Summer Challenges for Vestibular Patients

By Sheelah Woodhouse, P.T., BScPT National Director of Vestibular Rehabilitation for LifeMark & Centric Health | Certified Vestibular Therapist | President, Vestibular Disorders Association

Summertime, and the Living is Not So Easy... If You Have a Vestibular Disorder

Summertime conjures up images of getting outside, traveling, going to social gatherings, having a few drinks on the patio. This all sounds great to most people but if you have a vestibular disorder, there are a lot of elements in these activities that can be a real challenge and can make symptoms worse.

Dizziness Symptoms and the Great Outdoors

First of all, let's look at getting into the great outdoors. Those with vestibular problems can't use the information from their inner ear(s) about balance and orientation as well as they used to. Therefore, they are typically more dependent on the position information they get from their feet and ankles than the rest of us. Walking on surfaces that are not hard and flat spells trouble (!), so walking on the soft grass, sand, or unpaved trails can create unsteadiness and fear of falling.

Balance Challenges on a Plane or Boat

How about travelling? Being on a plane or boat can also be very challenging for those with vestibular problems, again because the information they are getting from the muscles and joints in their bodies is no longer the same as what they get when on solid ground.  These forms of travel also create a mismatch in the balance system because the things on the boat or plane that you are looking at suggest that you are stationary because they are moving the same as you, yet your body and your inner ears sense that there is in fact some motion taking place.  Usually the inner ear/vestibular system would step in to sort out this conflict, but if that isn’t working properly, people can start to feel quite disoriented and unwell.  Looking out of the plane or boat rather than at items inside can be helpful so that your eyes can see that there is some movement taking place, and then can agree with your body and inner ears.

Vestibular Disorders and Visual Cues

Well then let’s just drive to the lake.  Driving in a car can create the same scenario as above, especially if sitting in the back seat which makes you more likely to be looking at things inside the car than outside.   Just like being more dependent on reliable cues from the ground, those with vestibular disorders are also more dependent on the information about orientation that they get from vision.  When that is the case, people can get quite stirred up by visual stimulation: the sunlight flickering through the trees, the motion of other vehicles around them, all the scenery going by.  And once you get to the lake, even just watching the movement of the water can be quite disorienting and disturbing.

OK well then let’s just stay home and visit with friends and family.  Sounds promising, but at social gatherings where there is the visual stimulation of people milling about, a lot of standing instead of sitting, head turning as you talk to this person and that, this can be a provoking option as well.  Add in spongy flip-flops or those great strappy shoes with a bit of a heel, and a few drinks, and those with vestibular disorders often don’t do well here either.

Education, Pacing, Strategic Choices and Appropriate Treatment all Help Vestibular Disorders

All is not lost!  With education, pacing, strategic choices and appropriate treatment, those with vestibular disorders can reduce and manage their symptoms and enjoy life!  See: http://vestibular.org/living-vestibular-disorder/everyday-challenges#travel   for tips.  Hopefully the scenarios described above can help those without these disorders appreciate the hidden challenges that those with vestibular problems are trying to work around, and offer their understanding and assistance.

Contact us at lifemarkvestibular.ca - we can help!

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.

Why Vestibular Rehab?

How Many People Experience Dizziness?

Dizziness is among the top three reasons why people see their doctors, and vestibular disorders can affect people of any age. Approximately 35% of Americans over age 40 have experienced a vestibular disorder.

80% of people over age 65 have experienced dizziness, and Benign Paroxysmal Positional Vertigo (BPPV) - when crystals get displaced into the semicircular canals - is responsible for at least 50% of dizziness in seniors. BPPV is also the most common vestibular disorder, and fortunately, the most straight-forward to treat.

People who go untreated for their dizziness problems may risk experiencing depression, anxiety and a higher chance of falling. In addition, if it's hard to get out of bed or move around without feeling dizzy, there is also a risk of becoming less physically active or not active at all.

Untreated dizziness problems can lead to isolation

Effects of Dizziness

Dizziness can lead to:

• increased fear of falling or increased risk of falling
• less mobility, which leads to isolation and deconditioning
• anxiety and depression
• increased memory and concentration issues
• less likelihood of experiencing positive outcomes in other areas of treatment

Sometimes people who are experiencing dizziness may adopt new ways of moving to try and avoid the feeling of dizziness or whirling. They might move very slowly or swivel their whole body instead of their head in order to look at something, or look down at the ground all of the time to try to get their bearings. But these patterns can give people headaches and muscle tension, and just tire them out that much more. Research shows that avoiding the sensation of dizziness at all costs, actually slows down recovery.

Vestibular Rehab is an Exercise-Based Approach

Vestibular rehabilitation therapy is an exercise-based approach that retrains the brain to process coordinated information from the vestibular system, proprioception, and vision.

Research shows that Vestibular Rehabilitation is:

• applicable to anyone of any age
• effective regardless of how long a person has had the dysfunction
• has no reports of adverse effects

If you are dizzy or experiencing vertigo, please contact us for more information.