Disorders of the vestibular system—the parts of the inner ear and brain associated with balance and spatial orientation—can greatly diminish an individual’s quality of life and ability to function on a day-to-day basis. Dizziness, vertigo, loss of balance, and visual disturbance are common complaints in people with vestibular disorders, and these can lead to secondary issues such as nausea and/or vomiting, reduced ability to focus or concentrate and fatigue. Vestibular disorders can take a heavy toll in other ways as well, often causing sufferers to experience emotional issues such, as anxiety and depression, and to become more sedentary to avoid triggering or exacerbating their symptoms, which in turn can lead to further decline in their health status.
“The impact of vestibular issues is huge,” states Alison Matson, a board-certified clinical specialist in Neurological Physical Therapy with The University of Toledo Medical Center Outpatient Rehabilitation Services Department. “For example, according to a recent study, there is a 12-fold increase in fall risk among people who are dizzy. Fear of falling then leads to a more sedentary lifestyle. In addition, their ability to drive can be affected and they may be unable to work or need to change their job or position in a company to avoid symptoms. It really impacts all facets of life.”
However, there’s good news for people in our community who are struggling with vestibular disorders: UTMC Outpatient Rehabilitation Services offers vestibular rehabilitation therapy (VRT) to help alleviate both the primary and secondary problems caused by vestibular disorders and help patients get back to their lives with the highest possible degree of function.
Matson explains that our balance system consists of vision, proprioception (the brain’s perception of the body’s orientation in space based on input from receptors in the joints) and the vestibular system of the inner ear, so addressing vestibular problems takes a multipronged approach. “When patients come for vestibular rehab, they’re given an extensive clinical evaluation to find out which systems are involved and determine whether the problem is peripheral or central, in other words whether it’s located in the inner ear or centrally located in the brain,” she says.
One of the most common vestibular disorders Matson treats is dizziness, which often stems from a condition called benign paroxysmal positional vertigo, or BPPV, which occurs when calcium carbonate crystals located in the inner ear migrate where they’re not supposed to be. Other problems can cause dizziness as well. Examples include certain (or too many) medications, blood pressure issues, and vestibular hypo function, in which there is asymmetry in the function of the vestibular systems of the ears.
VRT is an exercise-based program, usually performed on an outpatient basis, that is primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. Patients are seen by a licensed physical therapist with advanced post-graduate training. The programs are individualized to the patient and highly variable, but oftentimes involve twice-per-week sessions for six to eight weeks. Matson notes, “Participants can expect to do a lot of balance training activities as well as some strengthening to try to get them to move more and learn how to accommodate and compensate for the condition. Compensation involves teaching them strategies to use in daily life so they can continue to function. For example, if a patient complains of getting dizzy when turning corners, we can teach him or her gaze stabilization strategies, which involve keeping the eyes focused on a fixed object once turned to decrease the sensation of dizziness.”
The outcomes for VRT patients vary considerably by diagnosis. Matson points out that the most common vestibular problem, BPPV, can often be fixed in one to three sessions, though future recurrence is possible. Vestibular hypo function also tends to respond well to therapy. “Generally speaking, peripheral vestibular problems, such as BPPV and vestibular hypo function, respond better to vestibular rehab. Problems located centrally in the brain, such as those stemming from brain injury, concussion, or multiple sclerosis, can also be improved, though perhaps not back to baseline,” she says.
Whatever the cause of a vestibular problem, it’s the rare individual who doesn’t get at least some benefit from VRT, and it’s highly unlikely that VRT will make the problem worse. “Anybody who lacks confidence in their balance or has a fear of falling will benefit from coming in for an evaluation. The vast majority of our patients achieve a greater quality of life and increased confidence with functional activities,” Matson states.
The Outpatient Rehabilitation Services Department at UTMC has therapists who are specially trained to assess and treat your dizziness. To schedule an appointment, call 419-383-5040.