Manage Post-Stroke Dizziness: Tips For Quick Relief

Dizziness is a common symptom after a stroke, but it is rarely addressed as a primary concern in rehabilitation programs. As a result, many people continue to experience dizziness long after their recovery, which affects their daily activities. Post-stroke dizziness can be caused by medications, long periods of inactivity, or sudden changes in blood pressure when changing positions. It can also be caused by the stroke itself, particularly if it affected certain structures in the brain, such as the cerebellum or brainstem, which are responsible for balance and coordination.

To effectively manage post-stroke dizziness, it is crucial to identify its underlying cause. This involves working closely with a medical team to determine the specific cause and develop a tailored treatment plan. Treatment options may include certain medications or specific strategies to reduce dizziness caused by position changes. Vestibular therapy, a specialised form of physical therapy, can also be beneficial for dizziness originating from the brainstem or cerebellum. This type of therapy aims to retrain the vestibular system and decrease sensitivity to visual movement, helping individuals regain their balance and coordination.

Identify the cause of dizziness with a medical professional

Dizziness after a stroke can be caused by a wide range of factors, and it is important to identify the cause to determine the best course of treatment. Here are some ways to identify the cause of dizziness with the help of a medical professional:

• Medical Assessment: A doctor will conduct a thorough medical assessment to identify the specific cause of dizziness. This may include taking your medical history, discussing your symptoms in detail, and performing a physical examination. Be sure to describe your dizziness as accurately as possible, including any triggers or intensifying factors.
• Blood Tests: Blood tests can help identify underlying conditions that may be causing dizziness. For example, blood tests can check for anaemia, diseases of the circulation, or problems with blood sugar or blood pressure regulation.
• Neuroimaging: Neuroimaging techniques such as MRI or CT scans can help visualise the blood vessels in the head and neck, as well as identify any structural abnormalities in the brain that may be causing dizziness. These scans can detect blockages, narrowing, or injuries to the arteries supplying blood to the brain.
• Hearing Tests: Dizziness can sometimes be related to problems with the vestibular system, which is located in the inner ear. Hearing tests, along with eye movement tests, can help evaluate the function of this system and determine if it is contributing to your dizziness.
• Cardiac Monitoring: In some cases, dizziness may be related to cardiac issues such as atrial fibrillation. Ambulatory cardiac monitoring can help detect abnormal heart rhythms that could be contributing to your symptoms.
• Eye Examination: Vision problems are common after a stroke and can contribute to dizziness. An eye examination can check for issues such as difficulty focusing, double vision, or eye movement problems. Your doctor may refer you to a vision specialist if necessary.
• Medication Review: Side effects from medications commonly prescribed after a stroke, such as high blood pressure medication or antidepressants, can cause dizziness. Your doctor can review your medications and make adjustments if needed.

It is important to work closely with your medical team to identify the cause of your dizziness and determine the most appropriate treatment plan. With the right approach, improvements in post-stroke dizziness are possible.

Understand the role of the vestibular system in balance

The vestibular system is a sensory system that creates our sense of balance and spatial orientation, allowing us to coordinate movement and balance. It is located in the inner ear, specifically in a region called the vestibule, and works in conjunction with the cochlea, which is part of the auditory system. Together, these structures form the labyrinth of the inner ear in most mammals.

The vestibular system is composed of two main components: the semicircular canals and the otoliths. The semicircular canals detect rotational movements, while the otoliths detect linear accelerations. This combination allows the vestibular system to understand all possible directions of movement.

The vestibular system sends signals to various parts of the brain and body to maintain balance and orientation. These signals help control eye movements, muscle coordination, and posture. For example, signals are sent to the muscles that keep us upright, allowing us to maintain our desired position in space. The system also plays a crucial role in eye movement control, stabilising images on the retina during head movement through the vestibulo-ocular reflex (VOR). This reflex produces an eye movement in the direction opposite to head movement, keeping the image in focus at the centre of the visual field.

In addition to its role in balance, the vestibular system contributes to our sense of spatial orientation. It provides constant information to our brains about our body's position and movement in space, helping us understand if we are lying down, standing up, or moving in a particular direction. This system is so integral to our sense of movement and balance that when it is disrupted, it can lead to dizziness, vertigo, and a loss of balance.

Vestibular dysfunction can occur due to various reasons, including stroke, head trauma, or certain diseases. When the vestibular system is not functioning properly, individuals may experience dizziness, eye movement problems, and a false sense of motion. This is where vestibular therapy comes into play, targeting the vestibular system to restore balance and reduce dizziness. By engaging the brain's natural healing process, known as neuroplasticity, vestibular therapy can help repair and recalibrate the vestibular system.

Learn about the effects of brainstem strokes

Brainstem strokes are the most lethal form of stroke and can have complex symptoms. The brainstem is composed of the midbrain, the pons, and the medulla oblongata, situated in the posterior part of the brain. The pons is the most commonly involved area of a brainstem stroke. Brainstem strokes can impair any or all of the basic activities of the central nervous system, including consciousness, blood pressure, and breathing.

The effects of a brainstem stroke depend on which part of the brainstem is affected. The midbrain is involved in vision, hearing, and movement; the pons is key in sensation, sleep-wake cycles, and breathing; and the medulla oblongata controls vital functions like heartbeat, breathing, and blood pressure.

Brainstem strokes can cause vertigo, dizziness, and severe imbalance. Other symptoms include double vision, slurred speech, decreased consciousness, and locked-in syndrome, where survivors can only move their eyes.

The risk factors for brainstem strokes are the same as for strokes in other areas of the brain: high blood pressure, diabetes, heart disease, atrial fibrillation, and smoking. Brainstem strokes can be caused by a clot or a hemorrhage.

Brainstem strokes are difficult to diagnose, and treatment must be prompt to improve the chances of recovery. Treatment options include medication to dissolve or remove the clot, surgery to remove the clot, angioplasty and stenting to widen an artery, and medication to reduce clotting.

Explore treatment options, such as vestibular therapy

Vestibular rehabilitation (VR) is a form of specialised physical therapy that addresses problems that may arise in the vestibular system. The vestibular system is an elaborate network that sends signals to the brain related to motion, head movements, and body awareness. When the vestibular system is not working properly, people often report dizziness with head and/or eye movements, loss of balance, and a false sensation of movement.

Vestibular therapy uses specific exercises involving head and eye movements to retrain the vestibular system and decrease sensitivity to visual movement. This helps re-educate the body on how to coordinate movement and balance while the head is in motion. Vestibular therapy uses two strategies, habituation and adaptation, to create these changes and improve your ability to perform everyday activities.

Vestibular therapy can be helpful in reducing dizziness with head movements, sensitivity to busy environments, and loss of balance. It can play a large role in helping patients regain independence and decrease symptoms of dizziness and imbalance with everyday activities.

• Gaze stabilisation exercises: These exercises help restore the vestibulo-ocular reflex, which, when impaired, can cause disorientation and vertigo.
• Habituation exercises: These exercises help reduce dizziness by exposing the person to the movements that bother them, such as bending over to pick something up. The goal is to increase tolerance so that those movements no longer affect balance.
• Balance and exertional training: As dizziness improves, more advanced balance exercises and cardio can be introduced to increase stability and endurance. The goal is to build up the person's stamina to pre-stroke levels.

Implement strategies to reduce dizziness from position changes

Dizziness after a stroke can be caused by a variety of factors, such as medications, long periods of inactivity, or changes in blood pressure when changing positions. Implementing strategies to reduce dizziness from position changes can be an important part of post-stroke recovery. Here are some ways to address this issue:

• Medication Review: Talk to your doctor about the medications you are taking. Certain drugs, such as blood pressure medications or antidepressants, can cause dizziness as a side effect. Your doctor may suggest adjusting dosages, switching medications, or trying new drugs to alleviate dizziness.
• Vestibular Therapy: This specialized form of physical therapy focuses on the vestibular system, which is responsible for balance and spatial orientation. Vestibular therapy uses specific head and eye movement exercises to retrain the vestibular system, reducing sensitivity to visual movement and improving coordination and balance during head movements.
• Habituation and Adaptation: These are two strategies used in vestibular therapy to decrease dizziness. Habituation involves exposing you to movements that trigger dizziness, such as bending over, to increase your tolerance and reduce the impact on your balance. Adaptation includes head-turning exercises to reduce dizziness and improve balance.
• Gaze Stabilization Exercises: These exercises can help improve balance and reduce dizziness. They should be prescribed by a specialist, such as an occupational therapist or a physiotherapist with expertise in dizziness.
• Balance Retraining Exercises: A physiotherapist can work with you to identify challenging activities and develop a personalized plan to improve your balance. This may include exercises for standing, sitting, reaching for objects, and standing on unstable surfaces. Practising these tasks can lead to improved balance and reduced dizziness.
• Equipment for Balance: Using assistive devices, such as a walking stick or an ankle-foot orthosis (a splint that supports your ankle and lifts your toes), can improve your stability and reduce the risk of falls.
• Environmental Modifications: Make your home environment safer by keeping floors clear of obstacles, improving lighting, and removing clutter. These simple changes can help you move around with more confidence and reduce the risk of falls.
• Vision Care: Get regular eye exams and wear prescribed glasses. Vision problems, such as difficulty focusing, double vision, or eye movement issues, can contribute to dizziness and balance issues.
• Managing Risk Factors: Addressing risk factors for stroke, such as high blood pressure, diabetes, and heart disease, can also help reduce the likelihood of ongoing dizziness.

Remember, it is important to work closely with your medical team to identify the specific causes of your dizziness and develop a tailored treatment plan. With the right approach, improvements in post-stroke dizziness are possible, leading to increased independence and a better quality of life.

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