Deborah Howell (Host): As we age, we all become more prone to falling. Welcome, I'm Deborah Howell, and in this episode of Weekly Dose of Wellness, Mitchell Tsurudome, a Physical Therapist at Memorial Care Orange Coast Medical Center Outpatient Rehabilitation, discusses common vestibular issues, such as dizziness, vertigo, and balance disorders, which can increase the risk of falls, especially in older adults.

He'll highlight the specialized balance and vestibular rehabilitation program at Memorial Care Orange Coast Medical Center and tell us how expert evaluation and tailored therapy can help patients regain stability, improve mobility, and enhance their overall quality of life.

Welcome Mitchell.

Mitchell Tsurudome, PT: Thank you very much for having me. 

Host: We're really, really delighted you're here with us. Jumping right in, what you do is so important for our beloved seniors and for those with vestibular dysfunction. Can you start off by explaining what the vestibular system is and how it affects balance and spatial awareness?

Mitchell Tsurudome, PT: Yes, the vestibular system is basically our balance center. And more specifically, there are small sensors located in the deep aspects of each ear that can precisely detect head movements and positions, including if we were to turn our head or body, if we were to move forward or backwards, bending down, getting up from lying down.

So these sensors communicate or send these signals to our brain, our body, and our eyes to make the necessary adjustments to maintain balance and provide a sense of equilibrium. 

Host: What are some of the most common symptoms of vestibular dysfunction, and when should someone seek medical attention? 

Mitchell Tsurudome, PT: Those with vestibular dysfunction can experience impairments or symptoms, including imbalance or unsteadiness. So you may feel as if your balance is not so good, or you don't feel quite steady on your feet. Some may have had a loss of balance and fell or has had a history of falls. Another symptom is vertigo.

This is defined as the perception as if you were spinning or the room is spinning around you. Fortunately, in most cases, these episodes of vertigo are short lived, maybe just a few seconds, but it could be very intense and frightful. Vestibular dysfunction can also cause dizziness. This shouldn't be confused with vertigo, which is the spinning sensation.

Dizziness is often described as feeling off, not themselves. It could be a fogginess or feeling faint and lightheaded. You can feel as if you're being pulled in one direction or another and along with this one could feel unsteady if they're on your feet. So in each of these cases whether it's imbalance, vertigo, or dizziness, regardless of the intensity level; one must inform your doctor because while the vestibular system can be involved, there are other major medical issues that must be cleared or examined and at the same time if the vestibular system is involved, we know that there are treatments or exercises that can be implemented. 

Host: Sure, that's great advice. What are the primary causes of vestibular disorders, and how do conditions like stroke, concussions, and aging contribute to balance problems? 

Mitchell Tsurudome, PT: There can be many causes of dizziness or vertigo including reactions to medications, heart issues, blood pressure issues, blood sugar issues. Less common would be actually stroke or brain tumors. Other factors could be stress or anxiety, alcohol or drug use, lack of sleep, or even migraines. But when it specifically involves the vestibular system, the most common dysfunction is a condition called benign paroxysmal positional vertigo, or BPPV for short.

This is where, small calcium crystals in our inner ear become dislodged, causing short episodes of vertigo of varying intensities. They can occur with lying down, turning in bed, or rising from lying down positions. Fortunately, these are easily diagnosed and treatable. Other causes could be ear infections, adverse reactions from medications, or some antibiotics.

And another common condition involving the vestibular system is the aging process. The vestibular system, those sensors in our ears can naturally deteriorate over time. Balance and mobility will decline. The elderly population is much more likely to lose balance and suffer a fall. 

Host: So, how can vestibular issues, such as dizziness and vertigo, affect a person's ability to perform daily activities or increase their risk of falling? 

Mitchell Tsurudome, PT: Yeah, imbalance or vertigo or dizziness can directly impact your risk for falls. The vestibular system fails to function properly. It cannot provide the information to maintain stability. Balance reactions are impaired, and we can't make the adjustments to stay on our feet. This can contribute to a fear of falling, decreased confidence, and increased dependence on others.

You have a difficulty with fundamental activities of daily living, work obligations and social activities are limited and frightful, and not to mention, suffering a fall can be devastating in itself. 

Host: Sure. So, let's take this closer to home. What makes the Balance and Vestibular Rehabilitation program at Orange Coast Medical Center unique in treating vestibular disorders?

Mitchell Tsurudome, PT: I was fortunate to have Orange Coast Medical Center allow me to take a competency course and receive specialized training in vestibular rehabilitation, as we felt there was a need to provide this service to our patients and our community. I've used this knowledge and experience to provide a well informed and enthusiastic approach to their condition, not just on a technical level, but on an emotional level as well.

I see how debilitating and emotionally upsetting it can be living with these impairments and symptoms. And I provide a one on one session providing a personalized program specific to their condition and intensity, with high sensitivity to their concerns and fears. 

Host: That's wonderful. I mean, that's what each person would really, really want in that situation, to not just be grouped into, here's how we treat everybody, but here's how we need to treat you specifically.

Mitchell Tsurudome, PT: Absolutely. 

Host: So what does a typical vestibular rehabilitation therapy session look like, and how is treatment customized for each patient? 

Mitchell Tsurudome, PT: First, it's important to get a good complete history. I find that it's often difficult to put their experience into words and become descriptive, but it's my job to guide them and to listen to them. From there, we need to conduct a few tests, so it might be examining reactive eye movements based on looking at objects or changing head position, or other tests include getting an objective assessment of balance based on certain conditions.

For instance, balance with your eyes closed or stepping up onto a curb. Bending down and picking something up from the floor, walking and turning your head at the same time. From there, we'll determine a possible cause or suggest the diagnosis. And finally, a treatment plan is implemented that we may include balance or repeated motion exercises, vision stability exercises, we call it gaze stabilization, or it could be through a series of body and head maneuvers to treat BPPV, the issues with those loose inner ear crystals. 

Host: Interesting. Now, since falling is such a concern for older adults, what proactive steps can individuals take to reduce their risk of falls and maintain stability? 

Mitchell Tsurudome, PT: It's important to inform your doctor to rule out potentially major issues. You should not have to live with imbalance, dizziness, or vertigo. And your doctor can refer physical therapy for balance and dizziness, including our Balance and Vestibular Rehabilitation Program. Strength and fitness training is important.

You are four times more likely to suffer a fall due to muscle weakness. Balance classes at your local gym, community center, or senior center are very valuable. Tai chi is also shown that it could be a nearly a 50 percent reduction in falls, vitamin D and calcium supplementation accounted for nearly a 50 percent reduction in falls.

And of course, use of an assistive device like a cane or a walker may be necessary.

Host: All good things. And I think most retirement villages these days have these kind of programs built into their centers. So for listeners who may be struggling with dizziness or balance problems, how can they get in touch with your team? 

Mitchell Tsurudome, PT: We are located of course, at Orange Coast Medical Center, 8111 Brookhurst Street, Suite 2,400 in Fountain Valley. Our phone number is (714) 378-5095.  

Host: Thank you so much, Mitchell, for your time and your expertise today. We really enjoyed having you on the show.

Mitchell Tsurudome, PT: Thank you very much. Thank you for having me.

Host: Our pleasure. And for more info or to listen to a podcast of this show, please visit MemorialCare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.