BPPV & Physiotherapy

Amber is a Physiotherapist at Nova Physiotherapy that has a special interest and additional training in treating a wide array of vestibular conditions. A common one that is seen in clinic is known as BPPV. Let's learn more about what BPPV is, how it happens, and what treatments may look like for this condition.

 

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is a vestibular disorder characterized by brief but intense episodes of vertigo (a symptom that makes it feel like the room is spinning) that occurs with specific head movements or a change in head position. 

This may look like moving your head down to look at something on the floor, looking up, rotating your head to look over your shoulder, or bending over to tie up your shoes. These symptoms may last for a few seconds or for a few minutes and then they typically resolve until you change your head position again.

 

How does BPPV happen?

BPPV is caused by the displacement of tiny calcium carbonate crystals, known as otoconia, within the semicircular canals of the inner ear. When these crystals become dislodged, they disrupt the normal flow of fluid in the canals, leading to changes in the signals about head position being sent to the brain. This can cause varying symptoms including vertigo.

 

Symptoms of BPPV

Common symptoms of BPPV include:

• Episodes of Vertigo: Sudden, intense sensations of spinning or tilting, typically triggered by changes in head position.
• Nausea and Vomiting: These can accompany severe episodes of vertigo.
• Balance Difficulties: Challenges with maintaining balance, particularly when shifting positions.
• Nystagmus: Involuntary eye movements often observed during physiotherapy assessment

 

Experiencing dizziness and vertigo can be unsettling, scary and can impact every part of your life. Correct diagnosis and treatment are important in improving symptoms and daily functioning.

 

What does Vestibular Physiotherapy look like?

A vestibular assessment at Nova Physiotherapy takes approximately one hour. The assessment will include a detailed history, an assessment with the use of the Insight Infrared Video Goggles, and a treatment plan based on the findings during the session.

Questions during the assessment may include;

1. When did your symptoms start?
2. What symptoms are you experiencing? Vertigo, faint, dizzy, light headed? 
3. Have you experienced these symptoms before?
4. Do these symptoms come and go or are they always there?
5. What causes these symptoms? This may be moving your head, moving your eyes in certain directions, changes in light, or something else you have noticed that brings on these symptoms. 
6. How long do symptoms last? A few seconds, minutes, hours or days?
7. Do symptoms come on slowly or quickly?
8. Does anything help when these symptoms come on?

 

There will be additional questions and you are welcome to add anything that you feel is important. Once the detailed history is complete, a full and thorough assessment will take place. 

 

The assessment will include:

1. Looking at how your neck is moving and assessing if any symptoms are caused by changes in head position
2. Testing your ability to move your eyes to track and focus on different objects
3. Testing your balance
4. Performing different specific Maneuvers to help determine the possible cause of your symptoms.

Oftentimes, the Dix-Hallpike Manuever is performed if a diagnosis of BPPV is expected. Your therapist will perform this Manuever with you and you will quickly move from sitting to lying on your back. The head of the bed will be tilted downwards and you will have your head positioned to either the right or the left. This will allow the therapist to identify which canal of the inner ear is affected so the appropriate treatment can take place. A positive test will show nystagmus (beating of the eyes) and you will experience vertigo that typically resolves after a short period of time.

During your assessment, the Insight Infrared Video Goggles will also be used. These goggles will go around your head securely and cover the eyes so it is dark. They connect to a computer to show clear and concise eye movements during different tests. These goggles enhance assessments as they allow for detailed observation of nystagmus (involuntary eye movements) in real time and help in accurate diagnosing of BPPV and other vestibular disorders. They also allow for assessment of the severity of symptoms and provide improved treatment planning. 

 

Treatment

Once assessment takes place and if it is confirmed that the diagnosis is BPPV, the appropriate treatment can take place! This is often done with a Repositioning Maneuver to help reposition the displaced otoconia (the calcium carbonate crystals). These Maneuvers help move the otoconia back where they can no longer cause symptoms.

Typically with BPPV, the correct treatment may drastically improve symptoms within 1-3 treatments!

 

In addition to the appropriate Maneuver, vestibular rehabilitation is essential for long-term symptom management and is often part of a treatment plan. This may include activities such as:

• Gaze Stabilization Exercises: Aimed at improving the ability of the eyes to remain focused during head movements.
• Balance Training: Exercises that enhance overall balance and coordination.
• Functional Activities: Tailored exercises to help with daily tasks and activities.

You will also be provided with education during your session including how to continue to manage possible symptoms through lifestyle changes. This may include focusing on increasing your water intake and working on getting more regular amounts of sleep.

With any vestibular physiotherapy assessment, it is recommend that someone drive you to and from your first appointment. 

 

Overview 

BPPV, dizziness, and vertigo can significantly impact the quality of your daily life, but with the right physiotherapy approach and appropriate treatment, relief is possible. Understanding the mechanisms behind BPPV and having the appropriate treatments may help manage symptoms effectively and improve your quality of life.

If you’re struggling with symptoms of BPPV or persistent dizziness, don’t hesitate to consult with Amber at Nova. She has taken courses to help treat vestibular conditions, is able to use Insight Infrared Video Goggles in clinic, and can create a treatment plan with you!

 

If you are experiencing any of the symptoms described above or are curious about vestibular physiotherapy - it is time to book in with Amber! You can book HERE.