Vestibular Rehabilitation

Greater than 30% of people over the age of 60 have or will have dizziness.² Not only is dizziness an unsettling feeling that can make one nauseated, it places a person at significant risk. Falls are the leading cause of accidental death in persons over 65 years.² When a person has dizziness or vertigo, there is a 1.14 fold (114%) increase in the incidence of fractures with falling.³

Dizziness can also be very disabling for a person. As seen in the graphs below, dizziness is one of the leading causes of disability for persons above the age of 65.⁴ Dizziness can also contribute to other diseases. People who are dizzy are typically more fearful of falling. A person fearful of falling is more likely to reduce their mobility, staying in a chair or in bed. This results in deconditioning, frailty, and immobility, further increasing the risk of physical and mental illness.

Percentage of disability attributed to dizziness.

BPPV (Benign Paroxysmal Positional Vertigo)

• Most common cause of vertigo (63% people over 65 years with dizziness)¹
• Makes you feel like the world is spinning around you or your head is spinning
• Most commonly occurs with laying down, rolling over in bed, and bending over
• Duration most commonly between 0-60 seconds, but can last up to 1-2 minutes
• For more information on BPPV and its treatment, please follow this link BPPV link

Vestibular Disorders

• Caused by:
  • Infection
  • Inflammation
  • Disease
  • Trauma
  • Medication
• Severe vertigo that lasts for 24 hours to a few days
• Residual imbalance and dizziness
• Difficulty keeping balance in a dark room, on uneven surfaces, or when turning head quickly

Vestibular disorders can be treated with:

• Gaze stabilization exercises: eye and head/neck coordination exercises
• Habituation exercises: gradual exposure to movements
• Balance and gait training

Cervicogenic dizziness

• Dizziness can be a result of dysfunction of the neck. 83% of whiplash patients reported that dizziness began immediately after or within one week of their accident.⁵ Patients often complain of disequilibrium, lightheadedness, or “wobbly head.” Typically have neck pain and limited or excessive range of motion.
• This can be treated through manual therapy, strengthening, and proprioceptive training.

Concussions

• No two concussions are alike in presentation or recovery. Concussions can cause dizziness due to the central injury to the brain, injury to the vestibular organs, and/or injury to the neck. Each of these alone may cause dizziness symptoms, but with a concussion, all factors may be present.
• Concussions can be treated through vestibular rehabilitation, manual therapy, strengthening, proprioceptive training, and metabolic conditioning.

Resources:

1. Chau AT, Menant JC, Hübner PP, Lord SR, Migliaccio AA. Prevalence of Vestibular Disorder in Older People Who Experience Dizziness. Front Neurol. 2015;6.
   doi:10.3389/fneur.2015.00268.
2. Fernández L, Breinbauer HA, Delano PH. Vertigo and Dizziness in the Elderly. Front Neurol. 2015;6. doi:10.3389/fneur.2015.00144.
3. Liao W-L, Chang T-P, Chen H-J, Kao C-H. Benign Paroxysmal Positional Vertigo Is Associated With an Increased Risk of Fracture: A Population-Based CohortStudy. J Orthop Sports Phys Ther. 2015;45(5):406-412.
   doi:10.2519/jospt.2015.5707.
4. Mueller M, Strobl R, Jahn K, Linkohr B, Peters A, Grill E. Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study. Eur J Public Health. 2014;24(5):802-807. doi:10.1093/eurpub/ckt171
5. Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J. Rehabil. Med. 2003;35(1): 36-43.