Sunday, December 16th, 2018

Dizziness? Headaches? Vestibular rehab helps

Posted: Wednesday, November 21, 2018

At some point in their lives, millions of Americans will experience dizziness, disorientation, balance issues or even unexplained nausea.

The culprit will likely be the vestibular system, a group of small organs also known as the inner ear. The inner ear helps the brain assess movement and spatial orientation, and when it malfunctions, it can make a person feel really lousy. Symptoms such as headaches, dizziness and nausea can make it hard to function, and can even lead to fall injuries.

Parkview Huntington Hospital’s (PHH) Rehab and Wellness Center offers relief in the form of vestibular therapy. A combination of positioning maneuvers and simple exercises can help patients regain normal function, or become accustomed to functioning differently if nerve damage has occurred.

Now, a quick anatomy lesson: The vestibular system consists of the semi-circular canals and the cochlea. The semi-circular canals are interconnected tubes filled with fluid that contains tiny crystals. As a person moves, the crystals move in the fluid and stimulate minute “hairs,” which sense the movement. The cochlea converts sound vibrations into nerve impulses that are also received by the brain.

“These ear structures convert sensory input into your sense of how you move, and where you are positioned in space,” says PHH physical therapist Molly Sittler. “For instance, I sense that I’m bent over, or I’m moving forward, or my head is turning. Being delicate, these structures can be easily upset, and the crystals inside the semi-circular canals can get displaced and accumulate in one spot. So the semi-circular canal is constantly getting input, being told, ‘We’re moving, we’ve moving,’ but actually, the head is still. This disconnect between what the brain perceives and what the body is doing is what triggers dizziness and other symptoms.”

Sittler, who has an interest in neurological issues as a physical therapist, earned her certification this summer to provide vestibular therapy. She explains that a variety of causes can make the vestibular system go haywire.

Vertigo, or BPPV (benign paroxysmal positional vertigo), can result from a head trauma, or even from something as simple as having a raging head cold and lying in the same position for a number of days. Concussion can cause a misalignment between the input the brain receives from the eyes and the input from the inner ear. Labyrinthitis is an inflammation of the inner-ear organs that is similar to an ear infection and can persist even after medication. Ménière’s disease, a chronic inner-ear disorder, can manifest in episodic bouts of dizziness, tinnitus (a roaring or ringing), severe nausea, and hearing loss that recurs and then clears up but can ultimately become permanent, and a feeling of pain or pressure in the ear.

These conditions can affect people ranging in age from their teens to their 80s.

“After a stroke, some people can have difficulty with regaining balance, and that can be because of the damage to the nerves,” says Sittler. “We work on balance and creating a ‘new normal.’ After a stroke, someone may not even know they’re dizzy; they just know they’re having a hard time transferring. For instance, their body may be sitting up, but their brain is receiving input to indicate something different, and they don’t understand why they don’t feel right. It doesn’t have to be that way. We can help.”

Motion sickness that doesn’t resolve can also cause dizziness.

“Sometimes people think you can’t do anything about motion sickness, but that again, is a lack of coordination between brain and head position, or between brain and vision, that causes the symptoms,” says Sittler. “We can give the patient exercises to coordinate that better and get the brain to either increase its sensory reception or not to be as aware of the images going by.”

For BPPV or labrynthitis, treatment consists of a repositioning maneuver, to coax the displaced inner-ear crystals back into their normal location. Sittler says many patients can experience improvement from their symptoms after one to two treatments. She cautions that patients should be aware that temporary severe nausea can occur immediately after the maneuver.

“When we get the crystals repositioned, it’s a lot of sensory input, so sometimes a patient might be down for the rest of the day,” she says. “We suggest they just lie low and take it easy for 24 to 48 hours. But it really can be one- to two-time fix.”

Patients who have chronic and recurring inner-ear issues can be taught a modified version of the repositioning maneuver so they can do it at home for faster relief the next time they have a recurrence.

“In other cases, we use exercises for coordination and habituation of the brain,” Sittler explains, “so we’re teaching the vestibular system and the eyes to coordinate better, and to a point, we’re also teaching the brain to be less sensitive, not to take in everything the person is seeing."

The exercises start off very basic, such as keeping your head steady and moving your eyes only to look back and forth 30 times between two objects. Then the therapist builds on that by adding different combinations of staying still or moving and shifting your focus between two points. Through repetition and increasing the amount of time the exercises are done, a patient can build stamina, but Sittler advises that the progression be slow. Dizziness and eye fatigue is natural at the beginning.

Sittler says that, as a therapist, she has to be a bit of an investigator, too, asking questions and observing each patient so she can accurately determine the cause of the symptoms and provide the appropriate treatment or suggested follow-up with a specialist. Patients should allow one hour for the evaluation at the first appointment. Most insurance will cover the therapy partially or completely when the patient is referred for vestibular therapy by a physician.

“Our goal is to help patients get back to their normal routine, or something approaching that, as quickly and comfortably as possible,” says Sittler.

For more information, call (260) 355-3240.

Shown in the photo is Molly Sittler, physical therapist, Parkview Huntington Hospital Rehab and Wellness Center as she performs a repositioning maneuver on a patient as part of vestibular therapy for inner-ear issues.