What Is Vestibular Physiotherapy?

In daily life, the human body mainly depends on the peripheral receptors of the three systems of vestibule, vision and proprioception to sense body position, movement, and external stimuli, and to maintain the body in a suitable position in the space through the integration and coordination of balanced central information. In terms of maintaining the balance function, the vestibular system is the most important of the above three systems. The vestibule is the main peripheral sensory organ of the human body's balance system and is one of the inner ear organs. It is located in the temporal bone rock and is closely connected with the semicircular canal and the cochlea, and together forms the inner ear bone labyrinth.

Basic Information

English name: vestibular function
Visiting department: surgical
Multiple groups: Cochlear vestibule

Common causes: Cochlear vestibular disorders, vestibular disorders, vascular; tumors, trauma, degenerative disorders, etc.
Common symptoms: Dizziness, dizziness, nausea, vomiting, diarrhea, etc.

Causes of Vestibular Dysfunction

Vestibular dysfunction refers to the imbalance of vestibular function, which includes low or loss of vestibular function and excessive vestibular function.

Vestibular dysfunction can be common in the following diseases:

Peripheral vestibular vertigo

(1) Cochlear vestibular disorders include: inside the labyrinth: such as sudden deafness, Meniere's disease, etc .; inside and outside the labyrinth: such as aminoglycoside ear poisoning.

(2) Vestibular disorders include: in the labyrinth: such as benign paroxysmal positional vertigo and motion sickness; outside the labyrinth: such as vestibular neuronitis.

2. vestibular central vertigo

Including: vascular; tumor, trauma, degenerative diseases.

The causes include: viral infections, inner ear circulation disorders, autoimmune diseases, trauma, tumors, ototoxic drugs, congenital factors, and so on.

However, vestibular dysfunction is not necessarily an organic lesion. It even includes hypersensitivity of the vestibular organs and dizziness and dizziness caused by excessive stimulation of the inner ear vestibule. The most common are motion sickness, which has certain genetic factors.

In addition, emotional stress, anxiety, lack of sleep, or smelling bad smells are also predisposing factors.

Vestibular Dysfunction

Dizziness and dizziness are the most common manifestations, and they come in the following forms:

Motor illusion vertigo

Rotary vertigo, linear vertigo, or displacement vertigo: The main manifestation of sudden vertigo during acute attacks is true vertigo. The patient feels that foreign objects are moving or is moving, with nausea, vomiting, diarrhea, and some patients appear Chest tightness, sweating, yawning, fast heart rate, high blood pressure.

2. Imbalance, imbalance

It manifests as a disorder of posture and gait balance. When the patient is standing or walking, he feels inclined or leaning to one side, feeling of instability, and hesitation or hesitation when walking.

3.Dizziness, dizziness

Patients often cannot clearly express their discomfort, such as dizziness, light-headedness, numbness in the head, emptiness, head cuffs, heavy pressure on the head, and blackness in front of the eyes.

May also be accompanied by the manifestations of primary disease, such as deafness, tinnitus and so on.

Vestibular Dysfunction Examination

Nystagmus

Nystagmus is an involuntary rhythmic movement of the eyeball. Vestibular nystagmus consists of alternating slow and fast motions. The slow phase is the slow movement of the eyeball turning to a certain direction, which is caused by the vestibular stimulation; the fast phase is the rapid return movement of the eyeball, which is the central corrective movement. The slow phase of eye movements is toward the side with less excitability of the vestibule, and the fast phase is toward the side with higher excitability of the vestibule. Because the fast phase is easy to observe, the direction pointed by the fast phase is usually used as the nystagmus direction.

(1) Vestibular eye movement examination method mainly refers to semicircular canal function test: 1) Hot and cold test The hot and cold test is to induce the vestibular response by injecting cold, warm water or air into the external ear canal. According to the various parameters of nystagmus, the slow phase angular velocity is mainly used to analyze the strength of the response and evaluate the function of the semicircular canal. Those with spontaneous nystagmus first stimulate the ears with slow nystagmus. Generally, the slow phase angular velocity is used as a parameter to evaluate the side semicircular canal palsy and the dominant bias. Trace ice water test: 0.4ml of normal vestibular function can induce horizontal nystagmus, the direction to the opposite side. 2) Rotation test The rotation test is based on the following principles: The semicircular canal rotates in a certain direction on its plane. At the beginning, due to the inertia, the lymphatic fluid in the tube produces a deflection of the ampulla of the opposite direction of rotation; when the spin is stopped, the lymph The fluid also deflected the ampulla due to inertia, but in the opposite direction from the beginning. 3) Shaking head test The sitting subjects were shaken left and right horizontally at specific frequencies for 10 to 15 seconds, and the latent and vestibular nystagmus induced by the subjects were shaken to the healthy side. 4) Head shake test Also known as pulse-type head swing test, when the unilateral vestibular function is reduced, the head immediately rotates toward the affected side, and rapid eye movement toward the healthy side occurs immediately.

(2) Otolith examination 1) Positional nystagmus method Positional nystagmus is a nystagmus that occurs only when the patient's head is in a certain position. Metastatic nystagmus is mainly used to diagnose benign paroxysmal positional vertigo. However, the characteristics of nystagmus induced, such as incubation period, duration, fatigue, direction of nystagmus, and presence or absence of vertigo, can be identified. 2) Vestibular evoked myoelectric potential is a muscle-derived potential recorded on the surface of the sternocleidomastoid muscle in a tense state by strong sound stimulation. It is a means of examining balloon function. VEMPs can be used to test the vestibular-cervical reflex pathway. The subject's head was tilted to one side, and the sound was given on this side, that is, the characteristic of unilateral conduction of VEMPs helps to make an objective assessment of the function of the balloon on the test side.

2. Other

Auditory tests and vestibular function tests should be performed. If necessary, head MRI and other examinations assist in diagnosis.

Vestibular Dysfunction Diagnosis

In addition to specific medical history and clinical manifestations, audiological examination and vestibular function examination should be performed. To find the cause, head MRI and other examinations assist diagnosis, and special attention should be paid to internal auditory examination to rule out other diagnostic possibilities, such as cerebellopontine angle tumors, brain stem hemorrhage, or infarction.

Vestibular Dysfunction Treatment

Vigorous activities should be avoided during acute episodes, bed rest, lying in a comfortable position, eyes closed, head fixed, avoid sound and light stimulation. Soothe their mood, reduce their fear and anxiety, and eliminate the cause of treatment. Vestibular nerve sedatives such as diazepam can also be used; anticholinergic preparations such as scopolamine and anisodamine; vestibular nerve depression and anticholinergic drugs such as theophylline, difenidol, and promethazine; vasodilators, Such as betahistine, flunarizine, sodium bicarbonate and so on. Those who fail to respond to medication can consider surgery to destroy the labyrinth or cut the vestibular nerve.

Those with low vestibular dysfunction will undergo Cawthorne-Cooksey vestibular rehabilitation training to promote vestibular compensation.

Vestibular function sensitivity is too high, you can try the practice therapy, the response to the same stimulus will gradually decrease or decay.

Vestibular Dysfunction Prevention

Maintain a good mentality, regular work and rest, reduce mental stress, exercise moderately, improve the body's immunity, avoid irritating food and tobacco and alcohol, eat less salt, should not go out alone during the outbreak period to prevent accidents.