Vestibular Physiotherapy and Rehabilitation
When you have dizziness, vertigo, stubborn BPPV or brain fog, it can be hard to know where to start on your recovery. That's why at Momentum Health and Evidence Sport and Spine, we have access to practitioners who utilize advanced tools to get you a complete diagnosis and appropriate treatment plan. Our job as practitioners is to determine the cause of your condition and treat it, giving relief and a return to normal function.
What are Frenzel Goggles?
Let's introduce you to an advanced diagnostic and treatment tool - Frenzel Goggles.
BPPV: Benign Paroxysmal Positional Vertigo
This type of vertigo is caused by a change in the function of the inner ear. The fluid within the labyrinth structures of the inner ear can be interrupted by crystals that normally provide proper balance signals. In this instance, the crystals instead get interrupted or stuck, causing the dizziness.
The structures involved in this condition are the upper cervical spine joints, the very top of the neck where the head rests on the spine. Affecting changes to the musculature involved in keeping your head-on-neck control is what can mimc BPPV but is instead just a muscular condition that can be addressed with relative ease.
Have a read on our Blog about the difference between the two conditions.
What's the difference between Concussion Rehabilitation and Vestibular Rehabilitation?
Often patients who have had a concussion also have a vestibular impairment as a part of their sequelae of injuries. So a patient may require vestibular assessment as a part of their concussion assessment. Some patients may have a vestibular impairment, or may have miscommunication between the vestibular and visual centers which would be picked up during this part of the clinical exam. Specific exercises would then be given to address these issues.
3 Most Common Questions about Dizziness and/or Vertigo and the Vestibular System
I have positional vertigo and was diagnosed with BPPV (Benign Paroxysmal Positional Vertigo). I was told to do the Epley maneuver, however this has not helped me. How come?
BPPV is a mechanical peripheral vestibular disorder where crystals (called otoconia) get dislodged and travel into any of the 3 semicircular canals within the inner ear structure. Between 85-95% of BPPV occurs in the posterior canal, and the Epley maneuver can be very effective in treating this canal. However, there is a smaller chance that a different canal is involved, which would require a different technique. Although this is less common, you can also have more than one canal involved. There is also a chance that the Epley maneuver is simply being done the wrong way or to the wrong side.
During our detailed physical exam we can help determine which side, and which canal(s) the crystals have dislodged to in order to provide the most effective treatment using the most appropriate maneuver. During these tests we are looking for the presence of nystagmus (an involuntary eye movement) that is typically brief and associated with vertigo symptoms. Each canal is associated with a characteristic pattern of nystagmus and so determining the direction of this eye movement is very helpful in diagnosis. However, this nystagmus can sometimes be missed and harder to see in room light. Our examination therefore uses special equipment called Video Frenzel Goggles that allows us to better see this eye movement as well as record it. This is especially helpful for those more complex cases.
Does a Concussion always involve the Vestibular System?
Although dizziness is one of the more common symptoms after a concussion, especially in the first 1-2 weeks post injury, the vestibular system may or may not be involved. If dizziness persists beyond this time frame, a concussion assessment is beneficial to help determine the source of dizziness- whether it's from the vestibular system, the neck, the eyes, physical exertion, headaches, OR a combination of these.
The Doctor said I have a Migraine after having a respiratory virus, but nothing is helping. What can I do?
Different conditions can share common symptoms, which can make diagnosis difficult.
A vestibular neuritis is a condition that affects the vestibular nerve and alters the signal being sent from your inner ear to your brain. This can occur after having a viral infection (more common than bacterial, although this can be the cause as well), and can leave you feeling dizzy, off balance, light and motion sensitive, and can even trigger headaches and brain fog. In the acute stage, a consistent and predictable pattern of nystagmus may be observed in room light. However, this nystagmus is often quickly suppressed making it hard to see, or or even become absent in room light. The video Frenzel goggles allow us to see and record nystagmus that can be missed for a more accurate diagnosis. This ability to rule in or out a vestibular problem can help us differentiate conditions that share common symptoms and ultimately guide treatment/management. This information would then be relayed back the doctor to ensure collaborative care.