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.

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!

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.

Why Am I Dizzy?

Spinning, Dizziness or Falling Can Mean the Complex System That Looks After Our Balance Isn't Working Properly

Dizziness can be caused by the balance organs of the inner not working properly

Our bodies have a complex system to look after our balance that includes the inner ear, brain, vision, muscles and joints. If any part of this system isn't functioning, the result can be a feeling of spinning, dizziness or falling. Many adults feel dizzy, and there can be many possible reasons, but one of the more common culprits is that the balance organs of the inner aren't working properly, or that some parts of the central nervous system that process information about balance aren't working properly.

The word 'dizziness' means different things to different people. People using that word may be trying to describe vertigo (spinning), feeling faint or light-headed, disequilibrium (loss of balance) or unsteadiness, falling, nausea, a sense of exaggerated motion or just feeling "off". The better you are able to describe what you mean by 'dizziness', the easier it is for your medical provider to try to diagnose what is going on.

Vertigo Usually Indicates a Problem with the Function of the Inner Ear

According to the Vestibular Disorders Association (VEDA), if you have vertigo (a sense of spinning or whirling), especially when you tilt or move your head around, that is likely a sign of a problem with the function of your inner ear. On the other hand, dizziness can mean that there is a different type of vestibular problem or other issues such as vision, metabolism, neurological, psychological or cardiovascular. Since there are so many different types of dizziness and possible disorders that dizziness can be a result of, it is sometimes challenging for medical professionals to diagnose, and difficult and frustrating for patients until help is found.

Many things can be the cause of dizziness, from ear infections or trauma to an ear, to Meniere's Disease, to medications, to age-related degeneration, to central processing issues such as a stroke, to migraine-associated vertigo, to cardiovascular problems, to the neck, among other causes.

Assessment is Crucial in Finding the Cause of Dizziness and Vertigo

The assessment stage of vestibular treatment is crucial in trying to find the cause of dizziness and vertigo. At LifeMark Dizziness & Balance Program, we take a thorough medical history first and screen for neurological problems. Our vestibular assessment includes vestibular-ocular reflex testing, or testing of the integration between the inner ear and the eye muscle to see if you can focus clearly while your head is in motion. It also includes many tests using an infrared camera in blackout goggles to check for nystagmus, which is an involuntary eye movement associated with vestibular problems. We also evaluate your sensitivity to specific movements and positions, your balance, and the possibility that other areas are contributing to your symptoms like your feet or neck.

Contact us with your questions!