Health Matters 3/5: Vestibular Rehabilitation Can Help Treat Vertigo

By Linda A. Lucuski, P.T. , D.P.T.

Life can become a challenge when simple movements like bending forward or turning suddenly cause you to become dizzy or experience vertigo.

Often, the cause is a disorder that affects the vestibular system – the parts of the inner ear and the brain that process sensory information involved with controlling balance and eye movements.

Approximately 69 million adults in the United States have experienced some form of vestibular dysfunction in their lives, according to the Vestibular Disorders Association.

At, vestibular rehabilitation helps decrease, manage, and eliminate symptoms of vestibular disorders, helping patients regain their balance and independence.

Defining Dizziness and Vertigo

Though slightly different, the terms dizziness and vertigo are often used interchangeably.

Dizziness is characterized as a whirling sensation or feeling as if you are ready to fall. It can also be accompanied by feelings of light-headedness, giddiness, swimming or floating.

Vertigo is characterized as feeling as if your surroundings are spinning or whirling about. Vertigo may also cause a jumbled or disoriented state of mind.

Dizziness and vertigo often occur together and can lead to balance problems and ultimately, to falls.

Understanding the Vestibular System

The vestibular system is part of the inner ear and contains specialized cells that detect movement and crystals that help control balance.

More specifically, the cells detect linear movement, such as when a plane takes off or when you start walking, and circular movement, such as when you turn around.

If the vestibular system is disrupted, it can lead to dizziness, vertigo and balance problems.

There are many conditions that can affect the vestibular system, including:

• Bacterial and viral infections
• ALS or Lou Gehrig’s diseases
• Multiple sclerosis
• Stroke
• Parkinson’s disease
• Migraines
• Meniere’s disease
• A tear or defect in the thin membranes between the middle and inner ears
• Non-malignant tumors
• Neck injury

One of the most common vestibular disorders, however, is a condition called benign paroxysmal positional vertigo or BPPV, which occurs when the crystals in the inner ear become displaced and send false signals to the brain.

For older adults, BPPV is typically associated with degeneration of the inner ear, while adults under age 50 may develop BPPV after sustaining a head injury. For many people, the cause of BPPV is unknown.

Symptoms of Vestibular Disorder

Symptoms of BPPV and other vestibular disorders may include:

• Vertigo
• Nausea
• Lightheadedness
• Dizziness
• Vision changes
• Hearing changes
• Memory loss and confusion
• Coordination problems
• Headaches
• Fatigue
• Sensitivity to changes in temperature
• Depression and anxiety

Not everyone with a vestibular disorder like BPPV will experience the same symptoms. Moreover, activities that cause symptoms of BPPV vary in each person.

Most often, symptoms are brought on by certain head movements and activities such as rolling over or getting out of bed or getting up from the dentist chair or shampoo bowl at the hair salon.

Diagnosis and Treatment

Diagnosing and treating a vestibular disorder typically starts with a visit to your doctor, who may refer you to a physical therapist for further evaluation and rehabilitation.

At Princeton Rehabilitation, therapists with specialized training offer comprehensive testing and treatment for dizziness, vertigo, and loss of balance due to vestibular disorders. Testing includes the use of infrared video goggles to assess eye movement and to accurately diagnose BPPV.

Depending on the cause, treatment for vestibular disorders may include medication, traditional physical therapy techniques, as well as balance and gait training, visual tracking exercises, and instruction in how to do activities of daily living in a way that reduces dizziness.

The goals of vestibular rehabilitation at Princeton Rehabilitation are to:

• Decrease symptoms
• Improve balance function
• Increase general activity level

For patients with BPPV, a technique such as the Epley maneuver can correct dizziness by repositioning the displaced crystals in the inner ear. The maneuver involves a series of sequential movements of the head, with each position held for 30 to 60 seconds, and is proven to be a highly effective treatment for BPPV.

If you are experiencing dizziness, vertigo, or loss of balance, talk to your doctor.

Most vestibular disorders can be easily and effectively treated so that the room stops spinning and you can return to a functional, productive life.

For more information about Princeton Rehabilitation or to find a physical therapist with Princeton Rehabilitation call 609-853-7840 or visit www.princetonhcs.org.

Linda A. Lucuski, P.T., D.P.T., is a licensed physical therapist and director of Penn Medicine Princeton Medical Center Princeton Rehabilitation in Hamilton.