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Old 10-10-2006, 04:24 PM   #16
billybignose billybignose is offline
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Re: bilateral vestibulopathy

Yes, vertigo at the begining then subsiding is classic of any vestibular insult (vestibular neuronitis for example), as once the initial damage is done a mechanism kicks in allowing the brain to turn off/reduce the worst of the faulty signals, then it's down to the fine tuning process - there is a far better description below... The virus only lasts for a few days (maybe a week or so), but steroids in the very early active stage have been shown to slightly reduce any damage caused - however it's quite rare anyone gets to take them, as GPs wouldn't know to prescribe them and it's often a month or so down the line before anyone gets to see a specialist at which point they won't be much use...


I wouldn't go out and get drunk everynight (obviously it would interfere with compensation) but the odd glass of wine won't hurt.

Increasing activity slowly is the key, little and often, and it's best to build up to going to bigger stores (the supermarket was a big no no for me )..

It sounds like your PT is going alon the right lines..






Quote:
Vestibular Injury:
Compensation, Decompensation, And
Failure to Compensate

By Thomas E. Boismier, M.P.H.
Director of the Balance Care Center

The balance system of the inner ear and brain can be damaged in many
ways. Viral infections (labyrinthitis and vestibular neuritis), disorders that
affect the fluid levels in the inner ear
(Ménière's disease and endolymphatic hydrops), trauma from head injury,
benign tumors (acoustic neuroma), and degeneration of the balance organ
cells with aging can all cause permanent damage to the balance organ or
balance nerve.
When the balance system is damaged, it has little ability to repair itself.
The body recovers from the injury by having the part of the brain that
controls balance re-calibrate itself to compensate for the unmatched signals
being sent from the damaged and well ears. This compensation process
occurs naturally in most people. Some patients require help from vestibular
rehabilitation therapy in order to recover from an injury to the balance
system.

Acute (Immediate) Compensation
When a sudden injury occurs to one side of the balance system, the
patient may feel very sick for hours to a few days with a spinning feeling,
unsteadiness, lightheadedness, and often sweating, nausea, and vomiting.
This is because the signals being sent from the two balance organs are no
longer equal and opposite, and the brain interprets the difference as
constant movement. Researchers theorize that after this initial period, the
brain recognizes that the signals being received from the ears are incorrect
and turns the signals off through a process called the cerebellar clamp.
When the clamp is in place, the spinning and much of the 'sick' feeling
improve. The patient feels unsteady while standing though, because the
balance organ signals normally used to maintain balance have been turned
off. The patient may also report dizziness or blurred vision with movements.
Vision and proprioception (the sense of pressure at the bottom of the feet)
are also used to maintain balance, so the patient can walk but will feel
unsteady and may fall in the dark or on soft or bumpy floors like thick
carpet, grass, or gravel.
At this point, most patients are well enough to get out of bed and visit a
doctor. The doctor
sees a person who is not spinning but whose gait is ataxic. If the patient is
not given an opportunity to clearly describe what has happened, he or she
may be immediately referred to neurology to rule out stroke because of this
ataxic gait.
If balance testing is performed during the acute (immediate)
compensation phase, test results may incorrectly suggest that the patient
has damage to both sides of the balance system, because the cerebellar
clamp reduces the eye movements that are looked for during balance
testing. The cerebellar clamp may persist for days to a few weeks after the
initial injury.

Chronic (Long-Term) Compensation
During the acute compensation phase, the cerebellum slowly releases
the clamp, gradually allowing more signals from the balance organs to pass
to the balance areas of the brain. As the brain receives these signals, it fine-
tunes the mathematics performed to interpret the information, in order to
account for the difference between the ears. The brain must receive signals
from the balance organs to be able to modify its interpretation of these
signals.
For most patients, the movements made during normal daily activities
are enough to achieve chronic (long-term) compensation, usually in two to
four weeks after the injury has occurred.
Once the chronic compensation process is complete, the patient is
essentially symptom-free. If unsteadiness and/or motion provoked dizziness
persist after that time, compensation is not complete and the physician may
prescribe a program of vestibular rehabilitation therapy (VRT).
VRT is a treatment program administered by a specially-trained physical
therapist. It is designed to provide small, controlled, and repeated 'doses' of
the movements and activities that provoke dizziness in order to (1)
desensitize the balance system to the movements, and (2) enhance the fine-
tuning involved in long-term compensation. VRT is most effective when
administered by a physical or occupational therapist who has special
training and specializes in this unusual form of therapy.

Decompensation
It's important to remember that even after the symptoms go away, the
balance system remains injured, and the brain has simply adapted to the
injury. For many patients, dizziness will return months or years after
compensating for a balance system injury. It is critical for the physician to
find out what type of dizziness the patient has. If the patient describes
another severe attack of spinning with unsteadiness and nausea lasting
hours to days, this suggests that a second injury has occurred to the balance
system, such as another viral infection or an attack of Ménière's or
endolymphatic hydrops. These conditions require diagnosis and medical
treatment. If the patient reports that dizziness occurs after particular
movements and lasts seconds to a few minutes, this suggests
decompensation. Decompensation simply means that the brain has
'forgotten' the fine-tuning procedure it developed during the chronic
compensation phase described above.
Events that can provoke decompensation include a bad cold or the flu,
minor surgery, long vacations, or anything that stops normal daily activity
for a few days. Recovery after decompensation is exactly like the recovery
that occurs during the chronic compensation phase.
Movements and activities are the stimuli the brain needs to fine-tune the
system. In our balance center, we routinely counsel patients to keep their
VRT exercise program instructions in a drawer even after they recover so
that they can begin the exercises immediately if symptoms return.
Usually recovery after decompensation is quicker than the recovery after
the initial injury to the balance system.

Failure to Compensate
Two things are required in order to compensate for an injury. First, the
brain must receive signals from the balance organs. This means that
movements must not be avoided, because movements create the signals the
brain needs to compensate for the injury. Secondly, the balance areas of the
brain must be capable of change.
During the early stages of dizziness, many physicians counsel their
patients to avoid quick movements and reduce their activities. Most patients
will be prescribed one or more anti-dizziness medications such as Antivert
(meclizine), Valium (diazepam), Xanax, Phenergan, or Compazine. This is
fine during the acute stages of a dizziness problem in order to reduce the
dizziness symptoms that persist for hours or days even when the patient is
not moving. However, once the acute phase is past, inactivity and
medications can interfere with the long-term compensation process. Any
medication that makes the brain sleepy, including all of the anti-dizziness
medications, can slow down or stop the process of compensation, so they
are often not appropriate for long-term use. Most patients who fail to
compensate are found to either be strictly avoiding certain movements,
using anti-dizziness medications daily, or both. Treatment includes VRT,
gradual reduction, and eventual elimination of these medications.
Brain damage caused by stroke, head injury, etc., can slow down or stop
the natural compensation process. It is difficult to predict which patients with
brain injury will improve or how much, so all patients should be given the
chance to improve through a VRT program. In our balance center, we use
several different measures of symptoms and functional capabilities in order to
assess progress repeatedly as treatment goes on. As long as a patient
continues to show improvement, even if it is gradual, treatment should be
continued.