Dizziness

Symptoms by body part:

Orbit (Eye)
Difficulty Concentrating
difficulty reading
difficulty riding in a vehicle
Dizziness
Spinning
Visual Changes

Dizziness has been defined as a sense of disturbed or impaired spatial orientation without a false or disotrted sense of motion. Vertigo is defined as a false sense of self-motion without any motion or the feeling of distorted self-motion with normal movement (1)

Dizziness is broadly characterized by incorporating four descriptive symptoms: 

  • Vertigo, which is nothig but a flase perception of movement of self or surrounding
  • Disequilibrium, or imbalance which is an inability to maintain balance
  • Presyncope, a sense of losing consciousness
  • Light-headedness, defined as a vague symptom of feeling disconnected from the environment (2)(3). 

According to the Barany society's committee for the classification of vestibular disorders, the terms 'vertigo' and 'dizziness' are non-hierarchical and reflect distinctly separate sets of symptoms. They define vertigo as a false sense of self-motion with normal movement. They have further sub-classified vertigo into internal and extenral, for separating the vestibular sense of false motion form the visual sense of false motion (4). 

Sensory mismatch due to an error within the vestibular, proprioceptive or central sytems

After concussion, two of the most commonly reported symptoms are headache and dizziness, followed closely by nausea and neck pain. Dizziness following a concussion may be due to dysfunction of the vestibular, proprioceptive or central systems. Proper orientation in space requires accurate and consistent input from the proprioceptive, visual and vestibular systems. If one or more these systems provide inaccurate information about spatial location, alteration in bgalance and dizziness may result due to mismatching of sensory information. Post-traumatic dizziness is believed to occur secondary to benign paroxysmal positional vertigo, central vestibular, peripheral vestibular, visual or proprioceptive dysfunction. In the case of persistent dizziness, neck pain and/or headaches with suspected cervical or vestibular causes, treatment of the affected systems may facilitate functional and symptomatic improvement and shorten recovery (5). 

How can we diagnose what's causing your Dizziness? 

By evaluating the brain and nervous system in its entirety, but specifically along the cervicovestibular pathway, we can localize regions that are dysfunctional and misrepresenting sensory information of spatial orientation to the brain. Autonomic dysregulation can cause dysfunction in the vestibular system and we perform careful evaluation of this potential involvement. Oxygenation is an important aspect of neurological function and is also evaluated very carefully. We're essentailly looking at your brain from an integration perspective, ensuring all regions are sending appropriate afferent information to the brain, including the vestibular system, proprioceptive system, visuomotor system, autonomic system, and oxygenation system. Our core model of care is multi-modal, ensuring that all potential regions that may contribute to Dizziness are properly assessed and treated to allow proper function to occur between the inner ear and brain stem/cortex. In order to do this, we must reset the Central Integrated State of the dysfunctioning neuronal regions involved with your Dizziness. We attempt to achieve this through a specialized program that combines Neurology, Chiropractic, Physical Therapy, Vestibular Rehabilitation, Occupational Therapy and Oxygen. 

Vestibular Core Testing:

  • Videooculography (VOG, sometimes referred to as VNG) that measure eye movements that relate to specific regions of the brain, brain stem and vestibular system.
  • Sensitive balance and coordination testing of proprioception and brain using Computerized Assessments of Posturography Systems (CAPS) that allow us to measure dysfunctional areas sensory input related to Vertigo.
  • Tilt Table Testing
  • Autonomic Assessment
  • Clinical Examination (Neurology, Proprioceptive, Respiration)
  • Gait analysis
  • Oxygen evaluation
  • Metabolic capacity
  • Objective measures
  • Spatial and Temporal Summation (Treatment Plan)

Vestibular Core Treatment:

  • Tilt Table Treatment (TTT)
  • Non-Invasive Nerve Stimulation (NINS)
  • Vagus Stimulation (VS)
  • Oculomotor retraining (eye movement exercises) (OMR)
  • Vestibular Rehabilitation (VR)
  • BPPV repositioning maneuvers
  • Vestibular Repositioning Maneuvers
  • Occupational Therapy (OT)
  • Rib Manipulation (RM)
  • Cervicovestibular rehabilitation (CVR)
  • Specific Chiropractic Neurological Manipulations for Oxygenation L/S/T (SCNM-O)
  • Mild Hyperbaric Oxygen Therapy (mHBOT)
  • Postural Restoration (PR)
  • Physical Therapy (PT)
  • Functional Neurological Rehabilitation/Neuroplasticity Retraining Exercises (FNR/NRE)
  • Co-treatment (Botox, Medications, etc..) (CT)
  • Migraine dietary recommendations (MDR), if applicable

How can our treatments change your Dizziness response? 

Neurons require Activation, Oxygen and Fuel (glucose) to maintain a healthy state of -65 mV and undergo Immediate Early Gene Response to create more cellular contents such as sodium/potassium pumps, mitochondria for ATP formation, axonal and dendritic connections with neighboring cells, etc. The list you saw is how we target the dysfunctional areas with activation, oxygen and carry fuel to those cells. This has to be done in a very graded, careful manner so as to not exceed the metabolic rate of the neurons involved. We observe metabolic capacity for each individual and maintain levels of treatment that stay below those levels so as to keep a steady progression of healthy return to a normal state of function. Neurons respond through Temporal and Spatial Summation, so we can develop treatment plans based on your severity that will allow maximal response and long-term changes. This is known as Neuroplasticity and is at the core of our Vestibular Program. I often tell people, I don't know how much I can help you, but in many cases, we're at least able to improve to 50% with the understanding that our goal is much higher. Your response depends on multiple factors, including genetics, central sensitization (chronicity), following our treatment plan and so forth. We are very open and honest with our patients and do our best to provide accurate information, but it is a functional issue and it is difficult to be exacting in our predictions. 

Can Portland Chiropractic Neurology treat my Dizziness successfully? 

For many individuals, yes we can, and we've been doing it for many years. However, that can range from 0% improvement to as close to 100% as possible, although most people will agree that an improvement of 50% is life changing. The rest we hope to control through lifestyle changes, dietary changes, Medical intervention such as medications, botox, etc. Our goal is for your results to be long-lasting and permanent without our continued care because we utilize Neuroplasticity appropriately along all aspects of our treatment plan, patients don't return to their previous state when they are finished treatment. That being said, genetics and many other aspects play a role in your Dizziness physiology, so it is difficult to determine or know for sure at the beginning of treatment if you are a 50% improved patient or a 100%, or anything in between. With the proper diagnosis, we can treat the areas that are the primary source of your Dizziness through Neuroplasticity Retraining Excercises that will change brain function involved with your Vestibular system. 

References: 

(1) Devaraja, K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. European Archives of Oto-Laryngology (2018) 275:2421-2433

(2) Lee AT (2012). diagnosing the cause of vertigo: a practical approach. Hong Kong Med J 18:327-332

(3) Post RE, et al. (2010) dizziness: a diagnostic approach. AM Fam Physician 82:361-369

(4) Bisdorff A, et al. (2009) Classification of vestibular symptoms: towards an internal classification of vestibular disorders. J Vestib Res Equilib Orientat 19:1-13

(5) Scheider KJ, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med 2014; 48:1294-1298