inner ear, brain, eyes, muscles and nerves through central nervous system compensation.   It is also therapy aimed at getting rid of mechanical problems within the inner ear that may be causing dizziness.  It is a cost effective way to help manage dizziness from vestibular problems through promoting maximal function of the vestibular system.  Vestibular rehab is most effective helping an individual with a stable inner ear problem.   There are four major types of vestibular rehabilitation: repositioning, adaptation, substitution and habituation.   Health care providers trained in providing vestibular rehab will choose the most appropriate form(s) to provide depending on the reason the individual has dizziness.

Can physical therapy help rid dizziness?

It depends on why you are dizzy.  If you are not sure why you are dizzy, go see your Doctor and follow these steps.  If you have an inner ear problem it is likely a specialized form of physical therapy called vestibular rehabilitation can help.   There are many types of dizziness, but over the last 11 years of working with clients who have dizziness and balance disorders, I witnessed many get relief from specialized physical therapy.

What does it feel like

to have your rocks loose?  You won't have to wonder if it happened.  When your rocks go where they are not supposed to go it is very obvious.  You will feel spinning when you lie down, roll over, bend over or tilt your head back.  If you hold perfectly still and not move, it should stop within one minute...until you move again.  The best way to manage this until you get help is to move like you have a glass of grape juice on your head and move very very slowly.

If the rocks become misplaced

we like to try to put them back instead of waiting for them to be moved back accidentally.  Depending upon in which canal the rocks are loose and whether or not they are floating freely or stuck/jammed will determine the type of maneuver we perform.  Canalith repositioning is a type of vestibular rehab we use and it works, most of the time, very well.

Rocks in our heads, the eyes and rolling in bed

So when these rocks break loose or too many are produced, they can fall out of the vestibule and go into the semicircular canals where they are not supposed to be.  When this happens, our eyes spin like crazy (nystagmus) and that makes us feel dizzy.  This nystagmus is usually perceived as spinning and often times occurs with any movement of the head...especially rolling in bed.

Do we really have rocks

in our heads?  Well.........yes, we all have rocks in our heads and, believe it or not, that is quite normal.  They are called otoconia.  Without these rocks you would not be able to do things like sense where your head is when sitting still, see clearly when you drive down the road, enjoy the ride up an elevator or a thrilling ride in a sports car.

Be careful you don't think

about your balance too much.  If you do, you might start noticing something that has always been there.  None of us stand perfectly still...don't worry, that is normal.  But, when we have a balance problem we may begin to perceive those small normal little movements as abnormal.  This causes what was once unconscious to become conscious.  Our ability to maintain balance works best when left unconscious (as long as our unconscious balance system is healthy).  Balance is mostly reflexive.  It occurs without us thinking about it.  When a problem with our balance system occurs, some of us tend to try to analyze and dissect the problem so we can figure it out and prevent it the next time.  The problem is we then try to take conscious control over an unconscious event.  We begin to sense normal movements that we never felt before (because we weren't paying attention) as abnormal and then we over correct a perceived problem that may not be there.

Does it really have to get worse

before it gets better?  While I work hard toward helping my clients get over their problem with dizziness as comfortably as possible, one of the fundamental themes of vestibular rehabilitation is that the dizziness will likely get worse before it gets better.  Exceptions to this rule apply and it may not get worse for long.  Most of my clients believe the payoff of not being dizzy is worth the effort.

"Spin" the eyes

No, they don't spin all the way around, but they can spin enough to make a person sense that kind of eye movement as spinning.  This abnormal eye movement is called nystagmus.  With nystagmus, there is a quick beat in one direction and a slow beat in the opposite direction.  Naming the nystagmus and looking for patterns with and without the ability to focus is key in figuring out why the nystagmus is present.