how physio helps

When you are referred to a physiotherapist you will first be assessed as to the nature of your dizziness. Whether your dizziness was caused by a head injury which has dislodged particles in the semicircular canals or if you've suffered an inner ear infection which has damaged the nerve ending.
They will also have to ascertain how severe your dizziness is by briefly triggering your symptoms - this is nothing to worry about though as it will pass after a few minutes.

There are several areas to physiotherapy that apply as your programme progresses and your physio will show you exactly how to do the exercises so don't worry if you're not sure exactly what position you're supposed to be in.

If you have dislodged particles in your inner ear the initial stage is to dissolve these loose crystals which are sending the confusing signals to your brain and creating the spinning sensation as you move or sit up quickly.

the epley manoeuvre

To dissolve the crystals the physiotherapist will perform what is called an Epley manoeuvre on you. The therapist will ask you to sit on the end of a bench with your back to them. You will then turn your head 45 degrees to the left/right and lie down quickly allowing your head to hang over the end of the bench, your therapist will hold your head in this position and ask you to keep your eyes open and tell them if you're experiencing any spinning. Once the spinning stops (and it will) you will then turn your head slowly to face the opposite side and wait again until any sensation stops. Then you turn your whole body so you're on your side and looking at the floor, there is another pause until the spinning stops and then you sit up quickly.

Your physio will be holding your head the whole time and you are not left alone, the whole process only takes 3-4 mins so although it is frightening it will be over quickly and it's not much to put up with when you know it will make you so much better.

This manoeuvre will reposition the crystals that have come loose from the canals in the ear where the nerve endings are to an area of the ear where they can dissolve without causing you any trouble. Getting rid of all of them can take a while and you'll need to let your physio do this to you until they can tell there are no more left. These crystals are microscopic and not detectable through x-ray so it is only by doing this with the therapist that you'll know if you have loose particles.

To keep the fluid within the inner ear moving and not allow any more crystals to settle or build up the next exercise is done at home and is much less vigorous.

brant-daroff exercise

You sit on the edge of your bed and turn to look 45 degrees to the left or right. Then keeping your head in this position lie down quickly on your side, you'll be looking at the top of the wall and the back side of your head will be on the bed. Then when the slight dizziness passes sit up quickly. You'll need to repeat this 5 times on each side and do it 2-3 times a day. It's best to do this without any duvet or pillows on the bed so you're lying totally flat. Try to do it as much as you can, even if you feel really ill make yourself do it once on each side to keep everything moving until your next appointment.

The last set of exercises are to teach your brain how to compensate for the differences that have occurred in the balance system. This is the trickiest part as you are trying to teach your brain how to balance all over again, just as it had to learn when you took your first steps. Now you've given it a new set of rules and it takes time for this adaptation to take place.

cawthorne cooksey exercises

These exercises will be prescribed by your physio as you go for your follow up appointments depending on your progress. There is a fairly standard list, and these are normally adapted by your physio for you individually.

The exercises start off quite simply with you moving your eyes to the left and right, and up and down without moving your head. Then they move on to moving the whole head up and down and left and right. They then progress to turning one way and the other, bending down and standing up, and eventually doing them with your eyes closed. I'm not going into much detail with these exercises as it is really important that they are shown to you by your physio and only undertaken with their advice. There is no point in working through them as if it were a 'to do list' because your progress will determine which you do and your physio needs to assess this.

As well as following the standard Cawthorne Cooksey exercises there are other day to day activities that will assist your balance further. Simple things for example if you find going up and down stairs is difficult go up and down them a few times more than you would. Clean out a closet, change your bed linen, or do a bit of cooking to improve your ability to bend down, twist, turn and make normal head movements. Throwing and catching a tennis ball will aid your hand to eye coordination. Even going for a walk will stimulate your symptoms and keep your brain active in making the necessary adjustments. I can honestly say this is not the condition that warrents rest or taking it easy you need to be as active as you can bare to trigger symptoms and assist your brain in it's recovery.

There is one more area of physio which is needed to a greater or lesser degree depending on you and your progress and that is with how the brain becomes overly dependent on the eyes for information.

gaze adaptation exercises

Normally your brain has three senses that tell it where it is in space. Your balance system in the inner ear, the information coming from your limbs and your eyes. Once you take away one of these systems your brain becomes even more dependent on the other two in order to work out where it is in the world. You are without your inner ear balance system at the moment and now your brain is depending on the signals coming from your limbs and your eyes to compensate.

But sometimes through normal activity you may also be without another of these senses. For example the messages coming from your limbs will be distorted when you sit on a rotating chair or on a very bouncy bed , when you step over a curb, walk on an uneven surface, travel in a car or train, anywhere where your normal body sensors are confused and not where your brain expects them to be.

The signals coming from your eyes can also be interrupted if you close your eyes, or are looking at a television or computer, if the sun is in your face and you can't see properly, or if you have the wrong prescription in your glasses. All these things are making it harder for your brain to work out where it is.

So normally if you were in any of the situations I've mentioned your brain would use the system in your inner ear to work out where and as you get better your brain should adapt and learn to use this system again, but sometimes the brain decides to keep depending on the other senses especially the eyes. This can be rectified with the use of gaze adaptation exercises.

This is the area which if not looked at means the recovery will be a lot slower than it will be for someone who is not having adaptation problems. The symptoms of adaptation problems are what I call 'hops' I find if I look at one thing for too long like a computer or the television or someone's face, if I'm having a conversation, my eyes hop away from the subject for a second and my dizziness increases for a while. This is because my brain wants to remind itself where it is which is all well and good but it makes me feel like I've driven over a hump-back-bridge!

The exercises to combat this are very simple and obviously, as I keep saying, need to be recommended and shown to you by your physio.

Hopefully after time your adaptation should improve and the 'hops' will lessen. If during the day you feel a hop occur you can do these exercises without anyone knowing you're doing them, you can stay sitting and turn your head as would do if you were standing at home.

generally

The most important part of your rehabilitation is your visits to your physio. You'll find that your progress is probably improving more than you think and it's really valuable to be able to compare each visit to the last. You'll receive so much support and talking about it to someone who understands your symptom will make you feel much more positive about your condition. It was such a relief to me to be able to give my list of symptoms to my physio and find out I wasn't mental and all the things I was feeling physically were 'classic' of BPPV.

Even if you feel you can't cope with the exercises I've described you must make yourself do them and go and see a physiotherapist. Yes you will feel a bit dizzier while you're there but it will pass and ultimately you will get better - it couldn't be more worth it.