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An Overview of Vestibular Disorders

Patients who suffer from vestibular disorders can experience different symptoms which can vary in intensity and duration. Majority of these symptoms lead to decreased quality of life and affect our daily functioning.

We can divide vestibular disorders into 2 groups. First group has its origin in central nervous system and is called central vestibulopathy.  Second group comes from peripheral vestibular system and involves vestibular – cochlear apparatus within inner ear. Each of these disorders can give various symptoms. Acute inflammatory processes of inner ear system as well as some central vestibular pathways disorders often will present with symptoms of vertigo which is a sensation of spinning of world around us. It is often caused by involuntary eye ball movement called nystagmus which represents abnormal communication of vestibular system with eye muscles through the brain. Vertigo can be present at rest and intensifies with movement of the body but also can be related to positional change in relation to gravity. This symptom we call positional vertigo. Many vestibular dysfunctions can give symptoms of imbalance and sensation of unsteadiness that can be a reason of falls. Another symptom is lightheadedness and fatigue that usually is present in subacute and chronic vestibulopathies. In some dysfunctions presence of symptoms of oscilopsia – gaze instability, can affect our ability to focus our vision when we look at the object. Oscilopsia usually  increases with head rotations.

Central vestibular disorders have its origin within central nervous system and are known to be affecting pathways between inner ear, eyes and its connections in the brain. Conditions that can cause these central vestibulopathies include but are not limited to stroke, brain tumors, Multiple Sclerosis or concussion. Peripheral vestibular disorders include acute vestibular neuronitis, labyrinthitis, BPPV, Meniere’s Disease, perilymphatic fistula and others.

Central vestibular disorders symptoms often are very “violent “ in  their course, causing patients to fall and not be able to function without assistance. Many times these patients need to be hospitalized and require supervision of family members to go day by day. Patients who present with inner ear dysfunctions, can manage their symptoms well despite their severity and progres faster with rehabilitation.

When patients are referred to vestibular rehabilitation, it is imperative for them to divide 100% focus into this process and follow clinicians guidelines. Progression of exercises should be always consulted and should not be performed when patient is not ready for it. As clinicians we have to look and listen to our patients symptoms and measure them in subjective and objective scales to determine if therapy is successful.

Next blog will be focused on proper diagnostics and treatment of various vestibular conditions and progression of exercises based on patients performance during vestibular rehabilitation therapy.

Dr. Bart Roman, PT DPT
Certified Vestibular Rehabilitation Therapist

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