Dizziness after stroke.

A stroke can affect the parts of the brain which control your vestibular system. This system helps maintain balance and eye movements and includes specific areas of your brain and inner ear. Problems with any parts of the vestibular system can cause dizziness, nausea, visual problems, imbalance and motion sensitivity.

In the case of a stroke, it’s the brain that is affected and is common in cerebellar and brainstem lesions. This system must be challenged as part of your rehabilitation. Your vestibular physiotherapist will work with you to reduce your symptoms of dizziness and improve your balance.

In the meantime, you’ll find answers to some common questions regarding dizziness following a stroke, answered by a vestibular physiotherapist. If you have questions that aren’t answered in this article, please feel free to reach out to the APA, who can assist in finding answers to these queries for you.

What can cause dizziness after a stroke?

  • A stroke (particularly a brainstem or cerebellar stroke) can affect parts of the brain that integrate and process sensory information from the vestibular system (inner ear balance system), the visual system (eyes) and somatosensory system (how you touch and feel things).
  • After a stroke, many people experience problems with these messages going to or from these systems—and the brain.
  • This will affect your ability to tolerate movement and can cause an increase in motion sensitivity, dizziness, nausea, visual problems and imbalance.
  • This is sometimes referred to as Central Vestibular Dysfunction.
  • Symptoms often occur immediately following a stroke and can be very debilitating.
  • Symptoms are often ongoing unless proper management is sought.

What is a vestibular physiotherapy assessment?

  • It is a specific assessment conducted by physiotherapists specialising in vestibular rehabilitation. These physiotherapists have special training in identifying dizziness and other balance-related problems caused by a stroke.
  • Sometimes there can be multiple causes for dizziness, and it’s essential that these are all identified and treated correctly. Vestibular physiotherapists work closely with specialists and GP’s, especially when there is a medical or medication component to dizziness.

What therapy can I do to reduce my dizziness?

  • For many people who feel dizzy, the natural response is to avoid any movement that amplifies this. However, to gain improvements, the system must be challenged. We call this ‘habituation’.
  • Dizziness can affect each person differently. However, people with Central Vestibular Dysfunction will generally show significant improvements in symptoms of dizziness and imbalance following vestibular rehabilitation.
  • Your therapy program should meet your personal needs and goals. Your vestibular physiotherapist will work with you to design an individualised rehabilitation programme to reduce your symptoms and improve your balance and postural control.
  • There will be lots of exercises given to you to do at home. Just like movement rehabilitation, frequency and intensity are fundamental.

What else can I do?

  • Research has found that the more you do, the better you get. So you should try to do as much as you can during therapy time. In addition, your vestibular physiotherapist should provide you with a home exercise programme that you can do by yourself or with the help of family and friends outside of therapy time.
  • There can be many causes of dizziness, such as changes to blood pressure, medications or another inner ear problem. It is crucial to address this, as these factors could also be contributing to your symptoms.

What if another inner ear problem causes my dizziness?

  • A widespread inner ear condition is called Benign Paroxysmal Positional Vertigo (BPPV). It can occur for no reason but can also occur following a fall or knock to the head. If you fell during or after your stroke, there is a chance you could have this condition. It is incredibly treatable, and people can expect to have 100% symptom resolution if managed correctly.
  • A vestibular physiotherapist will be able to accurately assess you for this (and other) inner ear conditions.

What is BPPV?

  • BPPV is an inner ear condition where calcium carbonate particles called otoconia fall into one of three semicircular canals in the inner ear. Because the otoconia are not supposed to be in the semicircular canals, it causes an overstimulation of the vestibular (inner ear) nerve. The brain, therefore, receives incorrect information about where the head is in space, causing vertigo (spinning sensation), dizziness, nausea and imbalance.

How is it tested?

  • An experienced vestibular physiotherapist will be able to test you for BPPV. The tests involve placing your head in specific triggering positions momentarily while looking for a characteristic reflex eye movement called nystagmus. The characteristics and direction of the nystagmus will allow your therapist to accurately diagnose which side and which semicircular canal is affected.

Can you treat BPPV?

  • Yes! BPPV is highly treatable and should never be left to suffer through. In many instances, it will take as little as 1-2 treatments to resolve. The treatment involves procedures called particle repositioning manoeuvres. Various manoeuvres can be performed, and they all include turning the head in precise directions to move the otoconia from the affected canal. Your vestibular physiotherapist will be able to determine the correct procedure depending on the type of BPPV you have.

In summary, if you are suffering from ongoing dizziness after your stroke, seek an assessment from a vestibular physiotherapist.

Although you don’t need a referral to see a vestibular physiotherapist, some information about your medical history is beneficial before your assessment.

When searching for a vestibular physiotherapist, make sure you specifically ask for a physiotherapist who specialises in vestibular rehab. Ideally, the therapist should also have a neurological background.