27 April 2015

Vestibular Hypofunction

Remember how much fun it was to twirl around the living room as a child? Without a care in the world, you'd spin and spin until you were dizzy - and maybe even fall down, laughing. As an adult, those same sensations are anything but fun. In fact, they may indicate a problem with the part of your brain responsible for movement and balance.

"Dizziness and related complaints of lightheadedness, unsteadiness and vertigo are some of the most common reasons people visit their doctors," says Deb Skansberg, PT, a physical therapist with Park Nicollet Clinic-Burnsville. "In many cases, these sensations are caused by conditions affecting the vestibular system, which is located in the inner ear and controls the sense of balance."

Therapy depends on the cause

Primary care doctors often refer patients who have balance disorders to vestibular rehabilitation therapists. Before therapists can treat the condition, they must evaluate for possible causes. To do so, they assess many things, including patients' balance and tolerance to changes in position.

"We have the greatest success when patients are able to identify specific positions or movements that trigger their symptoms, because it helps us pinpoint the underlying condition," Skansberg says. In some cases, therapists also watch for reflexive eye movement, which can indicate certain vestibular conditions. Most imbalance disorders are caused by one of the following.

Benign paroxysmal positional vertigo (BPPV) occurs when certain head movements cause dizziness. The vertigo sensation typically lasts about 30 seconds, and often is triggered when people roll over in bed or move to an upright position after bending over or tilting their head back.

"BPPV is caused when crystals in the inner ear become displaced and send incorrect signals to the brain, creating a whirling sensation or loss of balance," explains Skansberg. "In most cases, this condition is easy to correct with physical therapy. We simply move the head and body through a series of positions, which repositions the crystals so they can no longer cause symptoms." About 85 percent of BPPV patients improve after one or two visits. For the other 15 percent, exercises may help retrain their brains to become less responsive to dizziness.

Vestibular hypofunction can result after an inner ear infection, trauma or other causes. It often creates imbalance and blurred vision when changing focus or making quick head movements. "We teach people to perform certain exercises to help improve their gaze stability, become less responsive to dizziness and to better interpret messages from muscles and joints," Skansberg says.

Aging frequently causes a decrease in vestibular function, physical strength and coordination, and makes it more difficult to interpret visual cues and information received from muscles and joints. All these conditions can contribute to balance disorders. Vestibular therapists can help older adults by improving strength and range of motion, and by helping retrain their brains to process information in new ways. "When safety is a concern, we encourage people to use a cane or a walker," Skansberg says.

Primary care doctors typically refer patients for vestibular rehabilitation as their first line of defense. "In most cases, we are able to help improve people's symptoms and balance problems. But, when needed, we work with audiologists and ENTs who further test and assess the patients' vestibular system," Skansberg says.

In addition to the Burnsville location, Park Nicollet offers vestibular rehabilitation at these Park Nicollet Clinic locations: Golden Valley, Hopkins, Maple Grove and St. Louis Park, and at Park Nicollet Methodist Hospital. This makes it convenient for most people in the Twin Cities area to receive care.