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Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear. This condition is characterized by episodes of brief vertigo (sensation of spinning), most commonly when rolling over in bed, bending over or tilting the head back. The vertigo typically lasts no longer than 10-60 seconds; however, people usually feel nauseous or unwell for minutes to hours following an attack. BPPV is a mechanical problem in which microscopic crystals of calcium get dislodged from one part of the inner ear and fall into another part of the inner ear. Research has shown that this condition can be completely eliminated in as little as 1-3 treatments. 

Cervicogenic Dizziness

Cervicogenic means dizziness that is caused by your neck.  The joints, muscles and ligaments of your neck send signals to your brain offering information about where your head is in space and what direction your head is moving.  The brain uses this information partially to help control balance.  Dysfunction in the neck, such as whiplash injury following a motor vehicle accident, can distort the information that the neck is sending to the brain and thus bring on dizziness.  It has been estimated that 40–80 % of people with whiplash injury can experience dizziness.  The treatment for cervicogenic dizziness is a combination of orthopaedic manual therapy to help restore normal neck movement and exercises that are designed to help teach your brain to better sense the signals coming from your neck.

Vestibular Neuronitis/ Labyrinthitis 
Vestibular neuronitis and labyrinthitis can be caused by a viral or bacterial infection that attacks the inner ear or the nerve that sends information from the inner ear to the brain.  Typically, the condition causes vertigo (sensation of spinning), nausea, vomiting, blurred vision, imbalance and occasionally hearing loss.  With a vestibular neuronitis hearing is usually spared while a labyrinthitis can cause hearing loss.  The severity of symptoms for these conditions varies; however, in the beginning symptoms are often constant for the first 1 – 3 days and gradually improve over the following 7 – 10 days.  Occasionally, permanent damage is caused and people are left with dizziness associated with quick head movements, poor balance (especially in the dark) and problems focusing on objects while they are walking.  Vestibular Rehabilitation Therapy (VRT) can be very effective at teaching the brain to recalibrate information coming from the inner ear to help eliminate symptoms over time.  Viral infections are much more common than bacterial; however, bacterial infections may require antibiotics so it is important to consult your family physician.

Persistent Postural Perceptual Dizziness
Persistent Postural Perceptual Dizziness (PPPD) is a clinical syndrome that was first described in 2007 in Archives of Otolaryngology by Staab and Ruckenstein. It is the second most common diagnosis made in tertiary neuro-otological clinics that have adopted procedures to identity it. PPPD is characterized by: 1) persistent non-vertiginous dizziness or subjective imbalance lasting > 3 months. 2) Hypersensitivity to motion stimuli, including a patient's own movement and motion of objects in the visual surround. 3) Symptoms are typically worsened in complex visual environments such as crowds or grocery stores. PPPD is most commonly caused by acute inner ear pathology (25%), mild head injury (10-15%) or anxiety/panic (15-30%). PPPD arises from poor adaptation in the early phase of the illness followed by continued failure to readapt even after the acute injury resolves.

Vestibular Migraine
Many people associate migraine with severe head pain and incapacitation. However, a large portion of people with migraine often do not present with pain, but will instead present with vertigo, lightheadedness and/or disequilibrium. Approximately 35% of migraine patients have vestibular symptoms at some point. These symptoms may be prior to, during or independent of the migraine itself. Symptoms may include motion intolerance with respect to head, eyes and/or body, difficulty focusing, light or sound sensitivity, poor balance, neck pain associated with muscle spasms, confusion, difficulty concentrating, spatial disorientation and anxiety/panic. Assessment involves a thorough subjective history, audiogram, balance and gait assessments, and documentation of limitations in daily functional activities with the use of questionnaires.

Concussion/Mild Traumatic Brain Injury
According to the 2012 Zurich Concensus statement on concussion, a concussion is defined as a brain injury caused by either a direct blow to the head, face, neck or elsewhere on the body with an "impulsive" force transmitted to the head. It typically results in rapid onset of short-lived impairment or neurological function that resolves spontaneously. The acute clinical symptoms reflect a functional disturbance rather than a structural injury and as such no abnormality is seen on standard structural neuroimaging studies (CT or MRI). Concussion results in a graded set of symptoms that may or may not include a loss of consciousness. The suspected diagnosis of a concussion can include one or more of the following: 1) headache, feeling in a fog, emotional symptoms. 2) loss of consciousness or amnesia. 3) Behavioural changes. 4) Slowed reaction times. 5) Sleep disturbances. The majority of concussions (80-90%) resolve in a short (7-10 day) period.

A stroke is caused by either the blockage or rupture of a blood vessel within or surrounding the brain.  Recovery from a stroke can be a long process and recovery can happen over a period of years due to brain plasticity.  Stroke survivors may experience difficulties in areas such as communication, functional mobility and self-care skills.  Caregivers may also face new challenges in assisting their loved one with their recovery.  Physiotherapists can help in the rehabilitation process with a therapy program designed specifically for each client - focusing on their needs.  This may include strengthening, stretching, conditioning, balance retraining, gait retraining, transfers, self-care needs and home care activities.  It is also important to identify and reduce the potential risk of falling.  We can carry out assessments and training for safe and proper use of adaptive/mobility equipment as well as training sessions for caregivers for assisting with transfers and mobility.  Existing home programs can be reviewed and updated as necessary and referral to our community-based Chairability Program is also available.  Home assessments may also be a valuable part of the rehabilitation program. 

Multiple Sclerosis (MS)
Multiple sclerosis is a disease affecting the brain and spinal cord that is caused by demyelination within the central nervous system leading to difficulties with nerve transmission.  This can result in weakness and spasticity in muscles throughout the body.  Fatigue is also a very debilitating factor and common feature of MS.  Many individuals with MS benefit significantly from the input of a physiotherapist with experience in treating this neurological condition.  Physiotherapy treatment for MS is an exercise-based approach that focuses on improving overall function through stretching and strengthening, balance and gait retraining, restoring normal movement patterns and general conditioning.  Physiotherapy can also help with compensatory strategies, reducing falls risk and assessment for appropriate assistive and mobility devices.  Referral to our community-based Chairability Program is also provided as necessary.  Home assessments may also be a valuable part of the rehabilitation program.  

Parkinson's Disease
Parkinson's Disease is a neurological condition affecting chemical transmitters of the brain. This can result in limited mobility, memory dysfunction, muscle tremors and increased muscle tone leading to difficulties with day-to-day activities. Although medication can be very useful in helping to minimize the symptoms, it is important for individuals to consider a regular exercise program to further address these effects. Physiotherapy treatment for Parkinson's can include assessment of general activities such as walking, getting into and out of bed and going up and down stairs. Specific strategies or appropriate handling techniques can be developed to assist with these activities. Programs can include stretching and strengthening exercises, as well as balance and gait retraining programs. Falls prevention is important to consider and a home assessment may be advised. Recommendations can be made regarding suitable adaptive and mobility aids to maximize independence and safety of the individual. 

More to come...