Michael Schubert, PT, PhD
Michael Schubert, PT, PhD, associate professor, department of otolaryngology head and neck surgery, Johns Hopkins School of Medicine, Baltimore.
Trying to find effective treatment for chronic, persistent dizziness — or vertigo — is enough to make your head spin! Now, here’s some surprising news — the person who can help you live more comfortably with your chronic balance disorder is not a doctor or even a pharmacist, but a physical therapist.
Feeling like you are living on a merry-go-round is more common than you might guess — dizziness affects more than 2.4 million Americans. While inflammation or damage to the vestibular nerve or head trauma are frequent causes, the most common by far is benign paroxysmal positional vertigo (BPPV). This is the medical name for a sensation of spinning that occurs when your head is moved into particular positions. Last year, I wrote about an effective treatment for BPPV called the Epley Maneuver, and now here are some additional natural interventions, this time from the world of physical therapy.
A recent special issue of the June 2010 Journal of Neurologic Physical Therapy (JNPT) focused specifically on physical therapy (PT) for chronic dizziness. I spoke to the two guest editors — Michael Schubert, PT, PhD, associate professor in the department of otolaryngology head and neck surgery at Johns Hopkins School of Medicine, and Susan L. Whitney, PT, PhD, associate professor in the departments of physical therapy and otolaryngology in the School of Health and Rehabilitation Services at the University of Pittsburgh and director of the vestibular rehabilitation program at the Centers for Rehab Services, Eye & Ear Institute in Pittsburgh, to learn what’s new in this evolving field.
Notable among the nine studies featured in that issue of the JNPT is an intriguing new technology that may soon make life safer for people who suffer from chronic dizziness, along with some other ways that vestibular rehabilitation therapy (VRT) can help patients with a variety of balance problems.
Key finding: “Eye control” during head motion can help reduce risk for falls. One study conducted by researchers from the Atlanta Veterans Administration and Emory University in Atlanta examined how being able to keep eyes focused on a target while turning your head (this is called “gaze stability”) helps reduce fall risk in older adults who complain of dizziness but have normal inner-ear function. Thirty-nine patients did balance exercises (such as trying to maintain balance while standing on soft surfaces and walking with their eyes closed), while 20 of the patients also did gaze stability exercises and the other 19 did a sham set of eye exercises. Results: 90% of the group that did the actual gaze stability exercises showed a reduction in fall risk versus 50% of the group that did the sham gaze exercises.
Key finding: PT can improve balance even in patients with traumatic brain injury. Gaze stability and balance exercises also proved helpful to soldiers with chronic dizziness as a result of blast-induced brain injuries sustained in Iraq or Afghanistan. Using standard PT treatments for dizziness to treat this relatively new patient population — injured US soldiers — suggests that it may be helpful to use the same types of exercises for patients with brain injuries from car accidents, falls or other types of trauma.
Key finding: VRT can improve thinking and concentration. It appears that doing exercises for gaze stability and concentration can help improve cognitive function in people diagnosed with vestibular disorders. In a study from the University of Pittsburgh, 50% to 64% of patients who received VRT — such as using a computer to sort out images on their right and left sides (a task that helps improve visual concentration and trains the brain to “reject” confusing signals from damaged nerves or receptors) — had improved cognitive function after six weeks of PT. This may reduce risk of falling by helping to keep a person more tuned in to his/her surroundings while moving about.
In another study, a specially designed balance-feedback belt was used to help patients suffering chronic dizziness relearn balance skills. The device looks like a wide, conventional belt, but it also houses small vibrators that buzz (first gently, but with gathering intensity as danger of falling increases) to warn patients when they are teetering in one direction or another. Dr. Whitney told me that she found this device intriguing. “The study shows that people can process this information as they walk, and it helps them to stay steady,” she said, adding that it might be a benefit not only to people with balance disorders, but also for anybody at risk for falls. Note: This belt is still in the testing stages, so it’s not yet available to consumers.
According to Dr. Schubert and Dr. Whitney, taken collectively these studies provide compelling evidence that PT can be extremely helpful for people with persistent vertigo or imbalance problems, regardless of the cause. If you are interested in learning more, for yourself or for someone you know who has such a problem, it is important to find a physical therapist who specializes in balance disorders. Dr. Whitney recommended two info-packed Web sites, both of which offer a list of physical therapists who specialize in balance. Take a look at NeuroPT.org and Vestibular.org… and show dizziness the door!