Dizziness and Motion Sensitivity

Motion Sensitivity Testing in a Vestibular Rehabilitation Assessment

Finding the movements that make you dizzy helps vestibular rehab professionals to tailor your exercise program

How Do We Measure Dizziness?

Dizziness is very subjective, making it difficult to measure.   In an attempt to quantify it and to be able to record improvement over time, one of the things often done in a Vestibular Rehabilitation assessment is called Motion Sensitivity Testing.  This involves a series of movements or position changes, where a person rates their dizziness after the movement on a 0-5 scale, and we compare that to the person’s baseline rating prior to the movement.  We also measure the length of time it takes to return to baseline after each movement.  These numbers can be calculated into a final Motion Sensitivity Quotient, and tracked over time. The movements are just one at a time, with a rest after each one to allow your symptoms to settle back down, so most people tolerate the testing well.  If too provoking, we would just modify the test or wait until later for testing when your dizziness is not so strong.

Finding the movements that make you mildly or moderately dizzy helps us to tailor a vestibular rehabilitation exercise program to your individual needs, as the brain needs to be exposed to these types of movements in order to be able to compensate for a vestibular imbalance.  With controlled exposure to the movements that make you dizzy, the brain can begin to habituate so that the movement becomes less and less bothersome.  Reduction in the intensity and/or duration of your motion-provoked symptoms is a good indicator that your vestibular rehabilitation exercises are helping you improve.

Should You Avoid the Motions That Make You Dizzy?

Research shows that avoiding exposure to the movements that trigger the error signals and make you dizzy actually delays recovery. The brain needs to see these mismatched signals in order to come up with strategies to adapt and compensate.  The mismatched vestibular signals may still be there, but in most cases the brain can make adjustments so that you don’t feel the symptoms anymore through a process called Habituation.

Feel free to contact us – we are here to help you!

Diagnosing Vestibular Problems

What Do We Test for in a Clinical Evaluation of Dizziness?

Before going into actual vestibular tests, it is important that Vestibular Rehabilitation Therapists take a thorough history and perform some safety checks to make sure that your dizziness is not potentially due to something that should be looked after by a Doctor.

When we ask about your history, we will want to know things like:

• When your symptoms started;
• Whether they were insidious ("out of the blue") or related to an incident or illness;
• If there were other symptoms than just dizziness, i.e. nausea/vomiting, hearing changes, vision changes, headache, numbness/"pins and needles", unsteadiness;
• The nature of your initial and current dizziness, i.e. lightheadedness, disorientation, feeling "off", "room spinning";
• The duration of your initial and current symptoms: seconds, minutes, hours, days;
• What increases or decreases your symptoms, if anything;
• Other medical conditions you are dealing with, medications, previous experiences with dizziness and family history.

Safety Checks in Initial Dizziness Screening Help to Identify any Medical Concerns

The safety checks we perform in our initial screening include:

1. Checking the mobility of your neck, and, if there has been trauma or rheumatoid arthritis, stability of the ligaments in the upper part of the neck;
2. Checking if certain neck positions produce signs or symptoms suggesting compromise of the blood flow through the neck to the head;
3. Performing tests to see if some of the control centers in your brain (cranial nerves and cerebellum) appear to be working properly;
4. If indicated by your history, blood pressure testing including a comparison between lying down and standing.

If there are concerns from your history or the testing above that your Doctor is not aware of and has not investigated, we would refer you back to your Doctor for further testing. In some instances we would put further testing and treatment on hold until your Doctor has seen you, and in other cases, we can proceed while you are awaiting further work-up by your Doctor.

Feel free to contact us – we are here to help you!

Why It Is So Important to Treat Dizziness

Dizziness and Doctor Visits

Dizziness is one of the top three reasons that people see their doctors.  A full 80% of people over age 65 have experienced dizziness and as many as 35% of Americans over the age of 40 have experienced a vestibular disorder.   BPPV  is the most common of all vestibular disorders and the most common cause of vertigo, or a ‘spinning’ sensation.

Dizziness and Seniors

Despite it being increasingly present as we age, BPPV frequently goes unrecognized, especially in seniors where dizziness is often assumed to be related to other health issues.  “Patients with unrecognized BPPV were more likely to have reduced activities of daily living scores, to have sustained a fall in the previous 3 months, and to have depression. These data indicate that unrecognized BPPV is common within the elderly population and has associated morbidity.”  [Oghalai JS1, et al. Unrecognized benign paroxysmal positional vertigo in elderly patients.  Otolaryngol Head Neck Surg. 2000 May;122(5):630-4.]

Dizziness and Injury

 Dizziness and unsteadiness are also very common complaints following whiplash disorder or concussion, and their presence is related to a longer recovery.  Vestibular involvement is often overlooked in post-concussion care.  The most current research and consensus statements suggest that combining vestibular rehabilitation and multimodal physiotherapy may optimize outcomes in those with persistent symptoms of dizziness, neck pain &/or headaches (McCrory et al 2013). 

Dizziness and Return to Work

According to a 2005 study conducted by Chamelian et al, dizziness is a negative predictor of return to work success. 

Seek Help!

Intervention is very important to avoid the downward spiral that can occur if dizziness disorders are not addressed. Some of the effects of untreated dizziness are:

• Falling, or fear of falling
• Decreased activities
• Depression and anxiety
• Memory and concentration issues
• Fatigue

It is extremely important to seek medical advice from a doctor knowledgeable in vestibular disorders or a vestibular rehabilitation specialist to treat dizziness and recover from any vestibular deficits that may be occurring.

Contact us to find a vestibular specialist near you.

How We Help BPPV in Older Adults

BPPV a Common Cause of Dizziness in Seniors

BPPV happens when loose crystals (otoconia) fall out into one of the canals

One of the most common causes of dizziness in seniors is Benign Paroxysmal Positional Vertigo, or BPPV.  This happens when calcium carbonate crystals (otoconia), that we all have in one part of the inner ear, become displaced into one or more of the inner ear’s semicircular canals. When otoconia move into one of the inner ear’s semicircular canals where they aren’t supposed to be, that canal sends different information to the brain about certain head movement than the other ear.  Both ears should be saying the same thing about what our head movements are, and they should be agreeing with what our eyes are seeing and our joints are feeling.  When there is a mismatch in these systems, it makes us feel dizzy.  BPPV is the most common cause of vertigo, which is an illusion of the room spinning or moving.

What Happens in the Inner Ear When the Room Starts Spinning?

Taking apart what's really happening to a BPPV patients as they experience vertigo can help patients to feel less frightened by it. The start of the problem often happens at night when a person is laying down.  Loose crystals can fall out into one of the canals, and when the person gets up in the morning these crystals are trapped out in the canal.  From that point forward any time the person moves their head into a position where gravity moves the loose crystals, that canal sends a message to the brain that is an error.  The most commonly provoking movements are getting in or out of bed, rolling over in bed, bending, looking upward and quick head movements.

Because of the connections between our inner ears and our eye muscles, during the time the crystals are moving, the incorrect signal makes our eyes move in a way that makes it appear like the room is spinning.  In the most common form of BPPV, the spinning only lasts until the crystals stop moving because they’ve reached the lowest point in the canal, which takes less than 1 minute.  If things are spinning longer than 1 minute, it is either a rarer form of BPPV called cupulolithiasis, or it is a condition other than BPPV.  A well-trained Vestibular Rehabilitation Therapist, ideally using special goggles allowing for a magnified look at your eye movements, can help you determine whether or not you have BPPV, and if so, what form you’ve got and what canal the loose crystals have moved into.  This then determines the treatment maneuver that should be used.

How We Treat Bening Paroxysmal Positional Vertigo (BPPV)

To help sufferers of BPPV a vestibular rehabilitation professional uses techniques to locate the crystals that are out of place and employs maneuvers to reposition them back to the correct chamber with the help of gravity.  Typically after 1-3 visits peoples’ BPPV is corrected.   Sometimes people have some mild sensitivity to motion and/or some balance issues that persist after the BPPV is cleared, but these are typically easily remedied with some simple home exercises.

If you or anyone you know is experiencing dizziness or imbalance, feel free to contact us – we are here to help you!

5 Symptoms of Vestibular Disorders

Changes to Parts of the Inner Ear and Brain Controlling Balance Can Cause a Vestibular Disorder

Problems with balance and spatial orientation can include difficulty walking straight or turning a corner

According to the Vestibular Disorders Association if the vestibular system gets damaged or altered, a vestibular disorder can result. The vestibular system includes the parts of the inner ear and brain that control eye movements, perception of head movement and balance. Therefore, problems in any of these areas or pathways can create dizziness, unsteadiness or visual issues.

Besides dizziness or vertigo, five of the most common symptoms of a vestibular disorder are:

1. Imbalance or falling
2. A rocking sensation
3. A sense of exaggerated or "after-motion" when you move
4. Nausea or vomiting
5. Visually provoked dizziness (see below), or blurry/'jumpy' vision during head movement

Problems with balance and spatial orientation can include a tendency to touch or hold onto something when standing, difficulty maintaining straight posture, clumsiness or stumbling, and difficulty walking straight or turning a corner.

With visually provoked dizziness, there can be sensitivity to light or certain types of computer monitors, poor depth perception, trouble reading or watching TV, and discomfort in busy visual environments like crowds, traffic, or stores.

Some people with an inner ear disorder can experience these as well as other symptoms, and an inner ear disorder can even be present without any obvious symptoms at all. It is important to seek professional help and get a vestibular assessment if you are experiencing any of the issues noted above.

Contact us - we are here to help!

Academy of Otolaryngology Position Statement on Vestibular Rehabilitation

Vestibular Rehabilitation recommended as a beneficial treatment for dizziness and balance disorders

Vestibular Rehab Recognized as a Valid and Beneficial Intervention for Individuals with Dizziness and Disequilibrium

We wanted to let our readers know that leaders in the field of inner ear disorders have reaffirmed their recommendation of Vestibular Rehabilitation as a beneficial treatment for dizziness and balance disorders. BPPV is the cause of approximately 50% of dizziness in older adults ^[1].

Recently at the Academy of Otolaryngology – Head and Neck Surgery’s 2013 Annual Meeting, the American Academy of Otolaryngology revised a position statement regarding Vestibular Rehabilitation. Their position now states that:

 “Vestibular Rehabilitation, or Balance Retraining Therapy, is a scientifically based and clinically valid therapeutic modality for the treatment of persistent dizziness and postural instability due to incomplete compensation after peripheral vestibular or central nervous system injury.”

“Vestibular Rehabilitation is a valid form of therapy for dizziness and imbalance resulting from the medical or surgical treatment of vertigo disorders and for acute vertigo or persistent imbalance that may result from a variety of peripheral vestibular disorders.”

“Balance Retraining Therapy is also of significant benefit for fall prevention in the elderly patient who may suffer from multiple sensory and motor impairments or for those who have sensory disruption with moving visual information.”

Many sufferers of dizziness, vertigo and imbalance have benefitted from Vestibular Rehabilitation, and we know how important this treatment is to them. It is also a very positive sign when the work of Vestibular Rehabilitation professionals is declared clinically valid by the Ear, Nose and Throat medical community.

^[1] Fife TD et al. Practice parameter: therapies for BPPV (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurol. 2008;70:2067-2074.

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.