Need Therapy for Balance?


As a vestibular therapist I am often asked if there is really anything that can be done to help someone with their dizziness. And the answer is YES! There are a large number of causes of dizziness that can be treated through vestibular therapy. To understand how this works, we first have to understand a little bit about what the vestibular system is and what it does.

The vestibular system helps to determine head and body position, as well as aid in balance and postural control. The vestibular system along with input from the visual system as well as somatosensory (body’s ability to sense the ground underneath of it) help us to maintain our balance and stability. The vestibular system is made of several small structures that are each responsible for a direction of movement. The semicircular canals control angular motion, while the otoliths (the utricle and saccule) control linear acceleration and tilt.

vestibular therapy
When the vestibular system has been disrupted it affects our ability to maintain balance, but can also cause a feeling of dizziness due to under or over stimulation of certain areas of the brain. The vestibular system can be disrupted through a variety of different mechanisms including BPPV (benign paroxysmal positional vertigo), concussion, unilateral hypofunction, migraines, as well as seizures. These dysfunctions can all present differently and it is my job based on symptoms to determine the probable cause of dizziness and the best course of action to address these symptoms.

One of the first questions I often ask a patient is how to describe their dizziness. Dizziness is a term that can have many different meanings. Usually the answers are in one of four categories. True vertigo or room spinning sensation, presyncope or a feeling like you might pass out, disequilibrium or a feeling of “off balance”/the world not moving in sync, and vague lightheadedness that does not fit into the other groups.

My next questions is usually how long do these spells or attacks last. Do the last for seconds, hours, days? Knowing how long these episodes lasts and if this has changed at all helps to determine possible cause and needed treatment.

The third important question is when do these spells occur? Do certain motions or activities increase the symptoms, such as bed mobility, transfers, walking, or just with sitting?

Based on your symptoms presentation, I will then begin performing tests to assess your vestibular systems function, as well as other related areas. I will assess your balance on various surfaces with eyes open and eyes closed to determine how effective your vestibular system is, as well as look at your eye movements to determine if the pathways between your vestibular system and eyes are working correctly.

Based on patient’s reports of dizziness, as well as the testing I have done, I am able to determine the best type of treatment for each patient. The treatment will fall into one of two categories, either repositioning maneuvers or vestibular rehabilitation therapy.

Repositioning maneuvers will help to correct Benign Paryoxsomal Positional Vertigo, or BPPV. BPPV occurs when small crystals in the inner ear becomes dislodged and begin floating around in the semicircular canals. Once in the canals the move around in the fluid, causing over stimulation of the vestibular system. A patient will generally describe a room spinning sensation, that occurs usually with certain activities including lying flat, rolling over in bed, as well as bending down and looking up. BPPV is confirmed with a simple test in which a patient is quickly laid back on the table with their head either turned to the left or the right. In this position, the patient will feel a room spinning sensation and I will note what is a called a nystagmus, or uncontrollable rotational movement of the eyes. Once the presence of BPPV is confirmed a repositioning maneuver is performed to move the crystals from the canals back to the utricle.

Vestibular Rehabilitation Therapy (VRT) is indicated when patient notes dizziness or light headed/fuzzy feeling with particular motions including quick head turns or full body turns, bending over, and with walking. VRT is essentially a series of exercises designed to increase a patient’s dizziness repeatedly so that the brain can compensate for the current dysfunction and in the end alleviate the dizziness. When a patient comes in for VRT their exercises can vary depending on what motions or activities increase their symptoms, however, common exercises including walking with head motions, with walking full body turns, tracking objects with the eyes, as well as balance exercises to increase the vestibular systems activity.

Balance/Vestibular Specialists are available for an evaluation at our Annapolis, Easton, Salisbury MD offices and our Millville, Millsboro, and Lewes offices.

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