Dizziness can be described as an assortment of symptoms from feeling woozy after a ride or light-headed with standing up quickly, to a sensation of being unstable or feeling faint. Some people, however, suffer with a more severe and specific type of dizziness called vertigo, a medical term describing a symptom of perceiving (falsely) the movement (whirling, spinning, or rotating) of the environment. The cause of this debilitating condition is sometimes difficult to delineate. Fortunately, in majority of cases a specific cause can be identified allowing for proper management. Proper diagnosis and management of vestibular dysfunctions requires an interdisciplinary approach.

Dr. Varveris, DPT is a specialist in vestibular rehabilitation who works closely with local ENT’s and neurologists for the most effective management of symptoms related to various vestibular disorders. Dr. Varveris is also a member of The American Institute of Balance (www.dizzy.com) and the Vestibular Disorders Association (www.vestibular.com)

What is the vestibular system?

For most humans walking on different terrain, getting up from a chair, getting out of bed in the middle of the night, crossing a busy intersection, or stepping off a curb seem second nature. For individuals suffering from an impaired balance, however, these activities not only pose a great challenge they may become life threatening.

The vestibular system along with the visual and proprioceptive systems is responsible for maintaining ones balance, spatial orientation and body awareness. The vestibular system, housed in the inner ear, provides information to the brain regarding motion, spatial orientation, and equilibrium. Linear motion is detected by the utricle and saccule while angular or rotational movements are detected by the three semicircular canals in each one of our two (left and right) vestibular apparatus. Both the left and right vestibular systems send proper impulses to the brain when both organs are functioning properly. Any disease or condition, which results in a damage to one or both vestibular organs, therefore, may not only affect how one feels, but also the ability to perform activities of daily living. The types and severity of symptoms associated with a vestibular disorder may vary, however the most common symptoms include:

• Vertigo and dizziness
• Motion sickness
• Nausea and vomiting
• Imbalance and spatial disorientation
• Hearing changes
• Blurred vision and visual disturbances
• Headaches
• Cognitive or psychological changes

What causes dizziness and vertigo?

Dizziness is referred to any sensation of lightheadedness, faintness, or unsteadiness while vertigo is any "sensation" or "perception" of movement, spinning, rotating of self or the environment when non is occurring. Dizziness and vertigo can be a result of either a central vestibular disorder (involving the central nervous system) or a peripheral vestibular disorder (involving the vestibular organ or the vestibular nerve). Many medical conditions (low blood pressure, aneurysms, atherosclerosis, defective heart valve, severe degenerative arthritis, embolisms, heart attack, vasovagal syndrome), medications, and environmental factors can cause dizziness. It is therefore important to seek medical help form your physician. Vertigo lasting for days or a few seconds is most often an indication of a vestibular dysfunction such as:

• Benign Paroxysmal Positional Vertigo (BPPV)- the most common cause of vertigo
• Acoustic Neuroma
• Autoimmune Inner Ear Disease
• Labyrinthitis and Vestibular Neuritis
• Meniere's Disease
• Mal de Debarquement
• Migraine Associated Vertigo
• Ototoxicity
• Perilymph Fistula
• Superior Semicircular Canal Dehiscence
• Secondary Endolymphatic Hydrops
• Cervicogenic Dizziness

How is vestibular disorders diagnosed?

Physicians and Physical therapists trained in vestibular rehabilitation use the patient's medical history, signs and symptoms along with a thorough vestibular system examination to determine the root cause of a patient's vertigo, imbalance and unsteadiness. Sometimes, additional diagnostics such as MRI, Electro/Video-Nystagmography (ENG or VNG), Rotary Chair tests, Video Head impulse tests (VHIT), Vestibular Evoked Myogenic Potential (VEMP), Computerized Dynamic Posturography (CDP), and Audiometry tests are required for proper diagnoses. Generally primary care physicians, neurologists, or ENTs will refer a patient to an audiologist, physical therapist and radiologists for further testing.

How can physical therapy help vertigo, imbalance and dizziness?

Physical therapists who specialize in vestibular rehabilitation therapy (VRT) have received extra training in the differential diagnosis and management of individuals suffering from various vestibular disorders. VRT is used to address the symptoms caused by the vestibular disorder. VRT utilizes specific exercises to alleviate and minimize vertigo and dizziness, visual disturbances (gaze instability), and falls and imbalance due to vestibular dysfunctions. Although some vestibular disorders may cause permanent damage to the vestibular system, VRT can help individuals feel better and regain the highest level of function through compensation. The primary goal of VRT is to design specific exercises based on a comprehensive physical therapy evaluation that will address specific problems.

Does PhysioNetics treat vertigo and vestibular disorders?

At PhysioNetics, Dr. Varveris, DPT has completed extra training in vestibular rehabilitation through the American Institute of Balance (AIB) and the American Physical Therapy Association (APTA). She is an AIB certified provider and has earned her certificate of achievement in Cervicogenic Dizziness, as well as completing the Vestibular Rehabilitation Competency Course at Emory University. She offers comprehensive evaluation along with physical therapy treatment and management of symptoms related to various vestibular dysfunctions. She is proficient in the diagnosis of BPPV and vestibular hypofunctions. The team at PhysioNetics will establish specific exercises to help with habituation, gaze stabilization and balance training depending on the specific vestibular deficits and needs of the individual identified in the evaluation. Dr. Varveris works closely with local ENT and neurologists to provide the most accurate treatment in order to achieve the individual's highest functional status.

Common exercises include:

• Gaze stabilization
• Habituation
• Balance training and substitution

In addition to these exercises, the team at PhysioNetics utilizes the AlterG Antigravity treadmill for safe and effective dynamic balance training. For severe cases of Ataxia, the clinic uses the BlanceWear postural control and stabilizing balance vest. Dr. Varveris is one of the few physical therapists in Florida certified to assess patients for BalanceWear products. Dr. Varveris and her team also perform Canalith Repositioning Procedures (CRT) for the treatment of BPPV based on which semicircular canal is involved. Although CRT can eliminate vertigo caused by BPPV in as little as one treatment, individuals with BPPV have a 30% higher chance of recurrence. PhysioNetics will give you the tools necessary to manage your condition if they reappear.

Fall Prevention

Most of us have experienced a fall or two during our childhood without any real thought given to the consequences of such falls. After all, falling is an inevitable part of our developmental process and children tend to bounce right back up! The same cannot be said about falls occurring later in life. About one out of three people over the age of 65 will report a fall each year with 20-30% sustaining serious injuries leading to more than 700,000 hospitalizations! Falls not only diminish ones ability to lead an active life, they may significantly impact the individuals independence.

In fact, 90% of hip fractures occur during a fall and according to the data from the Centers for Disease Control (CDC), 25% of individuals sustaining a hip fracture from a fall will die within a year. Although we are all at risk for falls, potential decrease in our sensory, motor, and cognitive skills that accompany the aging process, influence the balance thus further increase the risk for falls. Other factors increasing this risk may include joint stiffness, inner ear problems, medications, environmental conditions, and various medical conditions.

On the bright side, research has shown that an individual can reduce their risk for falls with the appropriate fall prevention care. Consulting with your primary care physician and setting up a fall prevention evaluation with your physical therapist has proven beneficial.

At PhysioNetics our comprehensive fall prevention care starts with the assessment of motor, sensory and vestibular function, postural control, joint range of motion and flexibility, and static and dynamic functional mobility. Results of the assessment are used in establishing a program tailored to your deficits and needs. Advanced technology such as the Alter-G Antigravity Treadmill and Motion Therapeutics Balance Wear are one of many tools utilized at PhysioNetics in the management of individuals at risk for falls. We believe it's never too early to begin a proactive fall prevention program. Starting now may prevent the "trip" you really didn't want to take!

For more information about the American Institute of Balance click here

For more information about the Vestibular Disorders Association click here.