Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014

PHYSIOTHERAPY INTERVENTION IN MANAGEMENT OF DIZZINESS

* Shahanawaz SD

ABSTRACT
Purpose: The aim of the study is to know the efficacy of exercise protocol in treating the patients with
dizziness. Design: Pilot study. Setting: RK Physiotherapy Department ,Rajkot, Gujarat, India; Madhuram
Hospital, Rajkot Methodology: Patients had evaluated by physician, Hall pike dix test, caloric test, postural
nyastagmography, Dizziness handicap inventory. Before the treatment patient had an outcome measured
with Dizziness handicap inventory, and Hall pike dix test. After that patient received design treatment
protocol for seven days. And after that all subject has to outcome measure with dizziness handicap
inventory, and Hall pike dix test. Results: Fifteen patients had at least one complication. 56 had myofascial
pain syndrome, 39 patients had post-operative joint stiffness, 23 had osteoporosis, 12 sustained path

KEYWORDS: Dizziness, DHI, Physiotherapy, Protocol

INTRODUCTION problem.1 According to studies, thirty

percent of older population suffer with
The brain coordinates information from the
dizziness and this percentage will increases
eye, the inner ear, and the body’s senses to
at the age of 85 years.2 For physicians
maintain balance. If any of these information
dizziness for older age group became
sources is disrupted, the brain may not be
challenge as it is associated with multicausal.
able to compensate. Which results in
The vestibular system is integral to balance
dizziness. Dizziness is one of the geriatric

41
 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

control. The paired vestibular organs, housed There is significant difference in treating the
within the temporal bone, include 3 patients with designed exercise protocol and
orthogonal semicircular canals (superior, were assessed on Dizziness Handicap
posterior, and horizontal) and 2 otolish Inventory (DHI) ,
organs (utricle and saccule). Together, the Null Hypothesis:
semicircular canals and otolish organs There is no significant difference in treating
provides continues input to the brain about the patient’s with designed exercise protocol
rotational and translationl head motion and and were assessed on Dizziness Handicap
the head’s orientation relative to the gravity Inventory (DHI)
This information from the vestibular organs
and their central pathways allows for the Material:
maintenance of gaze and postural stability Couch, stop watch, Goniometre.
via the vestibular ocular reflex and vestibulo
spinal reflex, respectively. Dysfunction of Study design:
the peripheral vestibular structures cannot be Pilot study.
directly observed but can be inferred from
assessment of these reflexes. Study area:
RK Physiotherapy Department ,Rajkot,
Background of study: Gujarat, India. Madhuram Hospital ,Rajkot
Dizziness is one of the geriatric problems.
According to studies, thirty percent of older Population:
population suffers with dizziness and this Subjects having dizziness.
percentage will increases at the age of 65
years. For physicians dizziness became Inclusion criteria:-
challenge as it is associated with multiple Age group is 18-65
causes. According to National Institutes of Both Males and Females
Health 54% of people experience feeling Able to experiencing symptoms for longer
dizzy at least once during life time. period of 3 months
Able to transfer from sitting to standing and
Aim of study: move independently
The purpose of this study was to Know the Able to tolerate the exercise.
efficacy of exercise protocol in treating the 1) Physician diagnosed dizziness
patients with dizziness. 2) Hall pike dix test (+ve)
3) Dizziness handicap inventory
Hypothesis: 4) caloric test (+ve)

42
 Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014
5) Nyastagmography.
METHODOLOGY
All subjects were explained about the study.
Informed consent forms had sign. Subjects
were examined thoroughly with assessment
format. Assessment format is given in the
annexure. Patients had evaluated
physician, Hall pike dix test.3 caloric test,
postural nyastagmography, Dizziness
handicap inventory4. Patient who had fulfill
any three inclusion criteria included in the
study. Before the treatment patient had an
outcome measured with Dizziness handicap
inventory, and Hall pike dix test. After that
patient received design treatment protocol
for seven days. And after that all subject has
to outcome measure with dizziness handicap
inventory, and Hall pike dix test.
RESULTS
The mean value of pre treatment is 48.00 and
post treatment is 38.14 .and statistically
assessed by using the Wilcoxon signed ranks
test the table value T=2.7831 and p value is
0.018 .hence it shows a significant
difference.
Findings: Patient with dizziness shown the
significant changes in pre and post DHI
outcome
measured.
by Wilcoxon Signed Ranks Test
CONCLUSION
Patient with dizziness shows significant
improvement post exercise protocol .Hence
the null hypothesis is rejected and Alternate
hypothesis is accepted.
DISCUSSION
In this study it has observed that the pre
treatment and post treatment values for the
subject 1 is 60 and 36 which were assessed
by using DHI ,when compare to the other
subjects .It shows the Subject 1 has practiced
more times /day.
Funding:
Self Funding
Conflict of Interest:
My interest is to set a exercise protocol on
dizziness which is cost effective and helpful to
the Indian society.
43
 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

ANNEXURE - 1
PROTOCOL FOR DIZZINESS PATIENTS

No. TASK Repetition Time

1 straight head 3 times 30second

2 Turn your ahead 60 degrees towards right 3 times 30 second

3 Turn your ahead 60 degrees towards left 3 time 30second

4 Close your eyes and imagine blank back ground 1time 30second

5 Close Your Eyes Busy back ground (Checker 1 time 30 second

Board)

6 Single Leg Stance -Right Side 1 time 30 second

7 Single Leg Stance - Left Side 1 time 30second

8 Heel and Toe raises 1 time 30second

9 Perturbation training 1 time 30secomd

10 Hip marching 1 time 30 second

11 Lift up your right knee as high as comfortable. 10,lifts(each 30 second

(Lower your leg, leg)

Alternate lifting your knees)

12 Sit and straight your right knee 6 times 30second

44
 Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014

DIZZINESS HANDICAP QUESTIONNAIRE

1). Does looking up increase your problem? o Yes (હા)

(ઉપરજોવામાતમનેુ કલીપડછે?)
o Sometimes

(કયાર ક)

o No (ના)

2). Because of your problem, do you feel frustrated? o Yes (હા)

( તમારુકલીનાકારણેતમેકંટાળવછો?)
o Sometimes

(કયાર ક)

o No (ના)

3). Because of your problem, do you restrict your travel for business or recreation? o Yes (હા)

(તમારુકલીનાકારણેતમનેધધામાં,બહારગામવામાં,કામમાંતકલીફપડ?)
o Sometimes

(કયાર ક)

o No (ના)

4) Does walking down the aisle of a supermarket increase your problems? o Yes (હા)

( બરમાંચાલવાથીતમરુશકલીવધીયછે .
o Sometimes

(કયાર ક)

o No (ના)

5). Because of your problem, do you have difficulty getting into or out of bed? o Yes (હા)

(તમારુકલીનેકારણેતમનેપલંગમાંથીઉઠતાંઅનેબેસતાતકલીફપડછે?)
o Sometimes

45
 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

(કયાર ક)

o No (ના)

6). Does your problem significantly restrict your participation in social activities o Yes (હા)
such asgoing out to dinner, the movies, dancing or to parties?
o Sometimes
(તમા'ુસામા(જકકાય),બહારજમવાજવા*ુ,િપ,ચરજોવા*ુ
ં ં -યકરવામાંતમનેતકલીફપડ
,*ુ
(કયાર ક)
છે ?)
o No (ના)

7). Because of your problem, do you have difficulty reading? o Yes (હા)

(તમનેવાચવાંમાંતકલીફપડછે.)
o Sometimes

(કયાર ક)

o No (ના)

8). Does performing more ambitious activities such as sports or dancing or o Yes (હા)
household choressuch as sweeping or putting dishes away increase your problem?
o Sometimes
(તમનેરમતમાં,*ુ-યકરવામાં,સફાઈકામમાં,વધાર તકલીફપડછે?)
(કયાર ક)

o No (ના)

9). Because of your problem, are your afraid to leave your home without having o Yes (હા)
someoneaccompany you?
o Sometimes
(તમારતકલીફનાકારણેતમનેએકલાંબહારજતાં0બકલાગેછે?)
(કયાર ક)

o No (ના)

10). Because of your problem have you been embarrassed in front of others? o Yes (હા)

46
 Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014

( તમારતકલીફનાકારણેતમનેબીનીસામેસરમઆવેછે?) o Sometimes

(કયાર ક)

o No (ના)

11). Do quick movements of your head increase your problem? o Yes (હા)

(ઓ0ચ3તતા*ુમા4ુ
ં હં લાંવાથીતમારતકલીફમાંવધારોથાયછે ?)
o Sometimes

(કયાર ક)

o No (ના)

12). Because of your problem, do you avoid heights? o Yes (હા)

(તમારતકલીફનાકારણેતમેઉચાઈનાકામટાળોછો?)
o Sometimes

(કયાર ક)

o No (ના)

13)Does turning over in bed increase your problem? o Yes (હા)

(પલગમાંપડખાંફરવાથીતમારતકલીફવધેછે?)
o Sometimes

(કયાર ક)

o No (ના)

14). Because of your problem, is it difficult for you to do strenuous homework or o Yes (હા)
yard
o Sometimes
work?
(કયાર ક)
(તમારતકલીફનાકારણેતમનેધરકામમાં,કયાડકામમાંતકલીફપડછે?)

o No (ના)

47
 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

15). Because of your problem, are you afraid people may think you are o Yes (હા)
intoxicated?
o Sometimes
(તમારતકલીફનેકારણેતમનેડરલાગેછેકલોકોએ6ુિવચારસેકતમે7રછો?)
(કયાર ક)

o No (ના)

16). Because of your problem, is it difficult for you to go for a walk by yourself? o Yes (હા)

( એકલાંચાલવાજવામાંતમનેતકલીફથાયછે ?)
o Sometimes

(કયાર ક)

o No (ના)

17). Does walking down a sidewalk increase your problem? o Yes (હા)

(તમનેનીચેજોઈનેબા8ુમાંચાલવાથીતમનેતક0લફથાયછે ?)
o Sometimes

(કયાર ક)

o No (ના)

18). Because of your problem, is it difficult for you to concentrate? o Yes (હા)

(તમારતક0લફનાકારણેતમને9યાનકરવામાંુ કલીથાયછે ?)
o Sometimes

(કયાર ક)

o No (ના)

19) Because of your problem, is it difficult for you to walk around the house in the o Yes (હા)
dark?
o Sometimes
(તમારતકલીફનાકારણેતમનેઘરમાં;ધારમાંચાલવામાંતકલીફપડછે?
(કયાર ક)

48
 Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014

o No (ના)

20). Because of your problem, are you afraid to stay at home alone? o Yes (હા)

(તમારતકલીફનાકારણેતમનેધરમાંએકલાંરહવામાં0બકલાગેછે?)
o Sometimes

(કયાર ક)

o No (ના)

21). Because of your problem, do you feel handicapped? o Yes (હા)

( તમનેઅપંગછો,એ6ુલ
ં ાગેછે?)
o

Sometimesકયાર ક

o No (ના)

22). Has your problem placed stress on your relationship with members of your o Yes (હા)
family orfriends?
o Sometimes
ુ કલીપડછે?)
(તમારતકલીફનાકારણેતમારાંપ<રવારકિમ=નાસં>બધોમાંશ
(કયાર ક)

o No (ના)

23). Because of your problem, are you depressed? o Yes (હા)

(તમારતકલીફનાકારણેતમેહતાસછો?)
o Sometimes

(કયાર ક)

o No (ના)

49
 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

o Yes (હા)

24). Does your problem interfere with your job or household responsibilities?
o Sometimes
ુ કલીપડછે?)
( તમારતકલીફનાકારણેતમનેતમારનોકર,કધરનીવાબદારમાંશ (કયાર ક)

o No (ના)

25). Does bending over increase your problem? o Yes (હા)

( નીચેવળવાથીતમારતકલીફમાંવધારોથાયછે ?)
o Sometimes

(કયાર ક)

o No (ના)

REFERENCES

1. Colledge NR, Wilson JA, Macintyre CC, Mac LennanWJ :The prevalence and characteristics of
dizziness in an elderly community.
2. Tinetti ME, williams CS Gill TM: Dizziness among older adults: A possible geriatric syndrome.
3. Cheryl D Ford-Smith, The Individualized Treatment of a Patient With Benign Paroxysmal Positional
Vertigo,(PHYS THER. 1997; 77:848-855.)
4. Richard A. Clendanie, The Effects of Habituation and Gaze Stability Exercises in the Treatment of
Unilateral Vestibular Hypofunction,(JNPT , Volume 34, June 2010.)
5. Janet OdryHelminski,: Strategies to Prevent Recurrence of Benign Paroxysmal Positional
Vertigo,(ARCH OTOLARYNGOL HEAD NECK SURG/VOL 131, APR 2005)
6. Ahmad H. Alghadir, review article on An update on vestibular physical therapy(Journal of the
Chinese Medical Association 76 (2013) 1e8)
7. Kathleen M Gill-Body, :Relationship Among Balance Impairments, Functional Performance, and
Disability in People With Peripheral Vestibular hypofunction,(PHYS THER. 2000; 80:748-758)
8. Courtney D.Hall , Vestibular-specific gaze stability exercises to standard balance rehabilitation
results in greater reduction in fall risk.(JNPT 2010;34: 64–69).
9. Fernando Vaz Garcia :Disequilibrium and Its Management in Elderly Patients(International Tinnitus
Journal, Vol. 15, No. 1, 83–90 ,2009)
10. Bara A. Alsalaheen: Vestibular Rehabilitation for Dizziness and Balance Disorders After
Concussion(JNPT 2010;34: 87–93)
11. Carol A. Foster a AnnandPonnapan b Kathleen Zaccaro c:A Comparison of Two Home Exercises for
Benign Positional Vertigo:Half Somersault versus Epley Maneuver(Departments of a Otolaryngology
and Audiology, University of Colorado Denver, Aurora, Colo. , USA)

12. Aggrawal NT, Bennett DA, Bienias JL, Mendes de leon CF, Morris MC,EvansDA:The prevalence of
dizziness and its association with functional disability in a biracial community population.JGerontol
(A Biolsci Med sci 2000, 55:M288-)
13. Sloane PD,Coeytaux RR, Beck RS ,DallaJ: Dizziness: State of the science. Ann Intern Med
2001,134:823-832

50
 Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014

14. Lawson J, Fitzgerald j, Birchall j, Aldren CP, Kenny RA: diagnosis of geriatric patients with severe
dizziness.J AM geriatrSoc 1999, 47:12-17
15. Madlon- Kay DJ: Evaluation and outcome of the dizzy patient. (J FamPract 1985, 21:109-113.)
16. Harvey SA, Wood DJ, Feroah TR: Relationship of the head impulse test and head-shake nystagmus in
reference to caloric testing. (American Journal of Otology)
17. Fujimoto M, Rutka J, Mai M: A study into the phenomenon of head-shaking nystagmus: Its presence
in a dizzy population. (Journal of Otolaryngology)

CORRESPONDENCE

* M.P.T. (Neurology), Ph.D, Assistant Professor, RK University, Rajkot

51