The Dizziness "Interrogation"

Taking a good history on a client with dizziness requires focused attention to the verbal and non-verbal communication provided by the client and family members.  I will sometimes have individuals describe dizziness as lightheaded, but use a circular motion with their hands at the same time.  In this case, it is interesting to point out these two conflicting reports from the same individual.  Once questioned, sometimes the individual will say they experience both spinning and lightheadedness. 

Dizziness can be confusing to individuals so it is easy for individuals to get off track and lose focus during the subjective portion of the exam.  Anxiety provoked symptoms and comments are not uncommon. Therefore, I warn my clients that I may need to interrupt them if I need more information about facts that they are providing.  Sometimes, the questions I ask can be difficult to answer and sometimes clients may change their minds in regard to answers they have already provided.    I have noticed tension build in individuals as they try to figure out what it is that they actually feel. 

Sometimes I feel like I am interrogating individuals in regard to their problem.  Understandably, this is necessary because of the complexity of dizziness as a problem.  I am now up to 146 possible words/descriptions that people have provided to me when I ask them what dizzy means.

"I'm dizzy, could it be from a stroke or tumor?"

One of the most common questions my client's ask me is in regard to whether or not I believe their dizziness could be from a stroke or brain tumor.   In response to this question I usually first ask, "have you mentioned your concern about a brain tumor to your Doctor?"  I think it is crucial clients talk openly about all of their symptoms and fears with their Medical Doctors.  Once an individual has this concern on their mind, it is very important they diligently pursue an answer.

My next response is to review central signs that a brain tumor may cause.  Some of these symptoms (in addition to various types of dizziness) may include: numbness, tingling, weakness, confusion, loss of hearing, loss of control of an extremity, slurred speech, blurred and/or double vision, seizures, spells of unconsciousness, difficulty swallowing and falling.   Clients could also have other symptoms not mentioned. 

As a vestibular therapist, my first priority is to ask questions and look for findings that may suggest a central vestibular problem.

The Cardiovascular System and the Inner Ear

A healthy Cardiovascular System is crucial to assure the inner ear gets the nutrients it needs to work properly.  The inner ear is tiny and, just like every other organ in our body, it relies heavily on a healthy heart, artery and venous system to regenerate and maintain balance.  Individuals should communicate with their Doctor regularly, especially when dizzy, to make sure key elements like blood pressure and cholesterol levels are well controlled.

Motion sickness as we get older

seems to be something I hear many individuals report.  Many say they never had motion sickness as a child, but once they hit their 20s and 30s they began to not be able to tolerate motions such as riding on rollercoasters, in the back seat of a car or in a boat.  So why does this occur?

I think one reason could be do to genetic changes that occur in our vestibular system over time.  Another possibility is we become less mobile as we get older.  If you don't use the vestibular system, it will adjust to a less mobile lifestyle.  If you don't us it you lose it.  As kids, many of us would spin around, twirl, dance, run, skip, roll and tumble.  We would play games that would make us fight through spatial disorientation for fun.  Once we become older, many of us stop "playing."

The vestibular system

is made up of two main parts: the central vestibular system and the peripheral vestibular system.  The central vestibular system is highly complex and includes structures within the brainstem and cerebellum.  The peripheral vestibular system is amazingly small, but has many important jobs.  It includes the vestibular nerve, the labyrinth and the vestibule. 

Dizziness coming from a problem with the central vestibular system is much more difficult to fix and can represent a serious life threatening problem.  Dizziness coming from a peripheral vestibular problem is often times more benign and is easier to correct.  Some individuals can experience dizziness from both peripheral and central vestibular disorders.

Both central and peripheral vestibular problems must be stable (controlled) in order for physical therapy to help most.

How Does Physical Therapy Treat BPPV?

Those who move a lot are more likely to correct BPPV on their own.  Of course, the individuals who move a lot may also experience more intense vertigo.  BPPV is treated by either accidentally or intentionally moving the head in special ways at the right time to reposition lose calcium carbonate crystals. 

Those who treat BPPV call this intentional skilled movement of the head "canalith repositioning." 

Do you have to feel spinning to have vertigo?

Vertigo is not a diagnosis it is a symptom.  The Vestibular Disorders Association uses the following terminology to define vertigo: Spinning or whirling sensation; an illusion of movement of self or the world. 

I have witnessed individuals with intense nystagmus describe their dizziness as other sensations than spinning.  The presence of nystagmus often represents either a central or peripheral vestibular disorder.    I see people all the time who have vestibular disorders (with nystagmus) and they describe their dizziness as lightheadedness, off balance, funny in the head, etc.  Many clients I see who have been told they have vertigo do not truly have vertigo. 

I have had clients with the diagnosis of Benign Paroxysmal Positional Vertigo present with typical BPPV nystagmus and describe their dizziness as lightheaded...not vertigo.