Tips to get rid of vertigo......

Conservative Treatment:

Vertigo treatment focuses on treating the underlying condition.

• If caused by drugs, stop using them is usually enough to relieve vertigo.

• If caused by benign paroxysmal positional vertigo (BPPV)., the most effective treatment is through canalith repositioning procedure, also known as Epley maneuver. This procedure involves a series of maneuvers (moving) head to remove calcium deposits from the posterior semicircular canal to the other parts in the ear canal.

• Vertigo can also be treated with vestibular rehabilitation therapy which involves a series of specific exercises guided by a physical therapist that is designed to minimize dizziness. The effectiveness of treatment depends on many factors, including age and health condition of the patient, the severity of the condition, and the patient's cognitive function.

• If vertigo is caused by a bacterial infection, antibiotic ear drops may be prescribed.

• If caused by Meniere's disease, taking diuretics and reducing salt intake can help reduce complaints.

• Additionally vertigo disorders can be reduced by taking enzyme Bromelain, Magnesium, Vitamin B12 which serves to regulate the balance of the nervous system. Ginger and Ginko is also very useful to improve circulation to and within the brain.

• For the case of vertigo that still light, aromatherapy is helpful to stabilize the nervous system, both inhaled (breathed in) or massage.

• Have a healthy diet that is low in sodium and sugar. Make sure you get your essential vitamins and minerals. If you are doing salads, add lemon peel to boost that vertigo-fighting meal.

• Lastly, talk to your doctor about the best treatment. Each individual may have a different case and require different types of treatment

• Suppression of the vestibular system by Labyrinthine sedatives.

•  Suppression of patient’s emotional reaction by mild tranquilizers.

• Wait for compensation. Compensation can be hastened by specific vestibular exercises.

•  Acceptance of the problem and using appropriate aids like walking stick.

Tips to overcome the vertigo attacks quickly

1. Sleep with your head a little high
 
2. Get up slowly and sit down before you got up from the bed
 
3. Avoid bending position when lifting objects
 
4. Avoid tilting the head position, for example to take an object from a height
 
5. Move your head carefully if your head in a flat position (horizontal) or when the neck in up position

physical therapy,goals,outcomes,and interventions:

• bed rest: brief ,useful during initial stages only;prolonged bed rest may delay recovery.

• implement safety measures;teach sensory substitution,compensatory strategies ;provide ambulatory aids as indicated;eg:cane ,walker.

• provide active exercises to promote vestibular adaptation[recalibration of system]

1.  habituation training:  repetition of movements and positIons that provoke dizziness and vertigo.

encourage movement; engage VOR and VSR as much as possible.  

                        

• eye and head exercises:eg; eye movements up and down,side to side;head movements up and down,side to side progressing slow to fast .                                                                                            

• exercises to improve postural stability;sitting and standing ,static and dynamic activities.eg:bending forward,turning,swiss ball exercises.

• emphasize functional mobility skills;walking,turning,stairs,community activities,activities with spatial and timing  constraints.

• relaxation training; decrease anxiety levels

• begin conservatively ,avoid excessive exacerbation of symptoms.

• recovery is better,generally faster in unilateral than bilateral vestibular dysfunction

• provide psychological support and reassurance. 

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness, most often 
 experienced when patients lies down.

Because BPPV is not intrinsically life threatening and symptoms are usually self limiting patient is usually kept under watchful wait but as BPPV can last for much longer than 2 months, it is better to treat it actively by Epley maneuvers or Semont Maneuver.

The Semont and Epley maneuvers may improve or cure benign paroxysmal positional vertigo (BPPV) with only one procedure however some people may need multiple sittings.

CRP / Epley maneuver/  Canalith repositioning procedure




The Canalith Repositioning Procedure (CRP) or epley’s maneuver is a rehabilitation treatment for Benign positional vertigo.  CRP is very effective, with an approximate cure rate of 80%. The recurrence rate for BPPV after these maneuvers is low. However, in some instances additional treatment may be necessary.

Canalith/otolith/or otoconia are small crystals of calcium carbonate attached to the otolithic membrane in the utricle of the inner ear. Because of trauma, infection, or aging, canaliths can detach from the utricle and collect within the semicircular canals. Here these canaliths shift with the head movement  and stimulate sensitive nerve endings to cause dizziness.

Epley’s maneuvers 

 involve a series of specifically patterned head and trunk movements performed by a trained professional. This head position change, moves the canaliths from the problematic location in one of the semicircular canal to the utricle.

Procedure: The procedure takes approximately 20-30 minutes.

You will be placed on a table and then laid back with your head hanging over the end of the table.

If you have a “positive” response in this position you will then be moved through the procedure.



A. Patient is placed in sitting position on the edge of the examination table (Position A).

B. Head is rotated 45° towards the affected ear, and the patient is swiftly placed in lying position with the head hanging 30° below the horizontal over the table edge (Position B). Positive response (primary stage nystagmus) is observed position is maintained for 1-2 minutes.

C. The head is rotated 90° towards the opposite ear while maintaining the head hanging position. (Position C)

D. Patient is turned further 90° towards the unaffected side to face the floor. (Position D)
The patient’s eyes are observed for secondary-stage nystagmus, it should be in the same direction as the primary-stage nystagmus.

E. Position is maintained for 30 to 60 seconds, and then again laced in sitting position (Position E). Upon sitting, there should be no vertigo or nystagmus in a successful maneuver.


Instructions Following the Canalith Repositioning Procedure

Wait for 10 minutes after the maneuver is performed before going home. Don’t drive yourself home.
For first 48 hours–

1. Do not tip your head up or down or bend at the waist. Use of the cervical collar will help prevent you from tipping your chin down.

1. Do not visit the places that require you to lie down or tilt your head (hairdresser, dentist, chiropractor or barber).

1. Avoid tipping your head up or down when brushing teeth, shaving or washing your hair.

1. Sit down and get up from chairs while keeping your back straight, without bending forward and avoid tilting your head forward.

1. Housework such as cooking or cleaning should be avoided for the next 48 hours.    

Do Not Lie Flat in Bed: 

 

Sleep semi-recumbent for the next night. This means sleep with your head halfway between being flat and 

upright (a 45 degree angle) by using a recliner chair or by using pillows arranged on a couch

 
 The Following Week:

• Do Not Sleep on your treated side

• Use two pillows when you sleep.

• Avoid sleeping on the “bad” side.

• Don’t turn your head far up or far down

(Like head extended positions at the beauty parlor, dentist’s office, and while undergoing minor surgery).

• No “sit-ups” for at least one week and no “crawl” swimming.

After 1 week you can resume your daily activities without any restrictions. Move around as you wish.

 
Contraindications to perform Epley Maneuver

• Unstable heart disease

• High grade carotid stenosis,

• CNS disease (stroke or Transient Ischemic Attack),

• Physical limitation– neck disease (rheumatoid arthritis, cervical radiculopathies, ankylosing spondylitis, cervical spine fracture or surgery)

• Pregnant women beyond the 24th week of pregnancy  

 

 

 

 

 

 

 

Semont Maneuver

The Semont maneuver (liberatory” maneuver) involves a procedure whereby the patient is quickly moved 

from lying on one side to lying on the other side.

Position 1. Patient is made to sit on the examination table with legs hanging over the edge and head turned 45 degrees horizontally towards the unaffected ear.

Position 2. While maintaining head rotation patient’s upper body is swiftly moved to side lying position on the affected side with head resting on examination table and nose pointed upwards. Position is maintained for 3 minutes or till vertigo and nystagmus subsides. This step moves the debris to the apex.

Position 3. Patient is rapidly moved through the sitting position (Position 1) to lying on the opposite or unaffected side (maintaining same head rotation) with nose pointed to the ground. Position is again maintained for 3 minutes or till the vertigo and nystagmus subsides. This maneuver moves the debris towards exit of the canal.
Idea is to move the debris into the utricle where it will no longer cause vertigo.
Semont maneuver is 90% effective after 4 treatment sessions


 Home exercise:

Brandt daroff exercises:

                   

 
                              

 vestibular suppressant medications :prolonged use may delay recovery ;severe cases may require ablative surgery

Surgical:

It is rarely used. It also depends on the cause of Vertigo. It is indicated in cases resistant to Conservative management. The various options available are Vestibular nerve section, and destruction of balance organ in the inner ear (labyrinthectomy) by chemical or surgical method. If the cause of Vertigo is an Intracranial then the disease is treated accordingly

Disclaimer: This information might have been copied from different sources to give the best accessible...

Know Vertigo, Causes and How to Overcome It....

      

There are a few tips to get rid of vertigo. Vertigo is a symptom of a medical condition characterized by the sensation of  moving around in space or  having objects move around a person ; tends to come in attacks;if severe,accompanied  by nausea and vomiting.

Causes of Vertigo

 There are a number of different causes of vertigo. Vertigo can be defined based upon whether the cause is peripheral or central.

 Central causes of vertigo arise in the brain or spinal cord while peripheral vertigo is due to a problem within the inner ear.

                                 

Brain or sensory nerve disturbance:


Central vertigo

  is a term that collects together the central nervous system causes - involving a disturbance to one of the following two areas:

• The parts of the brain (brainstem and cerebellum) that deal with interaction between the senses of vision and balance, or

• Sensory messages to and from the thalamus part of the brain.

The central nervous system regulate a sense of balance. Disruption by diseases of the central nervous system such as multiple sclerosis, tumors, neck damage, or stroke can cause vertigo

Uncommon causes are stroke and transient ischemic attack, cerebellar brain tumor, acoustic neuroma (a non-cancerous growth on the acoustic nerve in the brain) and multiple sclerosis

Inner ear disturbance:

 

 unilateral vestibular disorder:[UVD]

 

Peripheral vertigo 

 is a term that collects together the inner ear causes.

The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity. By telling our brains when there is movement from the vertical position, we are able to keep our balance, maintain equilibrium.
Disturbance to this system therefore produces vertigo and can be created by inflammation among other causes. Viral infection is behind the inflammation seen in the following two conditions:

• Labyrinthitis - this is inflammation of the inner ear labyrinth and vestibular nerve (the nerve responsible for encoding the body's motion and position

• Vestibular neuronitis - this is thought to be due to inflammation of the vestibular nerve. an acute infection with prolonged attack of symptoms,persisting for several days or weeks;caused by viral or bacterial infection.
  Infections such as colds, flu, or other inflammation can affect the inner ear and cause vertigo.

• Ménière's disease

        This form of vertigo is thought to be caused by high pressure of a fluid in a compartment of the inner ear (a swelling that is also known as endolymphatic hydrops).

As well as infection, Meniere's disease can result from metabolic and immune disorders.

 recurrent and usuallay progressive vestibular disease;episodic attacks may last from minutes to several hours with severe symptoms ;usually associated with tinnitus ,deafness,sensation of pressure/fullness with in ear;etiology:unknown,edema of membranous labyrinth is a consistent finding

 

Benign paroxysmal positional vertigo

Benign positional vertigo is due to a disturbance within the inner ear. The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to movement of the fluid, which occurs as you change position. The fluid movement allows your brain to interpret your body's position and maintain your balance.

Benign positional vertigo develops when a small piece of bone-like calcium breaks free and floats within the tube of the inner ear. This sends the brain confusing messages about your body's position.

                             

Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance. BPPV is benign, meaning that it is not life-threatening nor generally progressive. BPPV produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly and with a change in head position. - See more at: http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo#sthash.ipE9F7RB.dpuf

Basic Prenatal Exercises

These few basic exercises will help increase your strength and flexibility. If you have limited time, these exercises are highly recommended and should take only about ten minutes per day. Check with a qualified prenatal exercise instructor if you are not sure you are doing the exercises correctly.

Arm/Upper Back Stretch (Flying Arm Exercise) - repeat 5 times:

1.    Raise your arms over your head, keep your elbows straight and the palms of your hands facing one another. Hold for at least 20 seconds.

2.    Lower your arms out to your side. Keep your upper back straight.

Bring the backs of your hands together as far as possible behind your back and stretch

Abdominal Muscles

Before beginning the next exercises-—the pelvic tilt and sit-ups—-review the following information on separation of the abdominal muscles.

During pregnancy, it is important to check for advanced separation of the abdominal muscles in order to take precautions to avoid any further separation.

1.    The abdominal muscle in the center is divided by a seam, so the muscle is really two halves.

2.    The hormones present during pregnancy cause this seam to soften and stretch as the abdominal muscles accommodate the growing baby. If the seam stretches enough, a separation of the abdominal muscle may occur.

A separation can happen gradually or as a result of sudden exertion if the abdominal area is weak. You may be unaware of the separation as it causes no direct pain. However, you might have increased backache, as the abdominal muscles are needed to control a pelvic tilt and maintain proper posture.

How to Check for Abdominal Muscle Separation

You can check for separation anytime during your pregnancy by following these instructions:

1.    Lie on your back and bend your knees, feet flat on the floor.

2.    Slowly put your chin to your chest - raise your head and shoulders until your neck is 6-8 inches from the floor. Hold one arm out in front of you.

3.    With the other hand, check for a gap (usually present in the first few months of pregnancy or postpartum) or a bulge (present in last 3 months of pregnancy) in the middle of your abdomen. There may just be a soft region between the muscles, wider than two fingers' width.

4.    If any separation is found, avoid further separation by:

• Doing mild abdominal strengthening while crossing your hands over your abdominal area to support and bring the muscles together.
• Exhale as you lift your head; this decreases pressure in your abdomen and allows your abdominal muscles to work more efficiently.
• Avoid abdominal bulging by consciously contracting your abdominal muscle when lifting and avoid straining of any kind.

Pelvic Tilt

This exercise is very important because it is the building block of good posture; strengthens your abdominal and back muscles; and therefore decreases back strain and fatigue. Practice it often. (see pictures below)

1. Lie on your back with your knees bent.

2. Inhale through your nose and tighten your stomach and buttock muscles

3. Flatten the small of your back against the floor and allow your pelvis to tilt upward. (see example below on left)

4. Hold for a count of five as you exhale slowly.

5. Relax,repeat.                                                                                                                                   

Other positions in which you can perform the pelvic tilt are while on your hands and knees or while standing upright.

• CAUTION: DO NOT arch your back, bulge your abdomen or push with your feet to obtain this motion! (as in example on right)

Sit-ups

There are two variations of sit-ups:

Forward Sit-up

1. Lie on your back with your knees bent and breathe in slowly through your nose.

2. Breathe out through partially pursed lips as you raise your head, hands pointing to your knees or placed behind your head.

3. Tuck your chin toward your chest and lift your shoulders off the floor (not more than 45 degrees).

Diagonal Sit-up

1. Lie on your back with your knees bent. Slowly breathe in through your nose.

2. Point your right hand toward your left knee while raising your head and right shoulder. Breathe out slowly through your mouth. Keep your left knee bent slightly and your heel on the floor.

Kegels

Kegel exercises tone the pubococcygeal (PC) muscle. This is the muscle you use to stop and start the flow of urine. Exercising this muscle helps prevent hemorrhoids, supports your growing baby, assists during and after labor, keeps the muscles of the vagina toned.

Learn to isolate this PC muscle by stopping the flow of urine a few times. Use this technique only to locate the muscle. Don't exercise the muscle this way as it may lead to a urinary tract infection.

• Squeeze the PC muscle for five seconds; relax for five seconds, then squeeze again. At first, do 10 five-second squeezes three times a day.
• Flutter exercises: Squeeze and release, then squeeze and release as quickly as you can.
• Work up to doing 100 Kegels each day.

Squatting

1. Move to the squatting position, knees over your toes.

2. Keep your heels on the floor; feel the stretch in the back of your thighs.

3.    Hold for 20-30 seconds. Gradually increase the time to 60-90 seconds.

4.    Relax your head and arms throughout this exercise.

This is a good exercise to prepare for squatting during the pushing stage of labor

Calf Stretch

1. Lean against a wall or firm surface.

2. Reach one leg out behind you, keeping your heel on the floor.

3. Lean into the wall to increase the stretch of your calf.

4. Hold for 20-30 seconds.

5. Repeat with each leg.

This is a good exercise to do before going to bed if you are bothered by leg cramps at night

Prenatal Exercises

Exercise slowly without bouncing or jerking. Do not stretch to the point of pain. Start with a small number of repetitions and gradually increase to your individual tolerance. It does not take long exercise sessions to ease aches, increase flexibility and circulation, and generally make you feel better. These exercises detailed in this section can be done while watching television or during short stretch breaks anytime during the day.

Use all the pelvic tilt exercises to help ease backache during pregnancy and labor. During labor, the pelvic tilt on all fours may be helpful in rotating a posterior baby.

Pelvic Tilt

Position - Lie on back with knees bent.

Action  

• Tighten the stomach muscles and flatten the small of the back down against the floor.
• Hold for 5 counts.
• Relax. Repeat.

Lying flat on your back after 20 weeks of pregnancy is not recommended.

 Pelvic Tilt on All Fours

Position

Assume all-fours position keeping back straight. Do not let lower back sag.

Action

• Tighten the stomach muscles so pelvis tucks under and lower back rounds.
• Hold for 5 counts.

• Relax. Repeat

Standing Pelvic Tilt

Position

Stand with knees slightly bent.

Action

• Tighten stomach and press the small of the back flat, as if against an imaginary wall.  
• Hold this position for one minute.  
• Relax.  
• Repeat often if standing for long periods.

Passive Pelvic Tilt

Position

• Lay on your side with knees bent. Have your partner position himself behind your hips.
• Using his hand nearest your head, your partner places his palm on the crest of your hip and then his other hand on your tail bone.

Action

• Partner slowly rotates the crest of your hip back toward himself.

• Release and repeat.

Wall Stretch

Position

Stand against the wall with knees slightly bent.

 

Action

• Place shoulders, elbows, and wrists against the wall with elbows bent and fingers pointing upwards.
• Slowly slide arms up the wall, straightening elbows.
• Once arms are overhead, try to pull abdomen up and in so the back flattens against the wall.
• Slide arms back down to the starting position.
• Relax abdominals.
• Repeat.

Tailor Stretch

Position

Sit on floor with legs spread apart.

 

Action

• Tilt pelvis and maintain position.
• Extend legs with knees straight. Extend both arms and reach forward slowly until you feel a mild stretch.
•  Return to starting position.
• Repeat.

Tailor Sitting

Position

• Sit on firm surface, preferably the floor.
• Sit up straight with your legs stretched out in front of you.

Action

Bend your knees then lower them outward toward the floor. Pull your heels toward your body

Wall Squat

Position

Hold a standing pelvic tilt with back against a wall.

Action

• Slowly slide your upper body down the wall until knees are bent as if sitting on a stool.
• Hold this position with contracted thighs and abdominals while relaxing all muscles not being used.

Slowly return to standing position.

 Progression

• Tighten and release pelvic floor.
• Use the contracted thighs to stimulate uterine contractions while practicing breathing patterns.
• Slowly return to standing position.

Building Pelvic Floor Muscles with Kegel Exercises

Pregnancy often causes noticeable pelvic floor muscle weakness. Pelvic muscle weakness and trauma can lead to:

• A difficult delivery.
• Onset of incontinence (uncontrolled loss of urine or stool).

Good muscle tone in pelvic floor muscle helps:

• Prevent urinary "dribbling" when coughing or laughing.
• May prevent the need for surgery later in life to pull up a "sagging" uterus or other pelvic organs.
• Decrease discomfort during pelvic exams.
• Shortens and makes second stage labor easier when the baby is actually born.
• Improve perineum healing with episiotomy repair and/or hemorrhoids.
• Fifteen minutes of exercise each day for a month can strengthen the pelvic floor muscles. 

Kegel Exercises

• Prenatal pelvic floor exercises, called Kegel exercises, can result in fewer complications with vaginal delivery, reduced tearing of the perineum, reduced need for episiotomy and reduced experience of back labor. Kegel exercises are done by contracting and releasing the pelvic floor muscles

To find the pelvic floor muscles, position yourself seated with your legs reclined. Tense the ring of muscles around your rectum as if suppressing gas or as if stopping a urine stream or bowel movement.

• Relax your legs.
• Do not lift your buttocks off the chair.
• Stomach should be relaxed.
• Continue to breathe normally.

Position

Sit on a chair.

Action

• Tense or squeeze the ring of muscles around the vaginal and rectal area like you are stopping the flow of urine in midstream. Squeeze the muscles tightly for 10 seconds and then release and relax the muscles slowly. Repeat these exercises 10 times, several times a day. 

• Another way to explain Kegel exercises is to use an elevator that goes up and down five floors as an example.
• To go up: Tighten the muscles, slowly making the muscles tighter with each floor.
• To go down: Relax the muscles, slowly allowing the muscles to relax with each floor.
• Rest

Be sure to get sufficient rest. Take time to lay down, nap if possible or just put your feet up and rest whenever possible. Try to get at least eight hours of sleep each night.

HELPFUL PRENATAL EXERCISES IMPORTANT FOR RELIEVING COMMON PROBLEMS DURING PREGNANCY 

 

1. As the uterus and abdomen increase in size, lordotic posture often occurs (back sways). Moms should concentrate on strengthening abdominal muscles, buttocks and quadriceps, and stretching the low back and hip flexor muscles.
2.  An ideal way to work the abdominals during pregnancy is in a supine, inclined position on a large exercise ball. (See illustration) Modified crunches and pelvic tilts can be done in a more upright position, keeping weight off the Inferior Vena Cava which typically is compressed when in a flat position. The back muscles also benefit from these exercises by increasing strength and flexibility.
3.  Buttock and quadricep muscles can be simultaneously strengthened in a modified squat exercise done at the wall against the ball. (See illustration) Keep knee flexion minimal during squat as connective tissue surrounding the joints becomes much softer due to hormonal increases. Stretching the low back during pregnancy can be done on all fours, rounding the back as the pelvis tilts under. Hip flexors are stretched in a "split stance" standing position, tilting the pelvis under until stretch begins in the hip flexor of the back leg.  

2. The extra weight of larger breasts during pregnancy tends to pull the shoulders forward, shortening pectoral muscles in the chest and overstretching and weakening the rhomboid and trapezium muscles in the back. Concentrate on stretching the chest muscles by holding a towel with both hands shoulder width apart and pushing the towel back overhead with extended arms. Then strengthen the back muscles by using low weights and rowing the arms back, contracting the shoulder blades together.  

3. Edema associated with pregnancy can cause swelling in the wrists resulting in compression of the median nerve. Symptoms include numbness and tingling when the wrists are in a flexed position, so avoid exercises which place the wrists in this position. Do not use rubber tubing for the upper body strengthening due to the tendency to 'break" the wrist alignment.

Before doing prenatal exercises please check your health status and conform with your doctor...

Exercise dos and donts for pregnant women...refer my previous post.

Disclaimer: This information might have been copied from different sources to give the best accessible...