EXERCISES FOR CERVICAL VERTIGO

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We want to indicate rehabilitation strategies for patients suffering from both primary and secondary vestibular disorders. The disorders that are seen in patients suffering from vestibular pathology of peripheral origin are various and include one or more of the following manifestations: nystagmus, dizziness, gaze fixation disorders, instability, ataxia. Symptoms such as increased muscle tension, stress, fatigue, decreased memory and ability to concentrate and loss of fitness are often associated or perhaps caused by these disorders.

 

Usually, even without any type of intervention, both men and animals who have experienced a sudden loss of vestibular function after a certain period of time demonstrate spontaneous compensation that occurs both for behavioral and physiological causes.

 

From a physiological point of view, compensation occurs due to an adaptation of the structures of the Central Nervous System (CNS) which have remained intact to the new situation.

 

Compensation processes can be influenced by the patient's experiences immediately after loss of function. This compensation can be facilitated by physical exercise and by exposure to visual and / or somatosensory stimuli. On the other hand, it has been seen that the compensation process can be prevented by the deprivation of visual stimuli, by anesthesia, by some medicines, and by immobilization in a plaster cast of the lower limbs.

 

The purpose of rehabilitation is to find an effective way to facilitate spontaneous CNS compensation.

 

POSTURAL CHECK IN ASSISA POSITION AND STANDING

The most recent neurophysiological research seems to suggest that postural control is not the result of rigid and unalterable vestibulospinal reflexes, but rather seems to be the result of the multiple interaction of inputs from the sensory musculoskeletal system. Postural control has the function of maintaining the body's center of gravity within the balance base formed by the feet. Any limitation of strength, normal joint mobility or flexibility prevents the brain from perceiving the signals that allow normal postural adjustments and prevent patients from organizing the movements required for normal compensation.

 

In addition, patients with vertigo and postural instability tend to compensate for these deficits by adopting motor strategies that minimize head and trunk movements and consequently tend to develop secondary musculoskeletal pains that consist of muscle tension, fatigue, and pain in the cervical region. .

 

EXERCISES

Patients with partial or total loss of vestibular inputs alter their normal postural control and operate joints that would otherwise be left at rest: p. es. resort to motor strategies that require the use of the hip instead of the ankle.

 

From a behavioral point of view, many patients with vestibular pathology tend to respond to small displacements of the center of gravity with hip movements or taking small steps rather than resorting to the normal strategies that involve the use of the ankle.

 

The treatment of these incorrect strategies involves teaching a correct motor strategy by seeking to maintain balance in contexts and with tasks of increasing difficulty.

 

Example: the patient is swayed barefoot forward, backward and to the side, with increasing angles and keeping the body erect (he must only use the ankle keeping his hips and knees still). Subsequently, the patient will have to use his ankles in more difficult tasks: p. es. the same exercises on Freeman's unstable planes.

In the most difficult cases, it can be started by placing the patient's shoulders against a wall to allow him to receive further proprioceptive inputs.

 

OCULO-CEPHALIC COORDINATION AND FIXING OF THE LOOK

The oculo-vestibular reflex generates compensatory movements of the eyes in response to signals from the vestibule that communicate the acceleration undergone by the head. This reflex serves to stabilize the gaze during head movements and can be achieved through controlled eye movements (saccadic and optokinetic responses).

 

Due to the loss of the normal function of this reflex, the patient has problems fixing his gaze during head movements and complains of confused vision.

 

EXERCISES

The purpose of the eye-cephalic coordination exercises is to improve the stabilization of the gaze during head movements, to allow trajectories to be followed with the movement of the eyes, thus achieving better modulation of the oculo-vestibular responses.

 

Example:

1) Follow the visual trajectories with your head still.

2) Keep your gaze fixed on an immobile object while the garment makes movements of progressively increasing and decreasing speed. In a second step, the therapist acts directly on the patient's head by regulating the speed.

3) Keep your gaze fixed on a target that moves in phase with the patient's head movements.

 

PERCEPTION OF MOVEMENT

The perception of movement derives from the sensation provided by redundant directional inputs which normally add up indicating the direction of movement of the body. Vertigo is the perception of a motor sensation in a stationary context. It occurs when sensory inputs are unsuitable for objective motor sensations. Vertigo can be associated or not or objective movements of the body such as swaying or falling.

 

EXERCISES

The purpose of these exercises is to adapt the patient's CNS to the refused sensation and this can be achieved by performing and repeating positions or movements of the head and body that normally cause vertigo. In the evaluation phase, a list of the movements causing the disturbance must be made.

 

Example: The patient is instructed to perform movements five to ten times two or three times a day. During the initial phase the movements are performed under the control of the therapist who assists and encourages the patient; subsequently during a period of time long from four to six weeks the patient is invited to perform the movements which must become progressively more difficult even on his own.