Strike a Balance
Monday November 14, 2011
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When Elizabeth Bisoux, PT, MPT, saw a patient for head trauma who complained of dizziness, her training in vestibular assessment and rehabilitation kicked in immediately. After further assessment, Bisoux was able to diagnose benign paroxysmal positional vertigo, a vestibular disorder that affects half of people age 70 and older.
Bisoux immediately conducted a therapy protocol to reset eye movement with the inner-ear nerve. The symptoms went away in less than an hour. “The patient was pleased with the outcome,” Bisoux said. “She said afterward she thought she would have to live with it for a long time.”
Bisoux said she fine-tuned these assessment techniques and therapy maneuvers at a three-day training session at the American Institute of Balance in Largo, Fla., one of the country’s largest balance disorders treatment centers. Led by Richard Gans, PhD, an audiologist who has specialized in dizziness and balance disorders for 30 years, the institute has trained about 6,000 therapists worldwide since 1994, Gans said.
“The No. 1 complaint of people 70 and older is dizziness,” he said. “But dizzy people don’t have to live with it.”
Vestibular rehabilitation therapy is used by audiologists, physical and occupational therapists , and physicians as a treatment and management strategy for patients with a vestibular dysfunction because of a vestibular disease or disorder, Gans said. A Johns Hopkins study showed about 85% of all dizziness or vertigo symptoms are a result of either damage or wear to the inner ear, he said.
Other common causes of vestibular dysfunction include: cardiovascular issues, diabetes, migraine (vestibular), vestibular neuritis, stroke, shingles (herpes simplex), traumatic brain injury, autoimmune disorders, labyrinthitis, labyrinthine concussion and Meniere’s disease.
No medication or surgery
The effects of vestibular dysfunction — dizziness or vertigo — can last for less than a few hours, or for days, weeks and even years, Gans said.
AIB’s evidence-based techniques to treat vestibular dysfunctions require no medication or surgery, Gans said. Rather, they are individualized and programmatic therapy protocols and programs involving sequential coordination exercises of the eyes, head and body.
Minimal training on vestibular treatment is done in physical therapy school, said Lori Bilodeau, PT, MPT, who works at Physical Therapy Today in Lubbock, Texas. “I only had one day on it in my neuro class,” she said. “PTs recently out of school tell me they are spending a week on it now, but that still isn’t enough time for an issue that affects so many people.”
Bilodeau said she began studying VRT at Emory University in Atlanta shortly after graduating from physical therapy school in part because her mother was suffering from vertigo. “She saw three [ear, nose and throat specialists] and no one diagnosed her BPPV,” she said. “They all put her on medication.”
Once Bilodeau learned more about vestibular disorders, she screened her mother, discovered the BPPV and performed a canalith repositioning that cleared up her mother’s dizziness in a matter of minutes.
Bisoux said she has gone to family physicians in the area and discussed VRT, which has increased her referrals from them in this treatment area. “It broadens your patient base,” she said. “There are a lot of other patients you can treat.”
Getting a physician to listen to the concept can be a challenge, however, Bilodeau said. “A lot are cynical about it. You can see the skepticism,” she said. “Patients are our best advocates. When they become better, they ask what they can do for us, and we tell them to tell their doctors about the treatment.”
Bilodeau estimated up to 30% of her patient base has dizzy symptoms, whether the patient recognizes it or not. “They may come in with a knee or shoulder replacement and we see that they also are dizzy,” she said. “The longer you practice, the more you realize there are a lot of dizzy people out there.”
Assessment and therapy options
A typical patient with dizziness may have a vestibular problem on just the right or left side, for example, that can be corrected with exercises, Bisoux said. “We get patients to walk and move their head side to side, or have moving targets come to them while they are sitting,” she said. “Once corrected, they might be able to go grocery shopping without using a wheelchair, which helps them stay more active. If they stay more active, it improves their quality of life.”
Assessment questions for vestibular disorders include finding out when a patient is dizzy — whether lying down, standing up or when turning the head. Based on the patient’s answers, a diagnosis can be made, Gans said.
There are three different approaches to therapy based on the causes for dizziness: adaptation, substitution and canalith repositioning, Gans said.
An example of an adaptation maneuver could be having the patient look at two lists of words while moving his or her head right and left while sitting on a balance ball, he said.
A substitution maneuver might be having a patient stand on a trampoline and either close his or her eyes or watch moving stimulus while retaining his or her balance.
Canalith repositioning is used to treat BPPV through a series of specific coordinated maneuvers of the head and body that move the otolith debris from the semicircular canals back to the utricle, where they can dissolve naturally within hours.
“Once you figure out what it is, the treatment falls into place,” Bilodeau said.
The AIB offers seven different educational workshops on dizziness and vestibular assessment and rehabilitation at its Florida location, as well as in seminars in the U.S. and around the world, Gans said. The seminars take two to five days and culminate in a certificate. They are accredited by the American Medical Association.
In March, AIB rolled out an online version of its seminars, which can be found through the American Institute of Continuing Medical Education at AICME.com or CME2Go.org. These seminars are available in English, Spanish and Chinese. Courses begin at $29. A smart phone application offering the seminars via iPhone and Droid also will be available soon, Gans said.
“My goal is that everybody should have access to the most current evidence-based education in this,” Gans said. “OT and PT specialists in this area have an opportunity help. Old people don’t have to fall.”
Teresa McUsic is a freelance writer.
Bisoux immediately conducted a therapy protocol to reset eye movement with the inner-ear nerve. The symptoms went away in less than an hour. “The patient was pleased with the outcome,” Bisoux said. “She said afterward she thought she would have to live with it for a long time.”
Bisoux said she fine-tuned these assessment techniques and therapy maneuvers at a three-day training session at the American Institute of Balance in Largo, Fla., one of the country’s largest balance disorders treatment centers. Led by Richard Gans, PhD, an audiologist who has specialized in dizziness and balance disorders for 30 years, the institute has trained about 6,000 therapists worldwide since 1994, Gans said.
“The No. 1 complaint of people 70 and older is dizziness,” he said. “But dizzy people don’t have to live with it.”
Vestibular rehabilitation therapy is used by audiologists, physical and occupational therapists , and physicians as a treatment and management strategy for patients with a vestibular dysfunction because of a vestibular disease or disorder, Gans said. A Johns Hopkins study showed about 85% of all dizziness or vertigo symptoms are a result of either damage or wear to the inner ear, he said.
Other common causes of vestibular dysfunction include: cardiovascular issues, diabetes, migraine (vestibular), vestibular neuritis, stroke, shingles (herpes simplex), traumatic brain injury, autoimmune disorders, labyrinthitis, labyrinthine concussion and Meniere’s disease.
No medication or surgery
The effects of vestibular dysfunction — dizziness or vertigo — can last for less than a few hours, or for days, weeks and even years, Gans said.
AIB’s evidence-based techniques to treat vestibular dysfunctions require no medication or surgery, Gans said. Rather, they are individualized and programmatic therapy protocols and programs involving sequential coordination exercises of the eyes, head and body.
Minimal training on vestibular treatment is done in physical therapy school, said Lori Bilodeau, PT, MPT, who works at Physical Therapy Today in Lubbock, Texas. “I only had one day on it in my neuro class,” she said. “PTs recently out of school tell me they are spending a week on it now, but that still isn’t enough time for an issue that affects so many people.”
Bilodeau said she began studying VRT at Emory University in Atlanta shortly after graduating from physical therapy school in part because her mother was suffering from vertigo. “She saw three [ear, nose and throat specialists] and no one diagnosed her BPPV,” she said. “They all put her on medication.”
Once Bilodeau learned more about vestibular disorders, she screened her mother, discovered the BPPV and performed a canalith repositioning that cleared up her mother’s dizziness in a matter of minutes.
Bisoux said she has gone to family physicians in the area and discussed VRT, which has increased her referrals from them in this treatment area. “It broadens your patient base,” she said. “There are a lot of other patients you can treat.”
Getting a physician to listen to the concept can be a challenge, however, Bilodeau said. “A lot are cynical about it. You can see the skepticism,” she said. “Patients are our best advocates. When they become better, they ask what they can do for us, and we tell them to tell their doctors about the treatment.”
Bilodeau estimated up to 30% of her patient base has dizzy symptoms, whether the patient recognizes it or not. “They may come in with a knee or shoulder replacement and we see that they also are dizzy,” she said. “The longer you practice, the more you realize there are a lot of dizzy people out there.”
Assessment and therapy options
A typical patient with dizziness may have a vestibular problem on just the right or left side, for example, that can be corrected with exercises, Bisoux said. “We get patients to walk and move their head side to side, or have moving targets come to them while they are sitting,” she said. “Once corrected, they might be able to go grocery shopping without using a wheelchair, which helps them stay more active. If they stay more active, it improves their quality of life.”
Assessment questions for vestibular disorders include finding out when a patient is dizzy — whether lying down, standing up or when turning the head. Based on the patient’s answers, a diagnosis can be made, Gans said.
There are three different approaches to therapy based on the causes for dizziness: adaptation, substitution and canalith repositioning, Gans said.
An example of an adaptation maneuver could be having the patient look at two lists of words while moving his or her head right and left while sitting on a balance ball, he said.
A substitution maneuver might be having a patient stand on a trampoline and either close his or her eyes or watch moving stimulus while retaining his or her balance.
Canalith repositioning is used to treat BPPV through a series of specific coordinated maneuvers of the head and body that move the otolith debris from the semicircular canals back to the utricle, where they can dissolve naturally within hours.
“Once you figure out what it is, the treatment falls into place,” Bilodeau said.
The AIB offers seven different educational workshops on dizziness and vestibular assessment and rehabilitation at its Florida location, as well as in seminars in the U.S. and around the world, Gans said. The seminars take two to five days and culminate in a certificate. They are accredited by the American Medical Association.
In March, AIB rolled out an online version of its seminars, which can be found through the American Institute of Continuing Medical Education at AICME.com or CME2Go.org. These seminars are available in English, Spanish and Chinese. Courses begin at $29. A smart phone application offering the seminars via iPhone and Droid also will be available soon, Gans said.
“My goal is that everybody should have access to the most current evidence-based education in this,” Gans said. “OT and PT specialists in this area have an opportunity help. Old people don’t have to fall.”
Teresa McUsic is a freelance writer.
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Monday November 14, 2011