Vestibular rehab & BPPV — what a dizziness session looks like (Seremban & Nilai)

A first vestibular session spends most of its time on screening, because 'dizzy' can mean very different problems. (1) BPPV (benign paroxysmal positional vertigo) — short bursts of spinning triggered by a specific head position (rolling in bed, looking up at a shelf). We confirm with the Dix-Hallpike test or a roll test. BPPV is extremely common in Port Dickson retirees and Seremban Chinatown seniors and is very treatable. (2) Vestibular hypofunction — a steady unsteadiness or feeling of 'motion sickness' that followed a viral infection, ear surgery, or ototoxic medication. Needs gaze-stabilisation and balance retraining. (3) Central causes — dizziness with new headaches, double vision, slurred speech, or weakness is NOT vestibular and needs Hospital Tuanku Ja'afar (HTJ) A&E for stroke screening. (4) Persistent postural perceptual dizziness (PPPD) — ongoing floating or rocking sensation that outlasts the original trigger. Needs a slightly different rehab approach combining exposure and balance training.

BPPV is caused by tiny calcium crystals (otoconia) that have dislodged from a sensor in your inner ear and floated into a wrong canal. Every time you turn your head a certain way, they push the canal fluid and send the brain a false spinning signal. The fix is mechanical: a series of slow head movements that floats the crystal back to where it belongs. For the most common (posterior canal) BPPV, we use the Epley manoeuvre — four positions, each held for 30–60 seconds. 80–90% of patients respond to one or two Epleys. For horizontal canal BPPV, we use the Gufoni or BBQ-roll — five positions, log-rolled to the affected side. After the manoeuvre, we give a simple 48-hour precaution: sleep semi-upright on two pillows and avoid extreme head tilts. Most of our Seremban Chinatown seniors are spin-free within a week. Residual imbalance after the spinning settles is treated with a short home habituation programme (Brandt-Daroff exercises or similar), usually over 2–3 weeks.

When the inner ear sensor on one or both sides is underperforming (common after vestibular neuritis or labyrinthitis), the brain needs to relearn how to keep vision steady during head movement and how to balance without reliable inner-ear input. Our home programme usually starts with: (1) VOR x1 — stare at a letter on the wall while turning your head left–right as fast as you can without the letter blurring. 1 minute, 3 times a day. Expect mild dizziness at first; it fades over 1–2 weeks. (2) VOR x2 — same but moving the target in the opposite direction to your head turn. Harder — added at week 2–3. (3) Standing balance — feet together then tandem then single-leg, eyes open then eyes closed, on firm then on foam. (4) Walking — walk with head turns, walk on foam, walk and catch a ball. Most Port Dickson retirees and Seremban Chinatown seniors with vestibular hypofunction improve substantially over 6–12 weeks of consistent daily practice. The dizziness does not disappear — the brain compensates — so skipping the exercises usually means the old symptoms creep back.

Most dizziness is inner-ear or neck-related and safe for physio. But please go to Hospital Tuanku Ja'afar (HTJ) A&E same day if dizziness comes with any of the following: (1) sudden severe headache or 'thunderclap' headache; (2) double vision, drooping face, slurred speech, or arm/leg weakness — stroke symptoms; (3) sudden hearing loss with spinning — possible labyrinth stroke or Meniere's attack needing ENT review; (4) dizziness after recent head injury with vomiting or loss of consciousness; (5) chest pain, shortness of breath, or palpitations alongside dizziness — possible cardiac cause; (6) new imbalance that does not settle with rest and progressively worsens over days. A rough rule: vestibular dizziness usually has clear triggers (rolling in bed, standing up, head movement) and eases between episodes. Constant dizziness or dizziness with neurological symptoms needs medical review before physio.