Symptoms
- ■ Vertigo — a spinning sensation triggered by head position changes or spontaneous onset
- ■ Dizziness, lightheadedness, or a sense of floating or rocking
- ■ Unsteadiness while walking, especially in the dark or on uneven surfaces
- ■ Nausea, vomiting, or visual disturbance associated with head movements
- ■ Frequent falls or near-falls and fear of falling that limits activity
Causes
- ■ BPPV — calcium carbonate crystal (otolith) displacement in the semicircular canals
- ■ Vestibular neuritis or labyrinthitis from viral inflammation of the vestibular nerve
- ■ Ménière's disease causing endolymphatic hydrops in the inner ear
- ■ Central causes: stroke, brain tumors, multiple sclerosis affecting vestibular pathways
- ■ Age-related decline in vestibular hair cell function, visual acuity, and proprioception
Diagnosis
- ■ Dix-Hallpike test to diagnose posterior canal BPPV
- ■ Roll test (Supine Head Roll) for horizontal canal BPPV
- ■ Vestibulo-ocular reflex (VOR) assessment via Head Impulse Test and Dynamic Visual Acuity test
- ■ Berg Balance Scale, Dynamic Gait Index, and computerized dynamic posturography for fall risk
* Evidence-Based Interventions
Clinical
Approaches
Canalith Repositioning (Epley Maneuver)
A series of precise head movements to reposition displaced calcium crystals and resolve BPPV vertigo.
Gaze Stabilization Exercises
VOR x1 and x2 training to improve the vestibulo-ocular reflex and reduce visual blurring during movement.
Balance & Proprioceptive Training
Progressive exercises on stable and unstable surfaces to rebuild postural control systems.
Habituation Exercises
Repeated controlled exposure to symptom-triggering movements to desensitize the central nervous system.
🏠 Home Exercises Guide
Strengthen your recovery. Perform these exercises strictly under pain-free limits:
📋 Execution Blueprint: Gaze Stabilization (VOR Training)
- 1Sit comfortably and hold a business card or target at arm's length at eye level.
- 2Focus on the target letter or symbol clearly.
- 3Move your head from side to side slowly and rhythmically while keeping the target in focus.
- 4Gradually increase the speed of head movements as the exercise becomes easier.
- 5Perform for 1-2 minutes, 3 times daily to improve vestibulo-ocular reflex stability.
* FAQs
Common Questions
BPPV is caused by displaced calcium crystals in the semicircular canals. The Epley maneuver successfully resolves BPPV in 80% of cases within 1-3 sessions. It is the most immediately curative condition in all of physiotherapy.
Paradoxically, vestibular exercises may temporarily increase dizziness during treatment — this is normal and indicates the exercises are challenging the system correctly. Symptoms typically reduce significantly within 2-4 weeks.
Dizziness is a general term for lightheadedness or unsteadiness. Vertigo specifically refers to an illusion of movement (spinning, rocking) typically caused by vestibular dysfunction.
Yes, chronic dizziness and fear of falling frequently cause significant anxiety and social withdrawal. Our rehabilitation program specifically addresses fear-of-falling through progressive confidence-building exercises and education.
Physiotherapy helps manage the balance and gait symptoms between acute Ménière's attacks. During stable periods, VRT and balance training significantly improve functional confidence and reduce the disability from recurrent vertigo.
Balance training should ideally begin in your 50s as part of preventive health. Risk of falls increases dramatically after 65, when vestibular, visual, and proprioceptive systems all decline simultaneously.
Yes, stroke can damage vestibular nuclei, the cerebellum, or sensorimotor pathways, causing severe balance impairment. Our neuro-vestibular rehabilitation integrates stroke recovery with balance retraining.
We use the Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Dynamic Gait Index, and computerized posturography to quantify balance function before and after treatment.
Begin Your
Recovery Today*
Comprehensive clinical assessment within 48 hours.
Exclusive Portal Offer
Free Initial Assessment
Includes clinical check, analysis, and personal recovery planning for Balance & Vestibular Disorders under Dr. Karolin Rockson, PT (BPT), Ex. CMC - Vellore.
Verified Author Protocol
Dr. Karolin Rockson, PT (BPT), Ex. CMC - Vellore
Board: Indian Association of Physiotherapists (IAP)
Reg No: PT-84729