Vestibular Dysfunction

Introduction:

Vestibular dysfunction, characterized by disruptions in the body’s balance system, can arise from peripheral or central factors, depending on the affected anatomy. These disorders often present with similar symptoms, necessitating a comprehensive physical examination for precise differentiation. However, vestibular issues usually manifest suddenly.

Etiology and Consequences:

Severe central vestibular dysfunction, accounting for up to 25% of cases, is most commonly attributed to ischemic strokes within the posterior fossa, housing vital structures like the brainstem and cerebellum. The second leading cause of central vestibular dysfunction is demyelinating diseases.

Complications stemming from vestibular disorders primarily revolve around an elevated risk of falls and a reduced quality of life. Many individuals grappling with vertigo find their capacity to work or engage in daily activities significantly curtailed if the condition remains untreated. When peripheral pathology underlies vestibular dysfunction, concurrent hearing loss can compound the disability.

Symptomatology:

Vestibular dysfunction manifests through a spectrum of symptoms, including vertigo, nausea, vomiting, intolerance to head motion, spontaneous nystagmus (dizziness), unsteady gait (ambulation difficulties), and postural instability. The prevalence of each symptom varies, with no single manifestation providing an unequivocal diagnosis for vestibular dysfunction.

Diagnosis:

The initial step in arriving at a diagnosis involves distinguishing between peripheral and central vestibular dysfunction.

Peripheral vestibular dysfunction is frequently characterized by nystagmus that responds favorably to repositioning maneuvers, particularly when the nystagmus follows a horizontal orientation.

In contrast, central nervous system etiologies should be considered if patients exhibit vertigo and dizziness accompanied by persistently vertical or purely torsional nystagmus, which remains unaltered with repositioning or visual fixation. A medical history featuring neurological disorders, symptoms, or risk factors for stroke further underscores a central etiology.

Physiotherapy Intervention:

In conjunction with prescribed medications, physical therapy plays a pivotal role in enhancing the quality of life for individuals contending with vestibular disorders.

1. Eye Movement Control Exercises:

• Gaze Stabilization Exercises: These exercises aim to improve the patient’s ability to maintain a stable gaze on a stationary target despite head movements. This can include tasks like following an object with their eyes while moving their head side to side or up and down.

2. Balance Reacclimatization Exercises:

• Static and Dynamic Balance Training: Patients are guided through exercises that challenge their balance, starting with simple static stances and progressing to more dynamic activities such as tandem walking or standing on one leg. The goal is to improve stability and reduce the risk of falls.

3. Stretching and Strengthening Exercises:

• Neck and Shoulder Stretching: These stretches help alleviate muscle tension in the neck and shoulders, which can contribute to dizziness and discomfort.
• Strengthening Exercises: Focused on enhancing overall muscular strength and coordination, these exercises target specific muscle groups essential for maintaining balance and posture.

The design of the rehabilitation program is contingent on individual needs, with treatment plans tailored to each patient’s specific circumstances. Variables such as session frequency and external/internal factors may influence the duration of the recovery process.

References:

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• Herdman, S. J. (2013). Vestibular rehabilitation. F. A. Davis Company.
• Bhattacharyya, N., Baugh, R. F., Orvidas, L., Barrs, D., Bronston, L. J., Cass, S., … & Haidari, J. (2017). Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1-S47.
• Brandt, T., & Dieterich, M. (2016). The dizzy patient: don’t forget disorders of the central vestibular system. Nature Reviews Neurology, 12(6), 352-362.