Balance and Vestibular Rehabilitation

h-soreThroat.jpgThe ability to maintain balance is a complex process that depends on 3 major things; your sensory systems for accurate information about your body’s position (such as your sense of touch, your eyesight, and your inner ear motion sensor); your brain’s ability to process this information; and your muscles and joints for coordinating the movements required to maintain balance.

Vestibular rehabilitation is a very specialized type of physical therapy which works on the mechanisms of the Central Nervous System to bring about improvements in balance, postural control and the way you move.

Canalith Repositioning (the Epley maneuver)

Dr. Bernal performs canalith repositioning (sometimes referred to as the Epley maneuver) to treat a condition called Benign Proximal Positional Vertigo or BPPV. BPPV occurs as a result of displaced otoconia, which are small crystals of calcium carbonate (also referred to as "otoliths" or “canaliths”) that are normally attached to the otolithic membrane in the utricle of the inner ear. Because of trauma, infection, or even simple aging, canaliths can detach from the utricle and collect within the semicircular canals. Head movements shift the detached canaliths and stimulate sensitive nerve hairs to send false signals to the brain, causing dizziness and other symptoms.

The goal of the canalith repositioning procedure (CRP), a form of vestibular rehabilitation therapy, is to move the displaced canaliths to stop these false signals and the debilitating symptoms they can cause.

Through a series of specifically patterned head and trunk movements, with Dr. Bernal observing eye movements with each position change, CRP moves the canaliths from the canal to the utricle. Once in the utricle, the canaliths may re-adhere to the otolithic membrane, dissolve, be broken up, or move some place where they can't cause symptoms.

These maneuvers take about 15 minutes to complete. Precautions are provided for the days immediately following the procedure in order to ensure that the canaliths don't have the opportunity to return to their formerly problematic location in one of the semi-circular canals.

CRP is very effective, with an approximate cure rate of 80%. The recurrence rate for BPPV after these maneuvers is low. However, in some instances additional treatment(s) may be necessary.

CRP is thought to be effective in canalithiasis because it can help move the free-floating canaliths from the sensitive area (semicircular canal) into a place where it won't cause vertigo. It can be used to treat BPPV of the posterior semicircular canal or the anterior semicircular canal. Most people undergoing the procedure do so for posterior canal BPPV.

As a trained physician, the physiatrist is able to determine whether certain health conditions (such as perilymph fistula, detached retina, vertebrovascular insufficiency, esophageal reflux, and others) exclude a person from being a candidate for this procedure. Potential complications from this procedure include the possibility of neck/back injury or debris moving into another canal.

Dr. Bernal might also prescribe Brandt-Daroff exercises to be done multiple times over a period of time. The exercises involve sitting on the edge of a bed, moving into a side-lying position until the vertigo ends, returning to the sitting position for a fixed interval, and then moving into a side-lying position on the opposite side, and so on. These exercises are repeated in multiple sets throughout each day until two days after vertigo has not been experienced.