Vestibular gymnastics for benign positional paroxysmal vertigo

Exercises for dizziness I came to the Center for my next rehabilitation with this question in September 2021.

That is, for the fifth rehabilitation at the Neurorehabilitation Center of Krasnoyarsk.

To be honest, after the operation and the stroke, when my mother took me two months later, I noticed that I often felt sick.

It wasn’t just that I felt bad, it all happened while moving, for example, in a car.

I realized that I was not just sick of the fact that I was traveling in a vehicle, but of the way the driver was driving the vehicle.

Sometimes I didn’t pay attention to the ride, and sometimes I got out and felt bad, that is, I had nausea and dizziness.

In other words, I periodically felt dizzy when traveling in public transport.

I didn’t feel bad at all, but it was not pleasant.

It’s just that before, I didn’t experience such inconvenience at all.

Secondly, I also noticed that standing, for example, on the road, I was very swaying, and it seemed like I was about to fall.

I tried to stand straight while waiting for a taxi on the road.

As soon as I stood half-bent over, the dizziness went away, and the feeling that I was going to fall went away.

That’s why I wanted to consult doctors about what to do or what exercises to use for dizziness.

Exercises for dizziness at the Neurorehabilitation Center

At the Neurorehabilitation Center, the rehabilitologist prescribed group exercise therapy classes for me with an instructor.

And, also, walking classes in an Adele costume.

During these classes, I had to do special exercises for dizziness.


A copy of exercises from the Neurorehabilitation Center of Krasnoyarsk

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Contraindications

Therapeutic gymnastics is not indicated in all cases. It happens that it is better to hold off on exercise.

Vestibular gymnastics is prohibited from being performed in the following cases:

  • disorientation (the period when symptoms of vestibulopathy appear);
  • there are pathologies of the respiratory and cardiovascular systems;
  • your health worsens after exercise.

In other cases, you can perform gymnastics, but only with serious medical supervision from a specialist who will draw up an individual training program.

Exercises

First of all, at group exercise therapy, we did squats, among other things.

That is, it seems, what’s wrong with sitting down and standing up?

But, there are special conditions for this.

Firstly, getting up and sitting down is not so easy after a stroke.

Exercise 1:

Get up from the chair and sit down on it, first looking forward at any stationary object, and then all with your eyes closed.

Exercise 2:

From a sitting position on a chair, lean forward, take out an object located on the floor, then return to the starting position.

Next, you need to return this item to the floor.

Exercise 3:

While sitting, move your head up and down and left and right.

First, accompany the movements with your gaze, then fix your gaze on any stationary object at face level.

Exercises 4:

From the starting position lying on your back, turn to your left side, return to the supine position, then turn to your right side.


Copy from the Neurorehabilitation Center of Krasnoyarsk

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Indications for classes

Dizziness in rare cases becomes a reason to go to the hospital. But do not underestimate the malaise, because in some cases it is an alarming signal, warning about the likelihood of developing a serious illness.

Indications for vestibular gymnastics include diseases such as the post-stroke period, osteochondrosis, pathologies of the ear area, as well as conditions after traumatic brain injury.


But it’s not always possible to do gymnastics yourself.
Self-medication can worsen the patient's condition when he has ischemic brain damage , and there is also a high likelihood of compression of the vertebral artery.
Only the doctor should decide whether gymnastics is indicated for the patient and in what way he can do it, independently or with the help of a doctor. Do not self-medicate and consult a specialist!

Exercises at home

Vestibular gymnastics exercise therapy for independent performance should be built according to the following rules:

  1. During the first week, turn your head in different directions.
    Don't worry if you feel a little nauseous. This is the norm for now, so keep practicing.
  2. Starting next week, start bending forward and backward, left and right. Remember to control your breathing, exhale when bending over.
  3. After twenty days, light boxing is added to the training. You need to box with an invisible opponent with your elbows bent.
  4. Then walking is added. Walk forward and back without looking back. Do 10-15 repetitions.

Read more about how to cope with dizziness at home here.

Treatment of dizziness most often occurs with the help of drug therapy, namely drugs and folk remedies.

Symptoms

The symptoms of this syndrome are characterized by the sudden onset of dizziness with a high degree of intensity; the abrupt onset and short duration of the attack make this type of dizziness characteristic of the pathology of the inner ear and the vestibular apparatus, consisting of semicircular canals. In addition to the main symptom of dizziness, benign positional paroxysmal vertigo is often accompanied by concomitant autonomic symptoms, such as:

  • Involuntary motor activity of the eyeballs or horizontal nystagmus;
  • A feeling of intense nausea and even vomiting that does not bring relief;
  • Increased heart rate and pulse.

It is important to note that the lack of physical activity on the part of the patient leads to a rapid subsidence of the symptoms of positional vertigo, and only during movement does an attack occur.

If the patient has an idiopathic form of benign positional vertigo, then during examination during questioning the patient does not complain of decreased or distorted hearing. Also, BPPV is not accompanied by symptoms such as tinnitus or tinnitus, or headaches.

Eye tracking

Sit in a comfortable position, take in your hand a small (the size of a postcard or map) thick piece of paper with a few words printed on it in regular font. Hold a piece of paper 30 cm away at eye level. Move the piece of paper horizontally to the right and left. Repeat the exercises, moving the sheet vertically, then diagonally. During the exercise, the head should remain motionless; you need to follow the leaf only with your eyes. Over time, move the piece of paper faster and faster until you can no longer make out the words written on it.

In each plane you need to repeat the exercise 15–20 times.

Damage to the lateral semicircular tubule

A lesion of the lateral RCC is detected with the patient lying down by turning the head in the plane of the canal from right to left and vice versa (roll test). Horizontal nystagmus occurs, with a clonic component directed downward, mainly when the affected ear is turned downward; if the healthy ear is located below, nystagmus also occurs, the clonic component of which is directed downward, but less pronounced.

In a quarter of patients, canalolithiasis in the lateral RCC is combined with canaloliasis in the posterior RCC. In contrast to downward-directed nystagmus, the clonic component of evoked nystagmus is directed toward the overlying ear. This form is combined with the location of otoliths in the anterior part of the lateral ACC or the otolith fixed to the cupula, while with freely moving otoliths, nystagmus occurs directed towards the underlying ear.

Test results may be influenced by cervical spinal canal stenosis, radiculopathy of the cervical segments of the spinal cord, severe kyphosis, restrictions of movement in the cervical spine: rheumatoid arthritis, ankylosing spondylitis, Paget's disease, spinal cord injury, morbid obesity, Down syndrome. In this case, it is possible to use a Barany swivel chair.

If the test results are negative, a preliminary diagnosis of BPPV is made based on complaints of positional vertigo and is confirmed by successful performance of vestibular maneuvers.

If examination reveals a nystagmus that differs from that described above, as well as other neurological symptoms, it is necessary to exclude other lesions of the nervous system.

A number of types of dizziness and nystagmus appear only when the position of the head in space changes - they are positional.

Nystagmus and rotational vertigo can cause both central (for example, associated with damage to the brain stem or cerebellum) and peripheral (canalolithiasis, vestibular neuronitis, damage to the ear ganglion, perilymphatic fistula) lesions of the vestibular analyzer, as well as combined damage to central and peripheral structures - meningitis, intoxication.

Dizziness can be caused by circulatory disorders: thrombosis of the vestibular arteries, migraine, orthostatic hypotension, paroxysmal heart rhythm disturbances.

The relevance of the differential diagnosis of these causes is due to the fact that the central forms require special intervention.

The most commonly ordered test is an MRI of the brain. In some cases, diagnosis may require an orthostatic test, blood pressure and ECG monitoring, duplex scanning of the brachiocephalic arteries/transcranial Doppler sonography, radiography of the cervical spine, and an ophthalmological examination.

Positional maneuvers are also used to treat the patient. Treatment is carried out with the participation of a doctor and takes into account the location of the otolith according to the diagnostic maneuver.

Photo

Below, as a visual representation, are photos and pictures of exercises for the vestibular apparatus.

When is the best time to do gymnastics?

Recently, doctors have been inclined to believe that too early exercise is less beneficial than exercise that can be done from 12 to 17 hours, when the body has already woken up enough, moved around and is ready for additional stress. However, not everyone has such a free schedule, and therefore everyone must independently decide on the time of daily gymnastics. The main thing is that this time is convenient for regular exercise and is 2 hours away from the last meal.

It is also recommended to carry out mini warm-up complexes for everyone whose work involves constantly being in an uncomfortable, constrained position or a sitting position. In this case, you need to stretch and massage your neck every 1.5-2 hours, performing 1-2 simple exercises. Try to organize a group of like-minded people at work - it will be more interesting and easier to do.

It’s a good idea to add 10 grams of edible gelatin to your daily diet for 15-20 days, simply shaking it in any liquid and a dose of calcium in an accessible form with vitamins C and D.

Conclusion

If you start experiencing dizziness due to cervical osteochondrosis, remember - God has no hands but yours.
Plan your day so as to free up the necessary time for gymnastics. Warn your loved ones, try to involve them in a healthy lifestyle too. Do the exercises without missing a single day, even when you have no time and it seems that the effect is not happening, still continue hard training, and the reward will find you. One happy morning you will wake up and realize that the pain and dizziness have subsided, and life is as beautiful as ever. The article belongs to the site When copying, an active, indexed link to the source is required.

Drug treatment

There are no drugs that have a direct effect on canal/cupolothiasis.

Drug treatment is advisable only for frequent attacks or during maneuvers.

Drugs are used that reduce the excitability of the vestibular system, both selectively and through a general sedative effect. The first include drugs with a vestibulolytic effect - blockers of H1 and H3 histamine receptors, cinnarizine, atarax, first generation antihistamines - diphenhydramine, pipolfen.

Evidence has been obtained in favor of reducing the intensity of dizziness when performing the Epley maneuver simultaneously with taking betahistine 24 mg x 2 times a day for a week.

Sedatives, most commonly benzodiazepine tranquilizers (diazepam), are used in hospital settings for the symptomatic treatment of severe recurrent attacks.

IP – LYING ON YOUR BACK

  • Arms extended behind the head, stretching in four counts. Repeat 6-8 times.
  • Arms are extended behind the head, without lifting your hands from the floor, raise your head and look at your outstretched socks. Repeat 4-6 times
  • “Bicycle” - put your hands under your head, legs bent, 3 sets for a count of 10.
  • Legs bent at the knees, straighten your legs up, spread them apart, then connect them and lower them down. Repeat 6-8 times.
  • Diaphragmatic breathing: inhale - inflate the stomach, exhale - draw in the stomach, 6-8 times.

General principles of vestibular exercises for dizziness

To properly carry out the therapeutic complex of exercises, the following recommendations should be followed:

  1. Exercise at a suitable time, but at least 2 times a day with an eight-hour break.
  2. Exercises are prohibited during infectious and cold diseases.

Exercise with the permission of the attending physician.

  • Do all exercises in a measured rhythm. As the body begins to get used to it, gradually increase the load.
  • Train in comfortable clothes that do not restrict movement and comfortable shoes.
  • The complex should last from one to one and a half months.
  • The complex must be adjusted by a specialist every two weeks.

IP – SITTING ON A CHAIR OR STOOL

  1. Arms are lowered along the body, tilt your head forward - slowly and touch your chin to your chest, and just as slowly come back. 6-8 times
  2. The arms are lowered along the body - we bend the arms at the elbows, move the elbows back - inhale, return to the starting position - exhale. 4-6 repetitions.
  3. Hands on knees, palms between legs. For 2 counts, tilt the head and torso to the left, return to the starting point, for 3-4 counts, tilt the head and torso to the right, return to the starting point. 4-6 repetitions.
  4. Rest – “coachman” pose: head tilted forward, hands resting loosely on knees, breathing calmly. 1-2 minutes.
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