Balance rehabilitation assists individuals with loss of balance, dizziness, spinning (vertigo), nausea/vomiting associated with movement and frequent falls. A thorough evaluation of the vestibular and neuromuscular system including strength, range of motion, head and eye movements, mobility, coordination and balance improves patients' functionality and mobility and reduces their risk of falls.
In this segment, Lisa Yonkers, Physical Therapist at Meritus Health, describes how an evaluation by a highly skilled vestibular physical therapist can lead to a treatment program that can increase quality of life for those that suffer from dizziness and benign positional vertigo.
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Dizziness, Vertigo, and Balance Disorders
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Learn more about Lisa Yonkers, PT
Lisa Yonkers, PT
Lisa Yonkers, PT earned her degree from the University of Medicine and Dentistry of New Jersey and Kean University, in Union, NJ. Her special interests are in vestibular balance disorders and dizziness.Learn more about Lisa Yonkers, PT
Transcription:
Dizziness, Vertigo, and Balance Disorders
Melanie Cole (Host): Have you ever had the feeling that you’re spinning or that everything around you is spinning? You may have benign positional vertigo or dizziness or balance issues, and that can affect so many aspects of the quality of your life. My guest today is Lisa Yonkers. She’s a vestibular physical therapist with Meritus Health. Welcome to the show, Lisa. In your expert opinion, do you see a lot of people with various dizzy kinds of episodes – vertigo episodes, balance issues?
Lisa Yonkers (Guest): Yes, actually, we do treat many patients with those disorders, both positional vertigo, which is a separate problem from other vestibular dysfunctions, which will also cause dizziness and lightheadedness.
Melanie: People freak out, they get dizzy, or they have a vertigo problem, or they have a balance issue, and right away they think the worst and they go through maybe even a battery of tests to make sure that there’s not something – God-forbid – going on in there. It might be just this vestibular issue. What are they? What is causing this?
Lisa: Right, in fact, a lot of our patients will be seen in the Emergency Room before they get to us thinking that they’re having a heart attack or a stroke or something like that. When we’re talking about positional vertigo, BPPV, it really is a problem of the inner ear where these – most doctors will call them crystals, sometimes we’ll call it debris – they look like, if you magnify them, they look like little, tiny boulders that sit in our inner ear. They’re really supposed to be there. They detect gravity for our body, but if you bump your head, or if you’ve had a lot of dental work, or sometimes we don’t know why they become loose, they can start to float in the semicircular canals of the inner ear, so when a person goes to look up or if they roll in bed, or do any of these kinds of positional changes, right away they will experience usually a pretty violent -- often violent vertigo, room spinning, nausea. They may even vomit with the symptoms.
Melanie: So then how is it diagnosed? How do we know that that’s what’s going on?
Lisa: We do have a test that’s pretty spot-on for detecting BPPV. It’s really a positional test where we take the patient, turn their head, and put them back in a position where that semicircular canal is going to be really tilted, and it’s going to cause those particles or crystals to flow. If they’re stuck in there, the person, right away, will experience positive symptoms of the room really spinning on them or nauseousness and dizziness. We’ll usually know right away. Also, they’ll have a, what we call, nystagmus in the eyes. We can look at the eyes, and they’ll have a beating of their eyes, which we’ll know that they are positive for the positional vertigo.
Melanie: Do people sometimes have syncope or faint when they have these vertigo episodes?
Lisa: There are a couple of people who, once in awhile, will feel like they’re – they’ll usually say, “I feel like I’m going to black out.” Typically, blacking out or passing out is not a part of positional vertigo, although we do find that when people are experiencing this, they also have a pretty increased, high-level of anxiety, so then some symptoms of anxiety, like a panic attack, might occur when they’re experiencing these symptoms and that may give them the feeling that they’re going to pass out.
Melanie: So what are some treatments? If somebody comes to you and they’ve got this benign positional vertigo, or they suffer from dizziness or balance disorders, what can you do for them as a vestibular physical therapist?
Lisa: The treatment that we use to treat the positional vertigo is something called the canalith repositioning maneuver. What we’re doing is we are putting the patient in what we call that provoking position. We’re putting them in that position where those particles are going to move through that semi-circular canal and what it’s going to do is it’s going to bring on their symptoms. Then we put them in other various positions so that we’re working those particles out of that semi-circular canal so by the time we sit them back up; those particles should be draining out of that semi-circular canal and going back into another part of the inner ear where they’re supposed to be. Usually, one to two treatments and the patient is symptom-free.
Melanie: Wow. Are there some things you like them to do at home? Because recreating that dizziness in a sense and what you do with them can sometimes be a little bit intimidating for someone to do at home.
Lisa: Right, so typically, what we do, we’ll do the maneuver here at our clinic and then we send them home with some home instructions, which are very specific. We’ll have them sleeping elevated for the first night, and then for the next three days, they’re not allowed to lay on that affected side because we don’t want those particles to go back into the semi-circular canal once we’ve cleared them. We like to give them a three-day window of trying to protect that so that they’re not coming back to us with symptoms the next week. Those are usually the home instructions, sleeping up a little bit elevated, not sleeping on that side for three days, and then usually when we retest them the next week most people are negative.
Melanie: What about medicational intervention? Are there any medications that can help people with this balance and dizziness?
Lisa: Now, for the positional vertigo, doctors will typically prescribe either what they call Antivert or meclizine. Both of those drugs are what we call a vestibular suppressant. I always tell patients the medication is going to make you feel better. It’s going to suppress your inner ear so that when you move around you don’t get as dizzy or as nauseous. The only problem with that is it could skew, or it could hide some symptoms that we need to see in therapy in order to help the patient and also, it doesn’t do anything to take care of the problem, it’s just masking it. We do try to have patients wean off that, the sooner, the better. I will always tell patients if you absolutely need it, if the symptoms are horrible, by all means, go ahead and take it, but we like to see them eventually wean off that.
Melanie: And what about certain exercises that they can do for balance? People hear about balance training and if somebody is suffering a balance disorder, or they get dizzy, or they get the vertigo, are there some exercises that you like to tell people they can do to help work on their balance and functional fitness?
Lisa: Right, this is where it gets a little tricky because symptoms of dizziness and vertigo get all intertwined with the words that doctors use. BPPV, which I just described, that’s a very particular treatment. If a patient comes in and they’re just lightheaded, dizzy, a little off balance when they’re moving around, sometimes they can have what we call a vestibular dysfunction, which is more – there might be an inflammatory process going on in their inner ear. It kind of makes them just feel a little off, so a lot of times what we’ll do with those patients is we’ll work on a lot of head-turning exercises because that’s something that, all of a sudden, they start moving like a robot. They don’t want to turn their head. We encourage a lot of head movement. We’ll do a lot of visual exercises because the eyes are actually hooked into our inner ear system as well -- they kind of work together -- plus a lot of strengthening and balance exercises.
Melanie: And what do you tell them about driving because that’s something – people turn their heads to look and if they’re somebody that suffers from this type of vertigo; that alone can signal an episode. What do you tell them about being careful and watching for some of those triggers?
Lisa: Right, oddly enough, for the patients who have positional vertigo, they usually are the ones who don’t typically have problems driving. They can get in their car and drive, and the usually don’t have an issue. It’s more our vestibular dysfunction people. They’re the ones that when they turn their head, they might have a little bit of blurred vision, or dizziness and lightheadedness. A lot of patients will choose on their own not to drive for a few weeks while the symptoms are a little more increased. Typically, we’ll say as they’re feeling more comfortable with moving around, get in the car, go into a parking lot with a family member, see what it feels like to get behind the wheel and turn the head again and make sure you’re comfortable before you get back out on the road.
Melanie: Wrap it up for us then, Lisa, with some of your best advice for people that suffer benign positional vertigo, or dizziness or balance disorders and what you want them to know and why they should come to Meritus Health for their care?
Lisa: Yep, sure. We’ve been treating this for a long, long time here at Meritus. We probably started treating these types of disorders since 1992; we have a great success rate – certainly, if you are suffering from positional vertigo we can take care of those symptoms in one to two sessions most of the time. If you’re someone who’s just having more generalized dizziness and lightheadedness, there are a battery of exercises that we can put you through to help get your system more in sync, having your eyes and your inner ear working together to start to reduce those symptoms. Usually, that’s a little bit of a longer rehab process – I would say four to eight weeks compared to the one to two sessions with the positional vertigo.
Melanie: Thank you, so much. That’s really great information and so important for people to hear. You’re listening to Your Health Matters with Meritus Health, and for more information, you can go to MeritusHealth.com, that’s MeritusHealth.com. This is Melanie Cole. Thanks, so much for listening.
Dizziness, Vertigo, and Balance Disorders
Melanie Cole (Host): Have you ever had the feeling that you’re spinning or that everything around you is spinning? You may have benign positional vertigo or dizziness or balance issues, and that can affect so many aspects of the quality of your life. My guest today is Lisa Yonkers. She’s a vestibular physical therapist with Meritus Health. Welcome to the show, Lisa. In your expert opinion, do you see a lot of people with various dizzy kinds of episodes – vertigo episodes, balance issues?
Lisa Yonkers (Guest): Yes, actually, we do treat many patients with those disorders, both positional vertigo, which is a separate problem from other vestibular dysfunctions, which will also cause dizziness and lightheadedness.
Melanie: People freak out, they get dizzy, or they have a vertigo problem, or they have a balance issue, and right away they think the worst and they go through maybe even a battery of tests to make sure that there’s not something – God-forbid – going on in there. It might be just this vestibular issue. What are they? What is causing this?
Lisa: Right, in fact, a lot of our patients will be seen in the Emergency Room before they get to us thinking that they’re having a heart attack or a stroke or something like that. When we’re talking about positional vertigo, BPPV, it really is a problem of the inner ear where these – most doctors will call them crystals, sometimes we’ll call it debris – they look like, if you magnify them, they look like little, tiny boulders that sit in our inner ear. They’re really supposed to be there. They detect gravity for our body, but if you bump your head, or if you’ve had a lot of dental work, or sometimes we don’t know why they become loose, they can start to float in the semicircular canals of the inner ear, so when a person goes to look up or if they roll in bed, or do any of these kinds of positional changes, right away they will experience usually a pretty violent -- often violent vertigo, room spinning, nausea. They may even vomit with the symptoms.
Melanie: So then how is it diagnosed? How do we know that that’s what’s going on?
Lisa: We do have a test that’s pretty spot-on for detecting BPPV. It’s really a positional test where we take the patient, turn their head, and put them back in a position where that semicircular canal is going to be really tilted, and it’s going to cause those particles or crystals to flow. If they’re stuck in there, the person, right away, will experience positive symptoms of the room really spinning on them or nauseousness and dizziness. We’ll usually know right away. Also, they’ll have a, what we call, nystagmus in the eyes. We can look at the eyes, and they’ll have a beating of their eyes, which we’ll know that they are positive for the positional vertigo.
Melanie: Do people sometimes have syncope or faint when they have these vertigo episodes?
Lisa: There are a couple of people who, once in awhile, will feel like they’re – they’ll usually say, “I feel like I’m going to black out.” Typically, blacking out or passing out is not a part of positional vertigo, although we do find that when people are experiencing this, they also have a pretty increased, high-level of anxiety, so then some symptoms of anxiety, like a panic attack, might occur when they’re experiencing these symptoms and that may give them the feeling that they’re going to pass out.
Melanie: So what are some treatments? If somebody comes to you and they’ve got this benign positional vertigo, or they suffer from dizziness or balance disorders, what can you do for them as a vestibular physical therapist?
Lisa: The treatment that we use to treat the positional vertigo is something called the canalith repositioning maneuver. What we’re doing is we are putting the patient in what we call that provoking position. We’re putting them in that position where those particles are going to move through that semi-circular canal and what it’s going to do is it’s going to bring on their symptoms. Then we put them in other various positions so that we’re working those particles out of that semi-circular canal so by the time we sit them back up; those particles should be draining out of that semi-circular canal and going back into another part of the inner ear where they’re supposed to be. Usually, one to two treatments and the patient is symptom-free.
Melanie: Wow. Are there some things you like them to do at home? Because recreating that dizziness in a sense and what you do with them can sometimes be a little bit intimidating for someone to do at home.
Lisa: Right, so typically, what we do, we’ll do the maneuver here at our clinic and then we send them home with some home instructions, which are very specific. We’ll have them sleeping elevated for the first night, and then for the next three days, they’re not allowed to lay on that affected side because we don’t want those particles to go back into the semi-circular canal once we’ve cleared them. We like to give them a three-day window of trying to protect that so that they’re not coming back to us with symptoms the next week. Those are usually the home instructions, sleeping up a little bit elevated, not sleeping on that side for three days, and then usually when we retest them the next week most people are negative.
Melanie: What about medicational intervention? Are there any medications that can help people with this balance and dizziness?
Lisa: Now, for the positional vertigo, doctors will typically prescribe either what they call Antivert or meclizine. Both of those drugs are what we call a vestibular suppressant. I always tell patients the medication is going to make you feel better. It’s going to suppress your inner ear so that when you move around you don’t get as dizzy or as nauseous. The only problem with that is it could skew, or it could hide some symptoms that we need to see in therapy in order to help the patient and also, it doesn’t do anything to take care of the problem, it’s just masking it. We do try to have patients wean off that, the sooner, the better. I will always tell patients if you absolutely need it, if the symptoms are horrible, by all means, go ahead and take it, but we like to see them eventually wean off that.
Melanie: And what about certain exercises that they can do for balance? People hear about balance training and if somebody is suffering a balance disorder, or they get dizzy, or they get the vertigo, are there some exercises that you like to tell people they can do to help work on their balance and functional fitness?
Lisa: Right, this is where it gets a little tricky because symptoms of dizziness and vertigo get all intertwined with the words that doctors use. BPPV, which I just described, that’s a very particular treatment. If a patient comes in and they’re just lightheaded, dizzy, a little off balance when they’re moving around, sometimes they can have what we call a vestibular dysfunction, which is more – there might be an inflammatory process going on in their inner ear. It kind of makes them just feel a little off, so a lot of times what we’ll do with those patients is we’ll work on a lot of head-turning exercises because that’s something that, all of a sudden, they start moving like a robot. They don’t want to turn their head. We encourage a lot of head movement. We’ll do a lot of visual exercises because the eyes are actually hooked into our inner ear system as well -- they kind of work together -- plus a lot of strengthening and balance exercises.
Melanie: And what do you tell them about driving because that’s something – people turn their heads to look and if they’re somebody that suffers from this type of vertigo; that alone can signal an episode. What do you tell them about being careful and watching for some of those triggers?
Lisa: Right, oddly enough, for the patients who have positional vertigo, they usually are the ones who don’t typically have problems driving. They can get in their car and drive, and the usually don’t have an issue. It’s more our vestibular dysfunction people. They’re the ones that when they turn their head, they might have a little bit of blurred vision, or dizziness and lightheadedness. A lot of patients will choose on their own not to drive for a few weeks while the symptoms are a little more increased. Typically, we’ll say as they’re feeling more comfortable with moving around, get in the car, go into a parking lot with a family member, see what it feels like to get behind the wheel and turn the head again and make sure you’re comfortable before you get back out on the road.
Melanie: Wrap it up for us then, Lisa, with some of your best advice for people that suffer benign positional vertigo, or dizziness or balance disorders and what you want them to know and why they should come to Meritus Health for their care?
Lisa: Yep, sure. We’ve been treating this for a long, long time here at Meritus. We probably started treating these types of disorders since 1992; we have a great success rate – certainly, if you are suffering from positional vertigo we can take care of those symptoms in one to two sessions most of the time. If you’re someone who’s just having more generalized dizziness and lightheadedness, there are a battery of exercises that we can put you through to help get your system more in sync, having your eyes and your inner ear working together to start to reduce those symptoms. Usually, that’s a little bit of a longer rehab process – I would say four to eight weeks compared to the one to two sessions with the positional vertigo.
Melanie: Thank you, so much. That’s really great information and so important for people to hear. You’re listening to Your Health Matters with Meritus Health, and for more information, you can go to MeritusHealth.com, that’s MeritusHealth.com. This is Melanie Cole. Thanks, so much for listening.