Dizziness (Vestibular) and Balance Disorders
Almost half of the adult population, in the United States reports episodes of dizziness, vertigo and balance problems to their doctors every year. Dizziness or imbalance is the second most common reason for visits to the doctor's office, second only to back problems. People in all age groups can experience episode of poor balance, dizziness and frequent falls.
The vestibular system, or balance system, is the sensory system that provides the dominant input about movement and our sense of balance. It is one of the physiological senses related to balance. Other senses play roles as well, for instance our visual system and proprioception. Fifty percent of community-dwelling adults who see their physician with symptoms of dizziness or vertigo have a problem somewhere in the vestibular system and 80% of those folks have inner ear or peripheral vestibular deficits. Between 33% and 50 % of the general elderly population fall at least once a year. As a result, they often become afraid to venture out of their own homes.
Everyone experiences dizziness differently. For many, dizziness is experienced as a sensation of lightheadedness or faintness. Many experience dizziness as the feeling of motion even if they are not moving. Others report a sensation of spinning in which they are moving or their environment is spinning around them (vertigo). Describing exactly what you experience when you feel dizzy will help your doctor determine the cause. Nausea and anxiety may also accompany your dizziness. Dizziness can occur along side other symptoms such as pressure or fullness in the head or ears and ringing in the ears (tinnitus). It is important to report these symptoms to your doctor.
Diagnosis Services
Who is at risk?
Patients with one of the following diagnosis can have balance and gait disorders.
- BPPV (Benign Paroxysmal Positional Vertigo)
- Peripheral or Central Vestibular Deficits
- Head Injury
- Brainstem or Cerebellar CVA
- Extrapyramidal Disorders
- Peripheral Neuropathy
Possible causes of these symptoms include:
- Inner ear infection and / or disease
- Stroke
- Sports Injury
- General muscle weakness or inflexibility
- Head injury as a result of falls, blows to the head or motor
vehicle accidents
The Vestibular and Balance Disorders Services offered at Braintree Rehabilitation Hospital uses both clinical expertise and the most advanced computerized technology to provide a complete evaluation, diagnosis and treatment recommendations for dizziness and balance disorders. The outcome of treatment can be specifically reevaluated using these devices. At present, the technology for diagnostic evaluation and rehabilitation are a computerized rotary chair system, dynamic posturography and static forceplate postural feedback rehabilitation device. We also offer Electronystagmography (ENG) through our Audiology Department.
Our team of professionals consists of:
- Otoneurologist
- Specialized Physical Therapists
- Vestibular Laboratory Technicians
The Vestibular and Balance Disorders Services are a regional diagnostic center providing specialized testing to help determine the cause of each person's symptoms. A network of community-based treatment centers carry out the prescribed therapy services.
You may also call our Vestibular Office directly at 781-348-2801
Locations for Vestibular Diagnostic Services
South Shore
Braintree
Computerized Devices Available
Dynamic Posturography (Equilibrium Platform Test)
This test will assess the components of your balance system in an upright position. Testing is performed on a machine, which has the ability to alter specific sensory inputs you use to maintain balance. You will be closely monitored during the evaluation in addition you will be fitted with a safety jacket to eliminate any risk of falling. Your task is to try to maintain balance throughout the process. Six test conditions will be performed using three 20-second trials for each. This test takes between 20 to 30 minutes.
Rotary Chair System
Vestibular Function Test
This test measures the vestibular-occular reflex. During head movements the vestibular system (located in the inner ear) sends signals to your occular (eye) muscles to stabilize your vision. This test will assess this reflex. You will be fitted with a headpiece that houses two small cameras to record eye movements. Afterwards, you will be seated in a chair within a six-foot enclosure. The chair will move slowly back and forth to stimulate the reflex while the mounted cameras record eye movements. The test is made up of 8 parts, the longest lasting 3 minutes. Breaks can be taken between tests as needed. The entire test time should not exceed 30 minutes.
Visual-Vestibular Integration Test
Test preparation is described above. Testing determines your ability to either enhance or suppress your vestibular reflex. During testing you will be instructed to follow certain targets with your eyes without the chair moving. Test time is 15 minutes.
Balance Master
Computerized Balance Training: This system uses forceplate technology to allow for objective measurement of the patient's center of mass/gravity and limits of stability. The patient utilizes visual biofeedback to help facilitate the development of static and dynamic balance skills.
Electronystagmography (ENG)
This three-part test assesses your balance system under varying conditions and is performed by an audiologist in our Audiology Department here at Braintree Hospital. Due to the interconnected nature of your vestibular (balance) system and your visual (occulomotor) reflex, measuring eye movement can provide important information with regard to balance system functioning. ENG detects and records rapid eye movements, called nystagmus, through the use of electrodes or goggles. The first part of the test involves following visual targets with your eyes. In the second part, eye movement is recorded as you lie in different positions. The final component of this test involves irrigating each ear with cool and warm air. By irrigating each ear separately, the balance mechanism on each side can be stimulated and measured independently.
Treatment Services: Physical Therapy
Although dizziness is a common symptom, living with this problem can significantly impact a person's lifestyle and function. Traditionally, dizziness has been treated with medication. Many balance problems, on the other hand, have been addressed with adaptive equipment such as straight canes or walkers. Today, a variety of new treatment opportunities exist for people with balance and dizziness disorders.
Balance is a multifactorial neurological function. Disorders of balance invariably involve several components of balance function. We identify the critical factors that are impaired in a balance disorder. Treatment is directed specifically toward the identified balance deficits and utilizes newly devised clinical protocols
Vestibular Physical Therapy utilizes specialized exercises to address specific areas of the individual's vestibular/balance disorder. The individual goals of vestibular rehabilitation vary, depending upon the type, cause and duration of vertigo/disequilibrium. Your physical therapist will work with you to develop a program to meet your specific needs.
Locations for Physical Therapy Treatment
Why Am I Dizzy?
Although there are many causes of dizziness, for 85% of the people who experience this symptom, the problem is due to changes in the "Vestibular System." The Vestibular system is the part of the inner ear that helps to control balance and body orientation. Your vertigo may be due to a mechanical problem in the inner ear. Dizziness may also be related to a loss of balance control. Balance control also comes from input from the eyes, muscles and joints. When you have an inner ear disorder, your brain cannot rely on the information received from your Vestibular system. As a result, your body becomes dependent on your systems, such as vision and your muscles and joints to maintain steady balance.
Lifestyle Changes
You have probably already adjusted the way you carry out your daily activities to prevent an increase in your symptoms. For example, by limiting head movements, you may have found that you don't get dizzy. Or, you may feel more secure walking if you stay close to the wall or hold on to furniture. All of these changes, which may seem helpful, are actually very stressful to your system and will decrease your ability to adjust to your Vestibular problem.
What Is Vestibular Therapy?
Vestibular therapy is an exercise-based approach with an emphasis on teaching the body to compensate for inner ear deficits. With therapy, patients ultimately experience a decrease in dizziness, improved balance function and an overall increase in activity level.
Secondary symptoms of decreased range-of-motion and strength (especially in the neck and shoulder region of the body) often leads to headaches and increased muscle tension. Physical therapy also alleviates these symptoms.
What Happens During Vestibular Therapy?
A thorough evaluation will be done at your first therapy appointment. Your physical therapist will carefully assess your dizziness balance control, strength, flexibility, walking and safety during certain functional activities. A specific program will be designed for you, based on your individual needs. This may include specific head positioning maneuvers to decrease symptoms of vertigo, and / or balance retraining exercises to be performed both with your physical therapist and at home. You will also be provided with educational information to help you become more aware of the correct ways to move and maintain your balance. With time and consistent work, therapy will teach you how to gain control of your balance system and, in a majority of cases, dramatically reduce your symptoms of dizziness, vertigo and nausea.
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