Tuesday, July 23, 2024

Physiotherapy Management of BPPV From Secondary Causes

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Vestibular physiotherapy for BPPV (Benign Paroxysmal Positional Vertigo) is aimed at treating this specific vestibular disorder. BPPV occurs when tiny calcium particles called otoconia become displaced and float around in the fluid-filled canals of the inner ear, causing sudden episodes of vertigo when you move your head. Vestibular physiotherapy in Sherwood Park utilizes a series of maneuvers called canalith repositioning procedures. These maneuvers aim to guide the displaced otoconia out of the sensitive areas of the inner ear, where they can no longer trigger vertigo.

What are the Secondary Causes of BPPV?

Benign paroxysmal positional vertigo (BPPV) can be triggered by various secondary causes, including head trauma, vestibular neuritis, Ménière’s disease, postsurgical procedures, orthostatic hypotension, labyrinthitis, and vestibular neuritis. These underlying issues disrupt the delicate balance mechanisms within the inner ear, leading to episodes of vertigo triggered by specific head movements. BPPV significantly affects a person’s life, causing dizziness, imbalance, and nausea, which can hinder daily activities such as driving, working, and even basic tasks like bending down or turning in bed. 

The unpredictability of BPPV episodes can also induce anxiety and a fear of falling, diminishing overall quality of life and independence. Treatment through maneuvers to reposition displaced inner ear crystals or vestibular rehabilitation exercises can alleviate symptoms and improve daily functioning for individuals with BPPV.

How Does Physiotherapy Address BPPV With Secondary Complications?

Physiotherapy management of BPPV (Benign Paroxysmal Positional Vertigo) from secondary causes involves a comprehensive approach aimed at both treating the underlying condition causing BPPV and addressing the BPPV itself. Here’s how physiotherapy can manage BPPV from secondary causes:

1. Vestibular Migraine: 

Vestibular physiotherapy in Sherwood Park focuses on vestibular rehabilitation exercises aimed at enhancing balance, minimizing dizziness, and managing symptoms associated with BPPV caused by vestibular migraine attacks. These exercises aim to habituate the vestibular system, stabilize gaze, and enhance postural control to mitigate the impact of vertigo episodes.

Canalith Repositioning Maneuvers (CRM):

  • Gufoni Maneuver: This maneuver is specifically designed for lateral canal BPPV, repositioning debris from the horizontal semicircular canal to the utricle.

Visual-vestibular Adaptation Exercises:

  • Optokinetic Exercises: These exercises involve visually tracking moving targets to enhance visual-vestibular integration and improve gaze stability.
  • Brandt-Daroff Exercises: These exercises are commonly prescribed for individuals with BPPV to promote habituation and adaptation to positional changes, particularly in cases of persistent or recurrent BPPV.

2. Meniere’s Disease: 

Physiotherapy interventions aim to alleviate vertigo, imbalance, and associated symptoms of BPPV caused by Meniere’s disease. Vestibular rehabilitation exercises can help patients adapt to vestibular dysfunction, improve balance, and reduce the frequency and severity of vertigo attacks. Furthermore, adjustments to diet and lifestyle may also be advised.

Vestibular Rehabilitation Exercises:

  • Habituation Exercises: These exercises involve repeated exposure to movements or positions that provoke symptoms, such as head movements or changes in body position, to desensitize the vestibular system and reduce vertigo. While habituation exercises are commonly used in both Meniere’s disease and BPPV, the specific exercises may vary based on the patient’s symptoms and functional limitations.

3. Labyrinthitis and Vestibular Neuritis: 

Vestibular physiotherapy plays a vast role in the management of BPPV caused by labyrinthitis and vestibular neuritis by promoting central compensation for vestibular deficits. Vestibular rehabilitation exercises help patients adapt to altered vestibular input, improve balance, and reduce symptoms of dizziness and vertigo.

Gaze Stabilization Exercises:

Gaze stabilization exercises aim to improve visual stability during head movements by training the eyes to fixate on a target while the head is moving. These exercises help reduce symptoms of dizziness and vertigo and improve functional stability in patients with vestibular dysfunction.

4. Orthostatic Hypotension: 

Physiotherapy interventions for BBPV caused by orthostatic hypotension may incorporate exercises to improve cardiovascular fitness, muscle strength, and autonomic regulation. Techniques such as tilt-table training, postural exercises, and gradual exposure to orthostatic challenges can help improve blood pressure control and reduce symptoms of lightheadedness and fainting.

Tilt-Table Training:

  • Tilt-table training involves gradually tilting the patient from a supine to an upright position on a specialized table. This technique helps improve orthostatic tolerance by gradually exposing the cardiovascular system to orthostatic challenges and promoting autonomic adaptation. Tilt-table training can be beneficial for patients with BPPV and secondary orthostatic hypotension by addressing both vestibular symptoms and cardiovascular regulation.

5. Head Trauma:

Physiotherapy is essential in the rehabilitation of patients with vestibular dysfunction following head trauma. Treatment may involve a combination of vestibular rehabilitation exercises, balance training, gait training, manual therapy techniques, and cognitive rehabilitation to address vestibular deficits, postural instability, and associated impairments.

Manual Therapy Techniques:

  • Manual therapy techniques, such as vestibular rehabilitation maneuvers or soft tissue mobilization, may be used to address musculoskeletal impairments, alleviate muscle tension, and improve joint mobility, contributing to overall rehabilitation and recovery following head trauma and associated complications.

Cognitive Rehabilitation:

  • Cognitive rehabilitation strategies may be incorporated to address cognitive impairments or deficits resulting from head trauma. These may include memory exercises, attentional tasks, problem-solving activities, and dual-task training to improve cognitive function and enhance functional independence.

Efficacy of Vestibular Physiotherapy in Managing BPPV: 

Vestibular physiotherapy in Sherwood Park plays a pivotal role in managing secondary causes of BPPV (Benign Paroxysmal Positional Vertigo), offering a multifaceted approach aimed at addressing both the underlying conditions contributing to BPPV. Emerald Hills Physiotherapy in Sherwood Park targets the root of the problem while also addressing the immediate symptoms of vertigo and imbalance. This comprehensive approach not only helps alleviate acute symptoms but also promotes long-term vestibular adaptation, enhances functional stability, and reduces the risk of recurrence. 


Vestibular rehabilitation therapy serves as a cornerstone in the holistic management of secondary causes of BPPV, facilitating recovery, restoring vestibular function, and improving overall well-being for individuals affected by these conditions.

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