In this month of South Simcoe Physiotherapy’s blog post, we are going to explore another real patient’s physiotherapy experience suffering from vertigo and dizziness – right from the initial assessment and diagnosis to the patient returning to their goals and graduating from physiotherapy!
The Case:
How did this individual present at initial assessment?
Patient Background:
The presenting individual was a 67 year old female. This individual had been suffering from vertigo for approximately 2 weeks. She reports that she woke up one morning and was very dizzy and the room was spinning. She reported that it randomly came on and she does not recall a specific mechanism of injury (i.e. falling, hitting her head etc.). This individual said that she has never felt like this before, as well as had a clear medical history.
Aggravating factors: rolling over in bed, turning head to the side, looking up, bending forward to unload the dishwasher
Easing factors: resting
Their physiotherapy goals were to:
1.Reduce their dizziness and room spinning
2. Improve their balance when walking
3.Return to recreational curling
The Physical Examination:
On examining their gait, this individual was quite cautious with their walking and holding on the the wall. She had short, shuffling steps, reporting she was worried about getting a vertigo spell.
On balance testing, she was able to stand comfortably with her eyes open and feet together, however when she tried to narrow her stance she would loose her balance within a few seconds.
A complete upper extremity neurological exam was completed, examining cranial nerve function, myotomal, dermatomal, reflexes and upper motor neuron reflexes, in which were all normal. We also went through a cerebellar examination, assessing coordination as well as rapid controlled movements, in which were also normal.
We went through a screen over her active range of motion, where she demonstrated slightly reduced movement in her left rotation of her neck.
Based off of her complaints, we did perform a Dix-Hallpike test, in which was positive for vertigo, dizziness and nystagmus (eyes involuntarily moving back and forth), more specifically her eyes were beating upwards, with a left torsion.
The Diagnosis: Left Benign Paroxysmal Positional Vertigo (BPPV) in her posterior canal
What did treatment look like for this individual?
Education
Initially, it was important to educate this individual on what BPPV is, how it may develop and, of course, how to treat it. In general terms, BPPV is caused by crystals being dislodged from one area and ending up in a place where they shouldn’t be. BPPV is more common in an older population, where the majority of the time it is idiopathic (of unknown cause). In this individual, there was an unknown mechanism, where she woke up with vertigo. They were advised that in most cases, the treatment for BPPV is straight forward, and should take anywhere from 3-6 treatment session to resolve, dependent on the chronicity and nature of the BPPV.
Guided Movement Treatment
There are varying types and forms of BPPV, however in this individual, it was found she had a left posterior canal BPPV. The first line of treatment, given she had normal neck range of motion, was to perform an Epley Maneuver. This maneuver consisted of 4 different positions to flush out the crystals from the affected area back to the area they belong.
This individual attended physiotherapy for approximately 6 sessions, which lasted over 4 weeks. Over the course of her treatment, her vertigo and dizziness improved, however she had some “sticky crystals” which required more treatment sessions. Once her vertigo and dizziness were resolved, her balance improved and she felt more confident on her feet. After the 4 weeks of treatment, she returned to her normal curling schedule.
This case study outlines the importance of physiotherapy to help someone return to their daily life and sport. This individual had been suffering from an impairment that can have a huge impact on day to day life and how you feel. The positive is, physiotherapy can help with treating vertigo, dizziness and BPPV. If this sound like you, don’t hesitate to reach out to our Alliston or Tottenham clinics for help!