What to Expect During Vestibular Assessment and Treatment

Dizziness or Balance Disorders Can Be Caused By a Number of Different Conditions

At LifeMark we give clients different tests to narrow down what may be contributing to their dizziness

There are many, many different conditions that can contribute to dizziness or balance disorders. To help narrow down a clinical diagnosis, at LifeMark we give clients a number of different tests and evaluations. One of the first steps of the assessment process is the Dizziness Inventory that we ask clients to download from the website and fill in before your first appointment. This questionnaire allows us to identify difficulties that you may be experiencing because of your dizziness or unsteadiness, and gives us some valuable clues about what conditions you might be dealing with.

Vestibular Assessment Includes Infrared Video-Analysis of Eye Movements

LifeMark's vestibular assessment is extensive and includes infrared video-analysis of eye movements, which provides information about the inner ear and its connections in the brain. Many of these eye movement clues cannot be detected in room light. Treatment can involve a combination of stationary and moving balance retraining, gaze stabilization to help you focus during head movement, training for motion sensitivity, and canalith resposition manoeuvres for BPPV; the results are often dramatic.

The balance retraining component is also effective for clients who don't necessarily have a vestibular problem, but have muscle and joint problems, brain-related disorders, sensation problems, or vision changes affecting their equilibrium. LifeMark is actively involved in collecting outcome measures to make sure what we do is making people better, and is committed to utilizing the most current, evidence-based tests and techniques in its training and treatment programs.

Vestibular Assessment Also Includes Motion Sensitivity Testing, Static and Dynamic Balance Testing and TMJ Testing

As part of your vestibular assessment we go through many of these tests, as determined by the nature of your symptoms:

• We take a thorough history
• We take your blood pressure both when standing up and lying down
• We perform motion sensitivity testing, scoring both the intensity and duration
• We perform static and dynamic balance tests, to compare to normative and fall risk data
• We test for TMJ (temporomandibular joint disorder) and cervical spine mobility
• We screen for any serious problems with the following:

1. Cranial nerve scan
2. Vertebral artery scan
3. Carotid pulse
4. Carebellar tests
5. Scans for upper motor neuron lesions
6. Ligamentous stability of the upper cervical spine

What is Vestibular Rehabilitation?

Vestibular Rehabilitation is a proven, research-based branch of physiotherapy where specific individualized techniques are used to maximize the brain's compensation for vestibular pathology, or where manoeuvres are done to correct mechanical dysfunctions in the vestibular apparatus.

What Can Cause the Problems?

Vestibular disorders can come from pathologies in any area of this complex system. They can be insidious ("out of the blue") or due to factors such as trauma (motor vehicle accidents, falls, contact sports, blows to the head), infections, aging, medications, brain-related problems, or secondary to other diseases or injuries. Symptoms can include dizziness, imbalance, blurry vision, motion sensitivity, nausea, poor concentration, muscle guarding/restriction of movement, decreased activity levels or social interaction, anxiety and depression.

Home-Based Exercise is Vital to Your Vestibular Treatment

Repeating Movements That Provoke Dizziness Will Help You Recover From It

Many sufferers of dizziness are surprised to find that not doing the movements that make you dizzy will actually delay your recovery in the case of vestibular problems. An exercise program that repeats the movements that provoke dizziness can train your brain to compensate and help you to overcome it.

At LifeMark Vestibular Rehabilitation, we educate our clients in specific techniques that gently reproduce the symptoms so that the brain can see the error signals enough to allow it to compensate for dizziness problems. The underlying problem may still be there, but the brain can do an excellent job processing signals in a different way so that you no longer feel the symptoms in many cases.

After an initial assessment, we provide individualized treatment plans with exercises to help your specific situation. Some ways that home-based exercises can maximize central nervous system compensation are:

• By reducing motion sensitivity (habituation)
• By improving static / dynamic balance
• By improving gaze stability (adaptation)

Just as figure skaters or ballet dancers learn to suppress and adapt to signals from the balance organs when they spin that would make the rest of us dizzy, we teach clients how to help the brain process this information so that the sensation of dizziness is lessened or removed altogether. When you are practicing the brief but specific exercises at home, we would typically see you once per week over a 4-6 week period, after which treatment is either complete or may be weaned down.

Exercise Helps the Brain Compensate For Vestibular Problems

Low-impact aerobics, Tai chi or a walking program can also improve general fitness levels, strengthen balance, and expose you to movements that help your brain compensate for vestibular problems. The Vestibular Disorders Association does not recommend doing vestibular exercises at home without a diagnosis and personal treatment plan from a vestibular specialist. We are here to help!

Contact us to find a vestibular specialist near you.

Taking Good Balance for Granted

It's Not Until Dizziness Becomes a Problem That We Notice How Important Our Balance Is To Us

According to the Vestibular Disorders Association (VEDA), the body maintains balance with sensory information from three main systems:

• Vision
• Proprioception (touch sensors in the feet, trunk, and spine)
• Vestibular system (inner ear)

The Brain Integrates Sensory Information to Help Us Keep Our Balance

These three systems send information to the brain, and in response, the brain figures out where you are in space and sends information to the eyes for steady vision, and to the muscles for balance. When your balance system is working properly, you feel normal when you are standing or moving around:

• you can keep your balance when you're doing different activities
• you can see everything clearly when you move around
• you don't give a second thought to whether or not you should move your head

But when the balance system isn't working, even small activities like walking on uneven ground or walking down the stairs can be challenging and even cause an accident.

When the balance system isn't working, walking down the stairs can be challenging

Conflicting Information to the Brain Causes Disorientation

If the brain is getting conflicting sensory information from the vestibular system, the eyes, muscles or joints, it is difficult to process it. The goal of vestibular rehabilitation is to correct problems in the inner ear, or create a treatment program for you that will help the brain re-establish the coordination between your inner ears, eyes, muscles and joints. 

Contact us with any questions you may have - we are here to help!