Balance Assessment & Treatment

Vertigo, dizziness, wooziness, unsteadiness, off-balance, nausea, and motion-sickness are all symptoms or terms that may be associated with a vestibular, or inner ear, disorder. Dizziness or loss of balance is the second most common complaint heard in doctors’ offices.

There are many causes for dizziness, but a large percentage is caused
from inner ear disorders. The good news is, often times, dizziness caused by inner ear disorders can be helped. However, in order to determine the proper course of treatment for individuals with balance problems, we must first determine the cause of the dizziness.

Electronystagmography (ENG) testing is used for evaluation of balance problems. The information obtained from the ENG may help in determining how your inner ear balance system is working.  For the test, electrodes will be placed next to each eye in order to monitor your eye movements throughout the test.  The test is broken down into three major components.

1. Ocularmotor: The patient is asked to watch a moving target on a light bar.
2. Positionals: This portion involves the patient moving into different positions.
3. Calorics:  The patient will have cool and warm air directed into his/her ears, which directly stimulates the balance mechanism and elicits a sensation of floating or spinning. This sensation dissipates shortly after the testing is stopped.

50% of dizziness in older people is due to Benign Paroxysmal Positioning Vertigo (BPPV).

BPPV is caused by debris that has collected within the inner ear. This debris, called otoconia, is made up of small crystals of calcium carbonate that are responsible for relaying head movement information to the brain. With BPPV the displaced otoconia shift, sending false signals to the brain which is perceived as spinning.

Symptoms of BPPV are almost always precipitated by a change in head position. Getting out of bed, rolling over, and looking are are common problem motions. Some people feel dizzy and unsteady when they tip their heads back to look up. The spinning usually lasts only a few seconds, but can actually wake a person up at night or can occur with other head movements and cause brief periods of imbalance.

Treatment

The form of treatment prescribed for vestibular disorders depends upon symptoms, medical history and general health, diagnostic test results, and physical examination.

Treatment can include:

• Vestibular rehabilitation therapy (physical therapy or VRT)
• Canalith repositioning maneuvers (e.g., the Epley maneuver)
• A change in activity levels
• Medication
• Dietary adjustments
• Talk therapy
• Surgery
• Treatment for any underlying disease that may be contributing to the balance disorder.

Vestibular Rehabilitation Therapy is designed to retrain the brain to recognize and process signals from the vestibular system in coordination with information from vision and proprioception.

Often, with balance problems, the brain cannot rely on the information it receives from the vestibular system and a person’s ability to maintain posture and coordinate balance can become overly dependent on vision or on the information received from the muscles and joints (proprioception). This leads to developing new patterns of movement or avoidance of movement all together.

Rehabilitation therapy often involves desensitizing the balance system to movements that provoke symptoms. The therapy plan is developed on a case-by-case basis after a complete evaluation. Some of the exercise and activities may cause an increase in symptoms, as the body and brain attempt to sort out the new pattern of movements. But with time and consistent work, the coordination signals from the eyes, proprioception, and vestibular system will occur.

Canalith Repositioning Maneuvers are used to treat patients with BPPV. The goal is to move the displaced otoconia out of the semicircular canals so that they don’t send false signals to the brain.

These maneuvers involve a series of specifically patterned head and trunk movements while closely watching eye movements with each position change. Movement and sleeping restrictions are required immediately following the treatment.