If most of the time, loss of balance and feelings of dizziness are not serious, vertigo still represents 4% of admissions to emergency departments.
These symptoms can result in particular from a dysfunction of the organ of balance, the vestibular system, which governs the perception of the movements and rotations of the body in space.
In which case it may be necessary to go to a specialized physiotherapist.
But how do we know if we need vestibular rehabilitation?
Explanations with Loïc Vest, physiotherapist specializing in vestibular rehabilitation in Paris.
What are vestibular disorders?
They are due to an abnormality of the vestibular system, a sensory organ located in the inner ear.
Usually, this organ governs our balance through the coordinated perception of visual and proprioceptive information, which integrates the position of the different parts of the body in space and of objects in our environment.
In concrete terms, the vestibular system of the inner ear is made up of channels in which a liquid circulates in which “crystals” are immersed, connected to small eyelashes.
When you move your head, the liquid begins to move and the crystals are carried by their weight, which causes the eyelashes to move.
This activates receptors connected to the brain by nerves which are responsible for continuously transmitting information about changes in the position of the head to our brain.
An abnormality of the vestibular system is usually manifested by
loss of balance
,
vertigo
, feelings of
lightheadedness
("spinning head"),
migraines
,
nausea
or
vomiting
.
Less commonly, patients suffer from
concentration and memory problems
,
disorientation
, anxiety
and
even
depression
.
"
Episodes of loss of balance can last less than a minute but repeat themselves several times during a day, which sometimes becomes very debilitating
," explains Loïc Vest.
If you suffer from it, it is important to talk to your doctor and/or an ENT specialist who will be able to identify the cause of the problem and possibly advise you on vestibular rehabilitation.
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What is vestibular rehabilitation?
Vestibular physiotherapy is an approach that uses the interaction between vision and the organ of balance to correct a deficiency in the perception of sensory information by our brain.
This discipline is one of the specialties of physiotherapy.
While some balance disorders resolve on their own, their cause may be pathological if they persist.
In this case, a doctor can further test your sense of balance, sight, hearing and coordination.
Once the cause has been identified, the physiotherapist intervenes to “re-educate” the deficient function (difficulty walking, instability of gaze, etc.).
It is important to note that the treatment of a vestibular disorder is based on close coordination between doctors, who will act on the cause, and a physiotherapist who will act on the restoration of functions.
“
For this, the physio will use a number of tests to highlight functional disorders.
Their nature and the number of sessions will then depend on the patient's symptomatology
,” says Loïc Vest.
Are physiotherapists the only ones who can exercise it?
"
According to the High Authority for Health (HAS), only physiotherapists and ENT specialists are authorized to handle patients in the context of vestibular rehabilitation
", insists Loïc Vest.
Osteopaths and chiropractors therefore theoretically do not have the right to practice this practice.
For good reason, vestibular physiotherapy can be dangerous if it has not been prescribed in advance by a trained specialist.
“
Indeed, certain vascular and neurological disorders and even certain tumors are capable of mimicking symptoms of vertigo.
However, these serious pathologies require treatment by doctors.
Even physiotherapists cannot manipulate a patient if the disease has not been identified because that would risk making it worse
,” emphasizes the physiotherapist.
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In what situations do we need vestibular physio?
Multiple pathologies (traumatic, viral, auto-immune, hormonal) can affect either the vestibular system or the transmission of information to the nervous system which includes the brain and the spinal cord.
However, the most common vestibular disorders are:
Motion sickness
is
a sensory illusion or “visual addiction”.
"
It concerns
60 to 70%
of patients who consult for vertigo
", specifies Loïc Vest.
There is a desynchronization of perception between body movements and visual information.
In the car, while you see the landscape scroll by, your inner ear is immobile, which can create a discrepancy between the information perceived.
Benign paroxysmal positional vertigo (BPPV)
accounts for approximately
25-35%
of vertigo causes and is diagnosed at any age (18-90).
"
It is linked to the detachment of small crystals from the inner ear (the otoconia) which begin to float in the liquids it contains
", indicates Loïc Vest.
When changing position, it causes dizziness, nausea and vomiting.
Ménière's disease
is
a chronic pathology characterized by attacks of vertigo, progressive loss of hearing and tinnitus ('ghost' noises).
It is due to an imbalance of pressure in the fluids circulating in the inner ear.
Vestibular neuritis
(or acute vestibular deficiency) is a viral attack that causes inflammation of the vestibular nerve connected to the inner ear.
It is manifested by a violent attack of dizziness for several hours or even days.
“
Certain risk factors such as anxiety, fatigue and even Covid can also increase the risk of developing balance disorders
,” adds the physiotherapist.
Age-related sedentary lifestyle is also an aggravating factor “
because the organ of balance is disturbed after a long period of immobility
”.
” READ ALSO –
How to fight against motion sickness?
How does vestibular rehabilitation take place?
"
First of all, you have to carry out an assessment to highlight the sensory disorders at the origin of the problem, whether they are visual, vestibular or proprioceptive (sensitivity to posture and movement information)
", indicates Loïc Vest.
"
Depending on the disorder, we can establish a personalized program
" including several types of exercises.
For example :
Balance exercises
: ask the patient to balance with their eyes closed on an unstable cushion or on a foot, for example
Gaze stabilization exercises
using virtual reality or not
Walking rehabilitation exercises
The rotary chair test
consists of placing a patient on a rotating chair and asking him to stare at a target until stabilization.
This corrects an asymmetry in the perception of information between the right and left ears.
The purpose of
optokinetic stimulation is to reduce the importance of the eyes, in particular by placing the patient in the dark, to work on the proprioceptive and vestibular functions.
How many sessions needed?
It all depends on the origin of the disorder and the patient's symptoms:
Generally, “
the treatment of BPPV is very
quick
and a few sessions are enough
,” says Loïc Vest.
Count
5 to 10 sessions
for a neuritis diagnosed quite early but much more for a later diagnosis.
For other vestibular and neurological pathologies,
15 to 20 sessions
are generally necessary.
These indications will also depend on other factors.
“
The more there is anxiety
,
apprehension and sedentary lifestyle, the longer the rehabilitation will take.
This is why it is necessary to involve the patient in his rehabilitation so that the effects are beneficial
”, specifies the physiotherapist.
In any case, the exercises to be performed are not limited to those performed in the presence of your physiotherapist.
The latter will tell you exercises to do at home for optimal recovery.
What reimbursement in France?
This practice carried out by physiotherapists is 100% covered by social security and mutual insurance companies, provided it is prescribed by a doctor.
However, there may be fee overruns depending on the practitioner.