Recently, I wrote an article about Labyrinthitis, and mentioned that with this type of inner ear problem, when it affects only one ear, the expectation is for full functional recovery. I received some feedback from some frustrated readers who had this problem but did not recover. They felt that I made it seem like everyone gets 100% better, and they were living proof that this is not always the case!
My training tells me that when a patient is not making progress as expected, it is time to stop and reassess what is going on, and why?
First off, could something have been missed? If so, this is the time to readjust the treatment plan to address the issue. If nothing was missed, then why is the patient not improving?
Here is a list of potential reasons that I have seen with patients over the years:
1. The patient is doing their exercises, but they are not doing the exercises correctly.
2. The patient is not compliant with their home exercises. They know how to do the exercises, but for whatever reason they are not doing the exercises, or not doing them as frequently as they were prescribed.
3. The patient is avoiding exercises that cause dizziness or nausea, and therefore the brain cannot learn how to adjust and recover.
4. The patient has many other health problems that are compounding their problem, and causing them not to fully recover.
5. The patient has memory and cognition problems, and has no social support network to help bridge the gap and assist them with their home exercise program.
6. The patient’s exercise program does not address all of the patient’s issues.
7. The patient has not been given the right exercises, or the right exercise progression.
If you are not improving with your vestibular therapy, it’s time to talk to your therapist. I can tell you, the therapist wants you to get better! Sometimes a good review will allow the patient to get back on track with their recovery.
If recovery is not occurring as expected based on your diagnosis, then you need to go to another professional for a second opinion.
Artwork: Reflection, a pastel by Odilon Redon
VOR stands for the Vestibular Ocular Reflex. This is basically the coordination that one has between head and eye movements. The way it works is this: when a person is moving their head, the ears send information to the brain to tell the brain how the head is moving. The brain then uses this information to coordinate the eye movements so that the person can stabilize their gaze on an object even though their head is in motion. We do this all the time! For instance, if I am talking to someone, and nodding my head yes or no, then I am using my VOR.
When a person has a weakness in one ear following an inner ear infection, for example, the brain that was used to getting the same amount of information from each ear, realizes that the information from the two ears is no longer balanced. The affected side is not sending the same amount of information as the healthy ear anymore. Initially, this can cause dizziness, nausea, and imbalance. To avoid these symptoms, patients will often avoid head motions. While this may seem logical at first, to continue avoiding head motions only makes the problem worse. You see, the brain needs to learn the difference that now exists between the two ears, and the only way the brain can do this is by experiencing the movement! The brain won’t learn how to recalibrate itself if the person continues to avoid moving their head. By doing the VOR exercise, we force the brain to pay attention to the inner ear information when the head is moving, because the brain must in order to coordinate the eye motions and allow the person to keep their eyes fixed on the target without the target looking blurry, double, or as if it is jumping around…
Initially, this exercise may cause dizziness, or increase the person’s baseline dizziness. The patient should first do this exercise at a slow speed, and for a short duration (30 seconds). That way if the exercise causes dizziness, the dizziness should dissipate in a few minutes after stopping the exercise. With practice, the exercise will no longer cause dizziness or nausea. Once this happens, then we work on increasing the duration of the exercise little by little until eventually they can do it for 2 minutes and feel fine afterwards. At that point, we work on increasing the speed of the head motion, so that the brain learns how to process faster and faster head motions, and not feel dizzy. After that, we move on to other variations. You see, there is a progression to the exercise, and a vestibular specialist will be able to teach you how to do the exercise correctly, and guide you in your journey toward recovery.
Man with His Head Full of Clouds- Painting by Salvador Dali, 1936
This is the time of year when one can reflect on our lives and the things we want to improve on for the upcoming year. Why not make it your goal to improve your balance? One way to decide if your balance needs improving is by having your balance tested. Balance testing can be high tech, or low tech. The low tech testing is something that you could do at home, without fancy equipment, and it is based on a physical performance test. In other words, we ask a patient to perform a balance skill, and then see if they can do it or not. A person with good balance, and no history of inner ear pathology or neurological problems should be able to do the test.
One such test is called the Rhomberg Test. When I do this test with my balance therapy patients in Sarasota, Florida, I have the patient stand in a corner about 2 inches away from the wall, with a chair in front for safety. Then, I am standing by just in case. If you decide to try this test, have a friend or family member stand by to make sure you do not fall and get hurt.
The test is this- the person must stand with their feet together, with no space in between the feet. (If you are knock-kneed and cannot get your feet together, then put your knees as close together as you can). Next, you stand as still as you can, trying not to sway. The goal is to be able to do this for 30 seconds without falling, needing to open your eyes, take a step, or touch the wall or chair for support.
When standing with the eyes open, the person is using their vision, their inner ear system, and their somatosensory system to help them balance. Somatosensation is the sensation that allows your joints and muscles to send information to the brain to tell you if you are steady, or swaying. If a person cannot perform this test for 30 seconds, then they are at high risk for falling.
The second part of the Rhomberg Test is performed with the eyes closed. Again, the goal is to stand for 30 seconds. When the eyes are closed, the brain must rely on information from the inner ear, and feeling the ground in order to maintain balance. If a person falls in this test, they are reliant on their vision to maintain balance. This means that they would be at increased risk of falling if walking in a darkened setting, or on a complaint surface such as grass in the back yard when the sun is setting, for example.
How did you do with the testing? If the answer is “not so good”, make it your 2015 New Year’s Resolution to do something about it before you fall and get hurt. What should you do? Talk to your doctor about your balance, and find a physical therapist who specializes in treating inner ear balance problems. You could find a balance specialist in your area if you go to the Vestibular Disorders Association website. They allow you to search for a physical therapist in your area by entering your zip code. I believe you can achieve the goal of better balance in 2015! Happy New Year!
Painting: Planting the New Year’s Pine by Keisai Eisen, 1830s.
It’s that time a year for the annual trip to the Christmas tree lot. Last week I went with my family to find the perfect tree. We walked around and around each tree, trying to find the one that looked just right. We were tipping our head back to look at the top of the tree, and then looking down to examine the bottom of the tree, searching for the perfect shape and height… We looked at so many trees! When we got home, we had to tip our heads back when we reached overhead to pull the tree off the roof of the SUV. Then we carried the bulky, heavy, awkward tree into the house. Once the tree was set up, which was tricky on it’s own, we climbed up and down ladders putting the star on top, not to mention the lights and the ornaments! Then I had to get down on my hands and knees and crawl under the tree to pour a pitcher of water in the container for the tree to drink.
I couldn’t help but think of my balance therapy patients in Sarasota, Florida, and of my patients with positional vertigo (BPPV). I was praying that they weren’t doing the same thing I was doing, and that I wouldn’t come in to work on Monday morning to find out that someone had fallen and gotten hurt.
Can you imagine doing all these things if you had vertigo? When a person has Benign Paroxysmal Positional Vertigo (BPPV), bending the head down, or tipping the head back, can trigger a vertigo spell. It goes without saying, that if you are standing on a ladder and reaching overhead to hang something on a tree, you definitely don’t want the world to spin!
So this is a tip for those with holiday cheer and vertigo, let someone else do the ladders, and the reaching overhead and bending over! If you have positional vertigo, aim for the ornaments in the middle of the tree where you can keep your head level. This way you won’t have to worry about triggering the vertigo, and potentially falling and getting hurt during the holiday session. Or, if you live alone, you could get a smaller tree this year that is 3 feet tall, and place it on a small table so that you can decorate it without having to tip you head back or bend over too much…
And also, for those of you with balance problems and BPPV, give yourself the present you deserve, and go and see a trained vestibular specialist and get treated for your problem, so that you can enjoy all the festivities that this time of year brings, but without the vertigo or imbalance! That would be the best present of all!
BPPV is a condition of the inner ear where the crystals in the ear that are supposed to be sitting on top of the nerve fibers become dislodged and start floating in the semi circular canals. When this happens, it can trigger symptoms of vertigo (a spinning sensation), dizziness, or imbalance. Unlike other inner ear symptoms, vertigo caused by BPPV lasts seconds, not for extended minutes, hours or days.
Top 5 Motions that can trigger BPPV listed in no particular order:
1. Vertigo or dizziness when getting in or out of bed.
2. Vertigo or dizziness when rolling over in bed.
3. Vertigo or dizziness when tipping your head back to look overhead.
4. Vertigo or dizziness when bending over.
5. Vertigo or dizziness when moving your head or body quickly.
Motion, 1962 an Abstract Painting by Ernst Wilhelm Nay
Labyrinthitis is a condition that affects the inner ear hearing and balance system. It is caused by an infection to the inner ear that can result in temporary or permanent damage to the inner ear. Symptoms associated with labyrinthitis include complaints of severe and sudden vertigo, dizziness, nausea, imbalance, veering during ambulation, difficulty walking, and sensitivity to head motions. Patients who have had labyrinthitis may be sent to a physical therapist that specializes in treating inner ear problems. This therapy is sometimes referred to as Vestibular Rehabilitation. The therapist is sometimes referred to as a “vestibular therapist”. This therapy is very specialized. Vestibular therapists must go for specialized continuing education after completing their degree and obtaining their license, in order to become competent. My physical therapy practice in Sarasota, Florida specializes in treating people with vestibular inner ear problems.
When it comes to labyrinthitis, the good news is that it is not very common for a labyrinthitis to affect both ears. What does this mean for the brain? It means that the good ear is sending the full amount of information that it always did, but the bad ear is not. Testing by an audiologist can confirm how much information each ear is sending. Patients with labyrinthitis can lose up to 100% of their inner ear balance function, or just a portion. Testing for this is done with video nystagmography (VNG). For there to be considered a clinically significant difference in the two ears, one ear must show a reduced responsiveness to testing of at least 21% to 100%. Even if the bad ear is 100% damaged, with therapy the brain will adjust and learn to depend on the good ear, and whatever amount of information the affected ear is capable of sending. Once the brain recalibrates itself to this difference in information that it is receiving from each ear, the symptoms will stop. The patient will regain their balance, and no longer be dizzy, nauseated, or sensitive to movement. They will be able to turn their head quickly, turn quickly, bend over, walk and look to the side, and basically return to life as normal. For many people, this recovery happens on its own. As the person gets back to life as normal and resumes their normal activities, the brain gradually adjusts. That is why it is really important once you are over the worst of things that you start moving your head again, and become active! The patients that come to see me for physical therapy in Sarasota somehow were unable to make this transition on their own, and need a therapist to guide them in exercises and activities to help them recalibrate their balance system and get back to life as normal. In general, a person suffering from labyrinthitis should get completely better within 8-12 weeks of the proper therapy. If you are having these types of problems, please know that there are treatments that can help!
Clissa Turned Left with her Hand to her Ear, pastel portrait by Mary Cassatt, 1895.
Basically, our brain relies on sensory input that tells it where our body is in space. Then the brain deciphers this information, and tells the joints and muscles what to do to maintain balance.
Where does the brain get its sensory information from? The 3 main sets of information the brain relies on come from our eyes, our ears, and the joints and muscles.
1. The eyes provide visual feedback as to where we are in relationship to our environment. For instance, if I walk outside and have to cross a crooked sidewalk, I see what is coming and subconsciously my brain tells my legs what to do to adjust my steps and maintain my balance.
2. A second set of sensory information comes from the nerve endings in our muscles and joints that tells that brain how we are shifting our weight on our legs, and if we are standing or walking on something firm, or soft, or slanted. We call this proprioception.
3. A third set of information comes from our inner ear system, (we actually have two of these, one in each ear). The ears act like little gyroscopes to tell the brain if we are moving. They tell the brain how far, how fast, and in what plane of motion we are experiencing movement.
The brain takes this sensory information, and then tells the joints and muscles what to do to maintain balance.
If you understand this concept, then watching Nik Wallenda walk a couple weeks ago between the skyscrapers in Chicago, will be even more meaningful to you. As some of you may have figured out, Nik Wallenda and I both live in Sarasota, Florida. A friend said to me, “Hey, Nik Wallenda is practicing for his Chicago walk tonight at 6 pm, do you want to go watch and show our support?”. How could I say no to that?!!! After watching him practice, I knew he could do it, and I was able to watch the Discovery Channel to see his triumph.
Here are some pictures I took of him when he was practicing in Sarasota.
As you can see here, he is walking on the wire up an incline. He is using his vision, his proprioception (feeling the alignment of his body on the wire), and his inner ear system. You could even argue that he is using his hearing too, but that is a topic for another blog. His brain is getting this SENSORY information, and then tells his joints and muscles what to do to maintain balance and walk the wire. At every second, this system is analyzing and reanalyzing, and deciding what to do next. When walking with his eyes open, his vision and inner ear system are sending very reliable information on what is happening, and his proprioceptive system is also sending information, but it is more variable because the wire can move and be unpredictable.
In this picture, Nik is walking blindfolded. WHATTTT!!! He essentially deprived his brain of very reliable information, and now he only has the sensation from a wire that can move, and from his inner ear system. His inner ear system is sending the most reliable information in this condition.
Nik- blindfolded on his way to the tower. Doing what he does, walking the wire blindfolded, with only 2 sets of information for his brain to utilize is astounding. When watching the Discovery program that night, I remember his wife and mother saying that they were most worried about the blindfolded portion. When they said that, I thought to myself, me too!!! Now I hope you can understand from a physiological standpoint why this was so unbelievable. Hopefully one day, Nik will be a guest blogger on my blog, because his mission is to inspire people. I bought one on his signed posters that day to put in my office to help inspire my patients with balance problems. It says at the bottom, NEVER GIVE UP-DARE TO BE GREAT! Thanks, Nik Wallenda for all you give to others.
Time to check my messages…
In this self-portrait of Vincent van Gogh, we can look at it and see that he has his right ear bandaged, and without even knowing him, we can surmise that something is wrong with his ear. He has a bandage on his outer ear, and looking at the painting, one can has some empathy for him. But when a person has an inner ear disorder, there is no bandage one can wear that alerts others that we are having a problem. I think it is fair to say that Inner Ear Disorders are “invisible” to others. What do I mean by that? Well, if you had a broken arm, every one would see the cast on your arm, and they could relate to that. I you had a cold, or the flu, even without a bandage, others can understand that because they know what it feels like themselves to have this type of illness. But with inner ear disorders, for those friends and family members who have never had an inner ear balance problem, it can be hard to understand what if feels like to have vertigo, dizziness, or imbalance. Some patients tell me that they feel as though their family doesn’t understand their problem, because they don’t “look” sick.
For the person with the inner ear problem, this can add to their stress and sometimes cause added depression. Hang in there!!! If it is possible (and you want them to), having a spouse, grown child, or your best friend come with you to your doctor or physical therapy sessions can help that person better understand your condition, and in so doing, be better able to offer you the empathy, support, and understanding you could use. I have also had physical therapy patients in Sarasota, Florida who did not have this support network. They may live alone, or have no children or friends near by. This is not uncommon here, where many people come only for the winter months to escape the cold northern winters. Some of these individuals decided to take the bull by the horns, and go and see a psychologist who helped them learn better coping skills that they could apply on their own. I really admired these patients and their commitment to do whatever it takes to help themselves learn ways to better deal with their “invisible disease”. Whatever the case, don’t be afraid to ask those around you for help. We all need a helping hand at some point in our lives...
Painting by Vincent van Gogh, Self Portrait with Bandaged Ear, 1889
Sculpture by Alice Aycock entitled Hoop-La (2014), Park Avenue Paper Chase, Painted aluminum & steel
You would have to be a person who loves the inner ear, and knows what it looks like anatomically speaking, to see what I see. I was in NYC July 2014 for the Open Forum ENT Meeting. When exiting my hotel to walk to the conference, I had to cross Park Avenue. For those of you familiar with NYC, they usually have sculptures in the median where they feature a new artist every year.
This year, the artist was Alice Aycock. She created a series of huge sculptures made out of metal. This sculpture reminded me of the inner ear with the circular patterns on the bottom right being the cochlea for hearing, and the swirls on the top and left being the vestibular system and its semi-circular canals.
Here is an anatomical drawing of the inner ear system:
This drawing was taken from the NASA website for teachers and educators. Click here to check it out.
I don’t know what Alice Ayock’s inspiration was for this sculpture, but if you ask me, it’s an inner ear...The artist entitled this work Hoop-La, and if you are talking about the inner ear system, I understand what all the Hoop La is about... Do you?
If you are reading this blog right now, chances are you are an adult. But adults aren’t the only ones with inner ear balance problems! Children are also affected. For example, dizziness may be a sign of an inner ear problem, and it is estimated that up to 15% of children have dizziness at some point in their childhood. If the child has a hearing loss, that number can be as high as 50%! As adults, it may be hard for us to know if a child is having a balance or dizziness problem, especially if they are young and unable to express their feelings.
Lucky for us, there are doctors like Dr. Sharon L. Cushing from Sick Kids The Hospital for Sick Children in Toronto, Canada, who specializes in treating children with inner ear problems. Dr. Cushing and I recently connected at the American Academy of Otolaryngology Meeting last September 2014 in Orlando, Florida. Together, we decided to create this blog to help parents recognize the top 5 signs that their child may be having an inner ear balance problem. This way, parents are better able to help their children get the help they need...
TOP 5 SIGNS of INNER EAR BALANCE PROBLEMS in CHILDREN
1. Delayed Head Control (these children often get labeled as “Having a head that is too big for their body”) Delayed sitting (>9months) and delayed walking (> 18 months).
2. Unable to stand on one foot (a 2 1⁄2 year old should be able to do for 1 second, a 5 year old for 10 seconds).
3. Unable to ride a bike without training wheels.
4. Brief attacks where children stop what they are doing and cling to a parent or object (they may be experiencing vertigo but may not have the vocabulary to articulate it).
5. Jumpy eye movements – the eyes twitch back and forth (this is an entity called nystagmus).
If these symptoms sound like something your child is experiencing, I encourage you to go see an otologist (an Ear, Nose, and Throat doctor who specializes in the treating the inner ear). If you live in the Toronto area, you’re lucky, because help is just around the corner...
Painting: The Infant (The sick child) by Jean-Francois Millet 1858
This week, we are celebrating Balance Awareness Week at my physical therapy practice in Sarasota, Florida. In honor of this recognition, I am happy to share with you a new infographic from the Vestibular Disorders Association. Infographics are pictures boards that help to communicate a concept or idea. I hope this infographic helps you better understand what causes dizziness, and what to do about it!
Bell Palsy is a condition that causes facial paralysis, and was named after Sir Charles Bell (1774-1842) who described the Facial Nerve and cases of facial paralysis in his writings.
Who: 20-30 people per 100,000 people develop Bell Palsy per year. It can occur at any age, but the median age is around 40 years old.
What: by definition, it is defined as idiopathic, acute unilateral peripheral facial palsy.
Where: It usually occurs on one side of the face. Bell Palsy causes weakness or paralysis in all branches of the nerve. In other words, people show signs of weakness or paralysis in the forehead, midface, and lower face with Bell Palsy.
When: It comes on suddenly, usually within 48 hours and reaches its peak within a week. People with Bell Palsy should show some signs of recovery within 6 months of onset. If a person has complete facial paralysis with no signs of recovery at 6 months, they need further work up, because chances are it is not Bell Palsy, and they may have something serious causing their facial paralysis.
Why: When Bell Palsy was defined, it was defined as idiopathic, meaning “we don’t know what causes it”. However, new research is pointing to the herpes simplex virus type 1 as a major cause of Bell Palsy.
What to do: If you have sudden facial paralysis, you need to find out right away what is causing it so that you get the proper treatment. A physician needs to examine you and determine if it is Bells Palsy, or something more serious such as a stroke or brain tumor.
How is it treated: Initially, patients with Bells Palsy may be prescribed an anti viral medication, and/or a steroid medication to help protect the facial nerve and promote healing. If the facial weakness does not completely recover on its own, the patient may be sent to a speach, ocupational or physical therapist who specializes in treating facial paralysis to retrain the facial muscles how to work again.
Reference: The Facial Nerve by Slattery and Azizzadeh, Chapter 9 on Bells Palsy & Ramsey Hunt Syndrome by Shingo Murakami.
Painting: Green Eye Mask by Amadeo de Souza-Cardoso, 1915
Old woman seen from behind, sketch and study in pencil by Van Gogh, 1882
Most people with balance problems want to avoid walking with a cane or rolling walker unless absolutely necessary. Even when necessary, many people refuse to use a cane because they are too proud or embarrassed for others to see them walking with one. The thing is, if a person is at risk for falling, a fall can cause serious injuries, and even death.
The Center for Disease Control estimates that one out of three adults age 65 and older falls each year, but less than half talk to their healthcare providers about it. And among older adults (those 65 or older), falls are the leading cause of injury death! This is a serious issue...
So I tell my clients, “You need, what you need, when you need it”. The purpose of the balance exercises is for the person to improve to the point where they don’t need the cane or walker. But until that time comes, the last thing a person needs is to add to their problems by falling and getting hurt... When my balance patients in Sarasota understand that the cane or walker isn’t meant to be a “forever thing”, they are usually willing to use it temporarily until their condition improves.
If you or someone you love falls into this category, I encourage you to use a cane or walker, and to seek out a physical therapist who specializes in balance disorders, so that you can address your balance problem and regain your safe and independent lifestyle again.
Balance Awareness Week is September 15th-21st, 2014!
Are you having a balance problem? The goal of balance awareness week is to help people recognize if they are having a problem, and to urge them to seek help. Falling is not a normal part of aging. We know that falls can lead to serious injuries and even death. If you have had one fall with serious injury in the last 12 months, or 2 falls without injury, I encourage you to seek out a professional vestibular balance specialist. Something can be done to help your problem!
Facial paralysis occurs when the facial nerve is damaged and unable to send messages to the muscles of the face that create facial expressions. This problem can occur for several different reasons. Some causes include: tumor, trauma, stroke, or genetic disorders.
The most common cause of facial paralysis is due to Bell Palsy. While most of the time, Bell Palsy patients recover fully, research tell us that about 20-30% have lasting weakness or paralysis.
I first started treating people with facial paralysis because I was a vestibular specialist. The vestibular system or inner ear balance system is innervated by cranial nerve 8 (the Vestibular Nerve). The muscles of the face used for facial expression are innervated by cranial nerve 7 (the Facial Nerve). These 2 nerves run side by side on their way to the brain in a tunnel in the bone called the Internal Auditory Canal (IAC). This is a very narrow space, with only enough room for the nerves to travel. If a tumor is growing in this small place, or an infection travels to this area, both nerves can be damaged. We see this with large acoustic neuroma tumors, or with infections such as Ramsey Hunt Syndrome.
When facial paralysis does occur, it can take a lot of time for the nerve to heal. The first signs of movements of the face can be only just a flicker, but as the nerve heals, the movements can become stronger. Working with a physical therapist who has special training in treating facial paralysis can help improve the outcome for patients with this problem. They can teach a person what to expect while they are recovering, how to do stretches to ease pain and tightness in the face, how to retrain the muscles to move in a symmetrical way with the unaffected side of the face, and how to manage a condition called synkinesis (when facial muscles which should not be working when making a certain expression try to “help” anyway).
*Sculpture by Jun Kaneko 2007, Untitled Head in Glazed Ceramic and Steel
This is the title of a radio interview I did on July 1st, 2014 with Heidi Godman on her radio program Health Check on WSRQ Sarasota Talk Radio. She interviewed me, and also my husband Dr. Jack Wazen who is an MD, to discuss answers and treatment advice on balance and dizziness problems. During the podcast, I shared with Heidi how physical therapy can treat these problems, and Dr. Jack Wazen talked about the medical side of diagnosing and treating specific balance or dizziness problems. Conditions we discussed included Meniere’s Disease, BPPV, labyrinthitis, and tumors.
Cilck here to go to the Sarasota Talk Radio WSRQ website, where you can find Heidi Godman’s Health Check program, which was recorded on July 1, 2014. I hope you enjoy listening to the program as much as I enjoyed making it.
U-STEP: A WALKER DESIGNED FOR PARKINSON’S PATIENTS by Laura Wazen and Charlie
Hi. My name is Laura Wazen and this is my friend Charlie. Today we want to show you a very cool walker you may not have seen before, that is especially good for people who are having Parkinson’s Disease. So, one of the things about Parkinson’s Disease, is that sometimes, it can be a little bit hard to control your momentum if you’re walking with a traditional walker- that is in a sense, rolling away from you. So the neat thing about this U-Step walker is that it will only move if you squeeze the handles. So if Charlie wants to take a step, he squeezes the handles, and takes a couple of steps forward. Now the neat thing about this is, if he’s feeling unsteady or needed to stop, all he would have to do is release the handles. And then he could regain his balance, and he can then take a step forward which is a really, really cool thing! Another neat thing about this walker is that if a person is having a problem taking a step forward, (they’re freezing for example), it has a little button, which is right here, that if you push the button, it puts a red laser on the floor that serves as a visual cue, so that you can just look down and see the red line, and then the person initiates a step by stepping over the line. Charlie, could you push the button on the laser? (Charlie demonstrates pushing the button). The laser would project on the ground, and then he could use that red line as a visual cue to take a step, and start walking again. There you go.
Very good, Charlie.
We have moved our office to 950 South Tamiami Trail, Suite 101, Sarasota, FL 32439. It is a great space with lots of windows, ample parking in the shade (which is huge if you live in Florida), and on the 1st floor of the building.
The new office is right on US 41 South, across the street from the old Sarasota High School Building. I am really pleased to be opposite such a great Sarasota landmark, because the old school is now the new home for the Sarasota Museum of Art (SMOA)!
What does this mean for me? Well, I won’t have to go far to see inspiring art. In fact, if you are sitting in my treatment room, you can see a fascinating art installation right on the front lawn of the museum. I thought you might enjoy it as much as I have, so below you can see some of the photos I took with my phone the other day. As you can see by the pictures, this makes giving directions to my clinic very easy…
I have driven by this exhibit hundreds of times, but actually being able to walk in and around the art, and touch the walls of the structure gave me a whole new personal experience to the art work. If you live in Sarasota, I highly recommend you take 5 minutes, and stop and do the same. While you’re at it, stop by my office to say hello!
Generally speaking, balance therapy is a type of physical therapy that is performed to help a person with a balance problem. Different therapists may approach treating a balance problem based on their own background and expertise. For example, a therapist who comes from an orthopedic background and loves treating mainly people with joint and muscle problems, will tend to do what makes their other orthopedic patients better. That is, put the patient on a bike, and give them leg exercises. If the patient’s balance problem is caused by muscle weakness, they will improve.
However, if the problem is not weakness, they will not improve. It is not unusual for me to get a patient for balance therapy in my Sarasota office, and for the patient to say straight out that they don’t think I will be able to help them, because they have had a lot of physical therapy and did not get any better. The next question I ask is, “Well, tell me what you were doing?”, and 9 times out of 10 they will say sitting on a stationary bike and using machines to strengthen their legs. I usually tell that person, well, good, I am glad to hear that the exercises I have in mind you haven’t done before, so there is still a chance that you will get better.
What are these exercises? They include inner ear balance exercises. Our inner ear system is the major organ in our body that powers our balance. It tells our brain when our head or body is moving, so that the brain can tell the joints and muscles how to move to maintain balance. A classic inner ear exercise is to improve the vestibular-ocular reflex, or VOR. This is a reflex between the ears, the eyes, and the brain. Just to explain it a bit… If a person looks at a target and moves their head side to side, they are stimulating their VOR. The inner ear sends messages to the brain to tell the brain how far or how fast the person is turning their head, and the brain uses this information to coordinate the person’s eyes on the target while the head is turning. If the VOR was not working properly, then when the person turns their head, instead of keeping their eyes on the target, they would find that they are looking in the direction of the head turn. If the person’s VOR is not working properly, the patient could have complaints of dizziness, and be unsteady when walking, especially if turning their head to look at something to the side. Another exercises involves keeping the head still, but watching a moving target. If you would like to see this exercise demonstrated, click here to check out the segment on falls and balance that I recently did for ABC News 7.
According to the CDC, one out of three adults age 65 or older suffer falls each year.
These are only a couple of examples of exercises that improve one’s balance. I know it may sound complicated, but it makes perfect sense. If you have a good balance physical therapist, they should know these exercises and include it in your program to make your ability to use inner ear information stronger. This is just one example of how working with a qualified balance and vestibular therapist, and not just someone who went to PT school, can make all the difference.
Related Article: Trips and falls cause millions of injuries a year
Sitting old man waiting in hall, by Abraham van Strij
Medicine and technology are amazing. People who are deaf can get cochlear implants to restore their hearing, while others get corneal implants for their eyes. There are hip and knee replacements for arthritic joints, and the list goes on… If you have in inner ear balance problem, you may be wondering, “When will someone make an implant to restore my balance?"
Well, Dr. Jay Rubinstein from the University of Washington is definitely one of the researchers in the know. A few years ago, I met Dr. Rubinstein at a University of Colorado ENT meeting. At that time, he was reporting on his early results from implanting human subjects with his vestibular device. When I saw him again in February 2014, he was kind enough to give me an update.
His first studies were done on rhesus monkeys that had healthy inner ear systems with intact hearing and balance function. In order to start testing the device on human subjects, the device needed approval from the Food and Drug Administration (FDA), and the study had to pass strict scrutiny by an institutional review board (IRB) to prove that the research was ethical and would not harm the subjects involved. Dr. Rubinstein had to find a population of people who from a hearing and balance point of view had nothing to lose and everything to gain by participating in the study.
The first group of 4 people to be implanted had a condition called Meniere’s Disease. These patients had already lost their hearing and vestibular function (inner ear balance control) due to Meniere’s Disease before they were implanted. He has now been following these initial patients for one to three years. Because the device can be turned on and off, Dr. Rubinstein compared how the device benefits the person’s balance control, and also how the device improves the ability of the person to stabilize their vision and decrease the visual bouncing phenomenon called Oscillopsia. Oscillopsia is kind of like the effect one would get if watching an amateur video that someone took as they were walking down the street. It looks as if the world is bouncing. One goal of the implant is that by restoring inner ear function, the oscillopsia would stop.
So you must be wondering, what did he find? Dr. Rubinstein found that over time, the electrical response from the device declined. Based on these findings, he adapted the vestibular implant to make the responses generated more robust.
Sounds great, right? But not so fast. Because research on human subjects is very, very regulated, Dr. Rubinstein has to go back to the FDA to get the new device approved, and then has to submit a whole new IRB research protocol for approval! Once that hurdle is jumped, the next hurdle is funding. As you can imagine, this type of research is very expensive and takes a lot of money…
So you see, research takes perseverance. Dr. Rubinstein certainly has that! I am very grateful that he took the time to talk with me, and has allowed me to share these things with you! I told him that my patients are always asking me when there will be a cure for their problem, and I tell them – “they’re working on it...” Truly, hope is on the horizon.