Vestibular physio: what is this specialty of rehabilitation of vestibular disorders?

Dizziness is the 3rd reason for consultation in general practitioners in France and represent 5% of admissions to emergency departments. However, the management solutions are often poorly known.

Vestibular disorders: what is it? what symptoms?

Vestibular disorders refer to impairment of the vestibular systema peripheral sensory organ located in theinner ear. This sensory organ stabilizes eye movements and helps maintain body position. Associated with sight and proprioception (the perception of the body by the brain), it contributes to the stabilization of our visual environment, to the maintenance of our static (standing) and dynamic balance (during movements or walking, etc.) and to our orientation in space.

The vestibular system can be affected by dysfunctions or pathologies: inflammation, infection, viral attack, congenital malformation, inner ear fluid pressure disorders, concussions, side effects of drug treatments…. But vestibular problems also include defects in the brain’s interpretation of signals from the balancing organs (motion sickness, dizziness from heights) .

Symptoms: dizziness, but not only

Behind this generic term vertigo, we can distinguish so-called “true” vertigo, vertiginous sensations and instabilities (balance disorders). According to Vincent Renaudie, president of the French Society of Vestibular Physiotherapists (SFKV),

“30% of people over 50 consult or will consult for vertigo. And we certainly underestimate the number of patients who are affected”

It is therefore a frequent and debilitating disorder in daily life. Vestibular disorders can cause many symptoms:

  • dizziness (the scenery revolves around you or you feel like you are spinning yourself; always associated with nystagmus);
  • dizziness: “head spinning”
  • disturbances in balance, posture and gait;
  • concentration and memory problems ;
  • confusion and disorientation;
  • anxiety, depression and social isolation ;

These symptoms sometimes invisible and difficult to describe, can unfortunately be neglected. And with only about 1300 specialized ENT specialists in France, the diagnosis can be complicated and long to make.

What diseases are grouped under vestibular disorders?

The most common vestibular disorders are:

  • the Vertigo Benign Paroxysmal Position or BPPV : the most common “true” vertigo. It is triggered byposition changes of the head. It is characterized by rotary vertigo lasting less than a minute. It is associated with a nystagmus (involuntary eye movement)as well as, more rarely, nausea or even vomiting;
  • Meniere’s disease, like all pressure disorders, is a chronic disease characterized by dizzy spellsa gradual hearing loss and tinnitus in one ear. It is linked to an imbalance of fluid pressure in the inner ear;
  • acute vestibular deficit (also called vestibular neuronitis or neuritis) is an inflammation of the vestibular nerve connected to the inner ear. Characterized by a sudden and severe bout of dizziness and major unsteadinessit can also cause nystagmus, nausea and vomiting requiring drug and rehabilitation treatment as early as possible;

Diagnosis: what is a vestibular assessment?

Dizziness represents 15 million consultations per year among general practitioners. The diagnosis is sometimes difficult to make, because vertigo can have several origins, and not all of them indicate a vestibular lesion. The diagnosis of vestibular disorders relies on general practitioners, ENT specialists (in particular otoreurologists, few in France) in the event of auditory symptoms, and neurologists in the event of suspicion of neurological disorders. Various examinations can then be carried out: a videonystamography, an audiometric test or imaging of the internal auditory canals and the brainstem.

Solutions exist to treat or alleviate vestibular syndromes:

  • them medications : it is possible to treat the vertiginous attack with an anti-vertiginous, a sedative and/or an antiemetic. Beta-histamine, a balance-regulating drug, is sometimes recommended as a long-term treatment.
  • the vestibular rehabilitation ;
  • the surgery (in some cases).

How do you know if you need vestibular rehabilitation?

“It generally takes 4 or 5 consultations before arriving at physiotherapy care, believes Vincent Renaudie. The route is chaotic, it is a real trauma for the patients. However, solutions exist if the diagnosis is made quickly”. Fortunately, “we are detecting dizziness better and better”.

Vestibular rehabilitation: what is the role of specialized physiotherapists?

In collaboration with doctors and ENT specialists, physiotherapists are responsible for patient assessment and personalized rehabilitation care. On medical prescription (therefore reimbursed by social security), they are the only health professionals legally authorized to practice vestibular rehabilitation. They are specially trained and equipped with specific and essential equipment for its practice. Only 800 in number in France, they treat vestibular disorders, but also vestibular symptoms related to old age or a pathology such as diabetes or travel sickness. “The field of action is very broad. We treat the symptomatology of patients. The big problem with what is called vertigo is that it brings together a lot of symptoms”, explains the vestibular physiotherapist.

The intervention of vestibular physiotherapists is particularly useful in the national plan to combat falls, launched by the government in 2022. “Each year, 2 million falls in people aged over 65 are responsible for 10,000 deaths, the leading cause of accidental deathand more than 130,000 hospitalizations” (source 1).

Where can I find a vestibular physiotherapist?

You can find a vestibular physiotherapist on the online appointment booking site Doctolib.

Two companies of specialized physiotherapists bring together the vast majority of trained and equipped professionals; the SFKV (French Society of Vestibular Physiotherapy) and the SIRV (International Vestibular Rehabilitation Society); a directory is available on their respective sites.

How many sessions are needed? What results to expect?

“The number of sessions is very variable”, explains the expert. It mainly depends on the disorder from which the patient is suffering.

  • In case of BPPV (benign paroxysmal positional vertigo), one session is enoughwith follow-up at 8 days to restore vestibular function.
  • In case of neuritis, if the management is early, it will take between 5 and 10 sessions, but more if the rehabilitation occurs late (hence the interest of a rapid diagnosis).
  • For all balance disorders (vestibular and neurological pathologies), between 10 and 20 sessions are required.

The sooner the patient arrives, the more obvious the social gain, since work stoppages, dissociation, the depression that can result, etc. are avoided.

“Therapeutic exercises in rehabilitation are dependent on the patient’s symptomatology, and therefore on the assessment carried out initially”, explains Vincent Renaudie.

Many exercises are performed during sessions to treat damage to the vestibular system, such as gaze stabilization exercises, the rotary chair, virtual reality, work on an unstable plane or even gait rehabilitation.

Here is an example ofexercise to do at home : the control of the support on one foot.

  • take support on one foot, then on the other;
  • eyes open then closed;
  • in shoes then barefoot;
  • for a few seconds first, then you can research the performance by timing yourself.

To know: to avoid falls in case of loss of balance, the exercise must be carried out almost leaning against the angle of a wall, with the back of a solid armchair in front.

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