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Vestibular Rehabilitation:
Vestibular rehabilitation is the primary treatment
for many causes of dizziness. This treatment consists of several
tailored exercises that are designed with two concepts in mind:
"adaptation" and "substitution." Adaptation is designed to retrain
the brain to compensate for loss of inner ear function. When one
inner ear is injured and not functioning properly and the other
inner ear is functioning well, the brain perceives the mismatched
signals as movement. This is analogous to an airplane with an engine
on each wing. If one engine stops, the plane will no longer fly
straight unless corrected by the pilot or an onboard computer.
Adaptation is a process by which the brain learns to balance out
asymmetric signals received from the inner ears. In this sense,
the brain is like the computer that makes the plane fly straight
when one engine is out. Adaptation is made possible by the "programming"
offered by vestibular rehabilitation exercises.
Substitution is a process by which a patient learns to compensate
for the disability caused by inner ear dysfunction by relying more
on other senses. Balance depends not only on inner ear function,
but also on visual cues and sensory input from the extremities and
trunk. The patient is taught to "substitute" inner ear input by
paying more attention to their visual surroundings and other sensations.
Canalith Repositioning:
The canalith repositioning maneuvers are specific treatments for
benign paroxysmal positional vertigo (BPPV). There are several techniques
that can be used to accomplish these maneuvers, however, all involve
turning the head in certain positions that use the force of gravity
to move dislodged calcium carbonate crystals back to their normal
position. These maneuvers are extremely effective and most patients
with BPPV enjoy immediate relief from vertigo.
Medications:
For the majority of patients with dizziness, medications are a negative
influence on recovery. This is especially true for patients suffering
from chronic dizziness after an acute attack of vestibular neuritis.
Recent studies have shown that medications can actually interfere
with the adaptation process that occurs naturally and during vestibular
rehabilitation. Nevertheless, certain medications can be very helpful
for certain causes of vertigo, especially fluctuating conditions
such as migraine and Ménière's disease.
Fresno Headache & Balance Center
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