The vestibular system is a tiny and complex organ situated in the inner ear. It is responsible for communicating with our brain to control our eye movements and maintain our balance as we move. A vestibular disorder or dysfunction occurs when there is damage to this structure, the brain, and/or its communicating pathways as a result of a wide array of conditions.
The most common symptoms of a vestibular disorder are vertigo (spinning sensation, the false sensation of movement of oneself or the environment), dizziness (lightheadedness, floating sensation), and disequilibrium (imbalance, unsteadiness, spatial disorientation, clumsiness). Other symptoms may include: nausea, motion sensitivity/sickness, fullness/pressure in the ears, tinnitus (ringing, whooshing, or other noise in the ears), hearing loss, headaches, difficulty focusing the eyes, sensitivity to lights and/or noise, sensitivity to pressure and temperature changes, discomfort in busy, visually stimulating environments (i.e. crowds, traffic, grocery store), difficulty concentrating, fatigue, anxiety, and depression.
While our vestibular system is known as our balance center, it does not work alone. Our vision and our somatosensory system – input from receptors in our skin (touch) and muscles and joints (position sense) – also send information to our brain, which contributes to our ability to maintain our balance. Our brain sorts and integrates all the information it receives from these three systems and we are able to keep ourselves upright, stable, and oriented to our environment. Damage or dysfunction to any one or combination of these systems will result in a balance impairment.
It has been estimated that nearly 35% of adults in the United States over the age of 40 (about 69 million Americans) have at some point suffered from vestibular dysfunction. In those 65 years of age and older, it is reported that 80% experience dizziness and one in every three experience a fall each year. Falls are the number one cause of both fatal and nonfatal injuries in this age group. Many people with balance issues, especially those who have experienced a fall, acquire a fear of falling. As a result, they tend to limit their mobility, which not only decreases their quality of life, but also actually increases their risk for falls.
While vestibular disorders are not life threatening, they are certainly life altering. Having a vestibular disorder can have a huge impact on a person’s life, effecting even the simplest of daily activities. Vestibular therapy is an effective and evidenced-based treatment designed to alleviate symptoms associated with vestibular dysfunction.
EVALUATION
The initial evaluation will consist of a detailed review of your medical history and present symptoms, and a thorough assessment to identify all impairments that may be contributing to those symptoms which may include: assessments of your eye movements (with and without video goggles), balance, gait, coordination, muscle strength, joint range of motion, sensation, motion sensitivity, fall risk, neck exam, and positional testing for BPPV (Benign Paroxysmal Positional Vertigo – one of the most common vestibular conditions).
TREATMENT
Vestibular rehabilitation involves specialized exercises designed to promote the brain to better recognize and process signals from the vestibular system, and to more effectively integrate those signals with those from our vision and somatosensory systems. The treatment plan is individualized based upon findings during the initial assessments. Therapy may include any or all of the following: exercises involving eye and head movement, balance, gait, motion/positional activities, general conditioning, strengthening, stretching, manual therapy techniques, and canalith repositioning techniques (modified Epley Maneuvers for treatment of BPPV).
Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009;169(10): 938-944. – See more at: http://vestibular.org/understanding-vestibular-disorder#sthash.7GbOKCde.dpuf
Ator GA. Vertigo—Evaluation and Treatment in the Elderly. – See more at: http://vestibular.org/understanding-vestibular-disorder#sthash.7GbOKCde.dpuf
Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 15, 2013.
Tromp AM, Pluijm SMF, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001;54(8):837–844.
Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Aging 1997;26:189–193.