The experience of dizziness or disorientation suggests a problem with understanding where you are in the world around you.
Understanding the sense of Disorientation
The thinking part of your brain doesn’t have a way to know where you are in the world because it’s locked inside your skull. So it uses sensors from around the body to understand your position and movement through the world.
It tries to understand where you are in relation to your environment through your visual system.
It tries to understand how your weight is distributed and the direction you’re moving by recognizing the changing weight distribution in your legs.
It tries to understand the position of your head by interpreting the information coming from the neck muscles holding your head up, as well as the sensors in the inner ear which provide information about your head position compared to vertical.
It tries to understand the self-motion of your head, that is, the motion of your head created by the neck muscles, by interpreting the information coming from the neck muscles.
And it tries to understand the motion of your head through the world by interpreting the information from the inner ear system.
But that’s not all!
All of this information travels along nerve pathways.
All of the nerve pathways connect to other nerve pathways in regions that act like bus stations. Many pieces of information come in and interconnect with other pieces of information.
The brain receives all of this information, and compares it to what it was expecting to experience.
So…
There are a lot of possibilities for problems to arise that might cause a sense of disorientation about where you are in the world.
The sensors might be sending the wrong signal.
A signal might be interrupted along one of its pathways.
Signals might combine in strange ways.
Finally, signals may be interpreted incorrectly.
AND a person’s emotional response to the experience also influences the experience as a whole. Parts of the brain (this might be thought of the protective part of your brain) recognize the experience as a danger to your survival. Certainly, if you don’t know where you are, then you are going to be less able to acquire food, help others, fight off an attacker, or escape a predator. For some people, this results in increased focus and attention on the smallest sense of dizziness or unsteadiness, and this results in a worsening of the symptoms in terms of severity, and ultimately in more and more limitations with activities of daily living. Some people move around less and less to control the strange sensations. This is helpful short term strategy the brain comes up with in limiting the symptoms, BUT reducing the experience of motion can actually increase your sensitivity to motion over the long term – and so increase the symptoms. The plan backfires. The short term strategy is not a good long term strategy for recovery. Like many things, avoidance is not a good long term strategy.
Examples of Dizziness and Disorientation
Here are a couple of examples of dizziness or disorientation that you may have experienced in your life:
In terms of the visual system, you might be seated in a stationary vehicle next to a bus. The bus begins to creep forward, and you have a startling sensation of your vehicle moving backward. Think about it for a moment. You actually FELT like you were moving backward. This was an illusion of motion.
Another example is a fun house situation where the floor is perfectly normal, but all the walls and furniture are tilted. People lean to correct for the visual input, but the other systems are providing information that the visual system is wrong. People try to walk through the room but are leaning and stumbling because they are correcting for a tilted world that doesn’t actually exist. They don’t usually fall because the information from the other systems is able to prevent a fall. But it would be dangerous for the brain to completely ignore the visual information so it must provide some form of reaction – just in case so the leaning and stumbling continue. Again, dizziness or disorientation are experienced.
Normally, you experience the world as a coherent place, understanding your body position, your movement, the surface you’re standing on, and where you are in relation to the objects around you.
But if there’s a problem somewhere in the tangled mess of inputs, connections, interpretations, and expectations, then you can feel dizziness, disorientation, or vertigo. This might be constant, or intermittent, or only in certain environmental situations.
It’s often helpful for people to understand these concepts and reframe their day to day experience in a new light.
A proper assessment should highlight the issues that have developed in the system, and a rehabilitation plan should be built to encourage change to occur and allow improved understanding of where you are in the world.