Should You Try Vestibular Rehabilitation Therapy for Your Dizziness or Vertigo?

Feelings of dizziness, vertigo, and loss of balance are more common than most people realize; 42% of the United States population (ninety million people) experience this at least once during their lifetime, and for many the situation becomes chronic. In the elderly, dizziness is the most common reason that people over seventy five visit a doctor, and for people over sixty five, falls resulting from a loss of balance are the number one cause of serious injury and death.

Approximately three-fourths of these cases of loss of balance and dizziness are caused by peripheral vestibular disorders that affect the inner and middle ear, such as labyrinthitis, perilymphatic fistula, vestibular neuritis, acoustic neuroma, benign paroxysmal positional vertigo (BPPV) and Ménière’s disease. These disorders cause abnormalities in the delicate areas of the inner ear that disrupt our ability to maintain and control our sense of balance. Although most cases of chronic vertigo and dizziness occur in adults, the condition can affect children suffering from it even more, because they are so active that a lack of balance can prevent them from engaging in sports or other activities.

These conditions can be treated with drugs and surgery, but there is another treatment methodology that uses physical therapy to stimulate and retrain the vestibular system and provide relief – Vestibular Rehabilitation Therapy (VRT). Vestibular Rehabilitation Therapy exercises are prescribed individually for each patient’s specific symptoms and often involve the use of eye exercises, head movements and gait training designed to improve patients’ gaze and stability. VRT cites its goals as seeking to improve balance, decrease the experience of dizziness, improve patients’ stability when moving or walking, improve coordination, minimize falls, and reduce anxiety.

For many people suffering from bilateral or unilateral vestibular loss and the conditions described above, Vestibular Rehabilitation Therapy has often been shown to be effective in reducing their symptoms. Several studies have confirmed VRT’s effectiveness in patients who did not respond to other treatment methodologies. On the other hand, VRT is not as likely to be beneficial if the underlying cause of vertigo or dizziness is due to transient ischemic attacks (TIA), anxiety or depression, reactions to medications, migraine headaches or low blood pressure.

Because the specific exercises in a regimen of VRT vary according to the patient’s symptoms and conditions, it is not easy to give an overview of them. But most of the exercises involve therapist-led movements of the head and body to help your brain and body retrain themselves to compensate for the erroneous information they are receiving from their inner ear, and thus regain control over their balance and equilibrium. Consult a balance specialist if you have experienced vertigo or dizziness for long periods of time, and if an inner ear cause of the problem is indicated, ask for more information about Vestibular Rehabilitation Therapy. You may also want to contact the Vestibular Disorders Association and take advantage of many of their short publications and resource materials.

What Is It and How Is It Treated

Vertigo – a perception of movement in which the individual or the individual’s surroundings seem to spin and move – is, generally an unpleasant event. The feelings of vertigo occasionally include dizziness, spinning or falling. Any time vertigo impacts balance, it can lead to falls and accidental injuries – especially in older adults. More serious cases may also trigger nausea, vomiting, migraine headaches, fainting and visual irregularities called nystagmus.

There can be many causes for vertigo, but one kind of it – benign paroxysmal positional vertigo, or BPPV – relates to hearing. BPPV occurs from calcium crystals that form naturally known as otoliths or otoconia, which in most people cause no problems. In benign paroxysmal positional vertigo, the crystals travel from their normal locations into the semicircular canals of the inner ear. When this occurs, and the individual with BPPV changes the orientation of their head relative to gravity, these crystals move around, resulting in an abnormal displacement of endolymph fluid, which leads to vertigo.

Everyday actions such as tilting your head, looking up and down or rolling over in bed can bring about the benign paroxysmal positional vertigo. The vertigo sensation comes on very suddenly and has a short duration. These symptoms can be made worse by lack of sleep, anxiety, or changes in barometric pressure, such as occur before rain or snow. The condition can manifest itself at any age, but it most commonly appears in people over age 60. The initial trigger for the benign paroxysmal positional vertigo is typically difficult to determine. A sudden blow to the head (for example in an automobile accident) is among the more well-known causes.

Benign paroxysmal positional vertigo is different from other forms of dizziness or vertigo because the episodes are transient (typically under a minute), and because it is always triggered by head movements. Vertigo specialists may diagnose it by having the patient rest on their back and then tilt their head to one side or over the edge of the examination table. Additional tests which can be used to diagnose benign paroxysmal positional vertigo include videonystagmography or electronystagmography, which test for abnormal eye movement, and magnetic resonance imaging (MRI), whose primary role is to eliminate other potential causes, such as brain abnormalities or tumors.

There is no full cure for benign paroxysmal positional vertigo, but it can be effectively treated using canalith repositioning (either the Semont maneuver or the Epley maneuver), both of which use bodily movements to shift the crystals to a position in which they no longer cause trouble.Surgical treatment is an option in the exceptional cases in which these treatments are ineffective. See your health care provider if you have felt symptoms which sound as if they could be related to BPPV, especially if they persist for more than a week.

Feeling Out of Balance? Your Hearing May Be the Culprit

If you have been struggling with your balance, your hearing may be the culprit. Many people are surprised to learn that balance and hearing are directly related, and with the help of hearing devices, you just might be able to regain your balance.

The ear has an organ called the labyrinth in the inner ear. This has a direct affect on the balance system, also known as the vestibular system. When it is not functioning properly, the other systems of the body that help it maintain its position, including the eyes, bones and joints, will not function properly. In this case, you might feel dizzy or feel as though things around you are moving.

When your balance is impaired, you may have a balance disorder. Symptoms of a balance disorder may include:

• The feeling of falling
• Vertigo
• Lightheadedness
• Blurred vision
• Feelings of disorientation

Notice, none of these symptoms are related to hearing, yet the ears have a vital role to play in balance disorders.

If the balance disorder is caused by the ears, a hearing specialist may be able to help. Balance retraining exercises, known as vestibular rehabilitation, can help restore balance for some people. Others may find that changes to their diet are the best way to control their balance disorder. Sometimes, in extreme cases, surgery is necessary to repair the ear.

If you are struggling with balance and feelings of dizziness, the first place you may want to look for help is with the audiologist at your local hearing aid provider. With their advice and the benefit of a hearing test, you can get pointed in the right direction to get treatment for your disorder, so you can function well once again.

Factors Affecting Balance in the Elderly Population

There are a number of factors that contribute to the amount of balance an individual has when they are standing or walking. Good balance needs a sensory input that is reliable from the person’s vision, inner ear balance and sense of movement and position for the legs and feet. Elderly individuals are more susceptible to numerous diseases affecting these systems, such as glaucoma, cataracts, macular degeneration and diabetic retinopathy, which all cause problems with vision. Senses in your legs and feet are affected by diabetic peripheral neuropathy, as well as a slow decrease in the vestibular system.

Balance also depends upon having joint mobility and exceptional muscle strength. If you are leading a sedentary lifestyle, having arthritis, or bone and muscle disease, it will play a key part in mobility and strength of your muscles. Since balance is a rather complex function, there is not necessarily one specific cause attributed to an elderly person falling. An older individual with a history of imbalance or chronic bouts of dizziness is considered two to three times more prone to falling when compared to someone who does not have those problems.

There are numerous causes that can contribute to a feeling of dizziness and lightheadedness, as well as a mild sense of vertigo. It could be anything from a disorder of the inner ear, issues with the central nervous system, problems with the cardiac system, low blood sugar, hyper-ventilation, infection, side effects from medications or a bad interaction with medication and an inadequate or imbalanced diet. A thorough evaluation is often required in an attempt to be able to determine all of the potential causes and end up with a proper diagnosis.

When there is more than one problem present, the task can become that much more complicated. In these cases, the amount of trouble within one system may not be as severe, but the effects might combine with enough issues to cause a serious issue with your balance. An elderly person suffering from arthritis in their ankles and a mild form of degeneration in their vestibular functions may have ample balance until they go into an operation for removing their cataracts. The change in their vision throughout the healing process and the necessary adjustment to their new contacts or glasses may be sufficient enough to cause an imbalance that makes them fall.

Dizziness and Balance Disorders

Dizziness and balance disorders are common and may be dangerous! If you are experiencing issues with dizziness, lightheadedness, or are just feeling off-balanced, you should contact an audiologist or otolaryngologist (ENT) as soon as possible! Inner ear dysfunction may be to blame.

The center for the body’s balance is controlled in combination by the brain, eyes, and vestibular system of the inner ear. Having issues with dizziness or balance typically means another problem is present. A thorough medical and balance evaluation should be completed to help determine your underlying issue. While some causes may be treated with pharmaceutical, medical, or surgical intervention, others may require more intensive balance rehabilitation.

Defining dizziness is involved. Dizziness symptoms include everything from feeling a little lightheaded to off-balanced, feeling unsteady or as if you were falling. Dizziness is common, and may make you feel nauseous, faint, anxious, disoriented, or as if you were moving when standing still. Your vision may blur, you may feel a spinning sensation, or objects may appear to spin around you (vertigo). Some people may notice that difficulties worsen when changing head or body position. Make sure to thoroughly describe your dizziness to your audiologist or physician.

Dizziness and balance issues may be associated with something as simple as the presence of a foreign object in the outer ear canal, viral/bacterial infections, changes in blood pressure, or migraines. More invasive disorders can also be connected to dizziness and imbalance, including: vision disorders, vascular disorders, fistulas, Meniere’s disease, multiple sclerosis, and tumors (benign and malignant). Certain types of medications, considered ototoxic or vestibulotoxic, can be detrimental to the vestibular system causing imbalance or dizziness.

Vestibular evaluations (balance testing) may be recommended for some patients. These tests should aid in determining the cause, location, and symptoms. Most testing requires specialized devices, so a trip to the clinic may be necessary. In many cases you will be asked to follow a series of lights in various patterns with your eye movement.

You will probably also move through a variety of positions from lying down to sitting up while the evaluation is being completed. Let your audiologist or physician know of any back and neck difficulties prior to evaluation. You will probably feel dizzy during the assessment.

Here are Some Tips for the Day of Your Assessment.

  • Do not eat heavily. If the assessment is early enough in the day and no other medical conditions will be affected, do not eat prior to testing. Bring crackers or another small snack in case the wait time to be seen runs long.
  • Ask if electronystagmography (ENG) testing is going to be completed. If yes, do not wear make-up or lotions on the head, neck or face. A good connection to your skin needs to be maintained throughout the test. Make-up and lotions may affect the contact between the testing pads and your skin.
  • Tell your audiologist about any major illnesses or back and neck difficulties you have. Other conditions may affect the way you are evaluated.
  • If you feel sick during the assessment, let your provider know. They will assist you in any way they can.
  • Have someone come with you. As your balance/dizziness may be affected, you may not feel up to driving or navigating your way around town following evaluation of dizziness and balance disorders.

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