Last Updated May 2012
The vestibular system is a sensory system responsible for movement and balance. Research shows nearly 20 percent of Americans age 65 to 75 currently have vestibular dysfunction particularly balance disorder, often resulting in unsteadiness and an increased risk of falls. In fact, falls are the leading cause of death among people over 65 and account for half of all accidental deaths in the elderly. Statistics such as these underscore the importance of vestibular rehabilitation services in the field of therapeutic care and, more importantly, skilled therapists who can provide those services.
Advancements in the research and treatment of vestibular disorders have led to the evolution of a major health field encompassing many different disciplines. For years physical and occupational therapy have included aspects of vestibular pathology and physiology in the treatment of neurological disorders—namely in the treatment of impaired balance—but only recently has specific treatment for vestibular disorders fallen into the hands of therapists. However, before treatment can begin, a detailed physical assessment must be made to develop a complete picture and guide the overall treatment plan.
Pre-treatment: Obtaining a Comprehensive Patient History
When a vestibular disorder is suspected, a thorough physical assessment is the key to determining treatment. However, prior to the physical assessment it is critical to obtain a comprehensive patient history. Of critical importance is investigating the patient’s complaints of dizziness, and answers to the following questions can quickly help narrow down the issue:
- Is it a spinning sensation, as in the case of vertigo?
- Is there blurred vision, nausea or imbalance?
- Is there a floating or rocking sensation?
- How does the dizziness come on?
- Is it acute or chronic?
- Is the dizziness episodic or constant?
- If it comes in episodes how long do they last?
- Did the dizziness come on suddenly or insidiously?
- Do certain positions bring on dizziness?
- Is the dizziness situational or related to stress?
- Do certain head movements provoke symptoms?
- Is the dizziness worse at a certain time of day?
The patient history should include also a thorough examination of past medical problems, such as cardiovascular disease or diabetes, history of TIA or CVA, migraines, head trauma, history of ear infections or hearing loss, history of falls, neurodegenerative disease (e.g. MS, Parkinson’s), as well as the patient’s psychological history. Any medications the patient has taken and is currently taking should be listed also. Include possible symptom-producing drugs such as anti-hypertensives, as well as symptom-relieving medications (meclizine for instance) and aminoglycoside treatment.
Finally, it is important to inquire about the condition’s effect on the patient’s function and daily life. This is useful not only for reimbursement, but as a “measuring stick” for the progress and ultimate success of treatment. Once a detailed patient history has been compiled, the therapist can then begin a comprehensive physical evaluation which may include tests to observe intact vestibular function, signs of dysfunction, specific tests for certain conditions (e.g. BPPV, or benign paroxysmal positional vertigo), as well as tests for balance dysfunction.
Therapists should remember, however, that the physical evaluation tests are merely screening tools, and a complete picture must be developed from all of the information gathered in order to form an accurate therapy diagnosis. Still, even with all the available information, oftentimes the problem eludes both diagnosis and treatment. This is why communication with the physician is important, and referral for more testing may be appropriate. Therapists will by no means perform all, or even a majority, of these tests with every patient, but should choose instead the appropriate tests to help further develop suspicions arrived at while completing the patient’s history.
Improvement through Education
In the past decade, the body of published literature on vestibular rehabilitation (VR) has increased exponentially. Treatments have been refined, new diagnostic tools have been created, and the concepts behind VR have been clarified and further defined. Although the body of knowledge has grown increasingly complex, the basic concepts that encompass the evaluation and treatment of vestibular disorders remain relatively simple and easy to learn. Through ongoing education therapists can learn more about proven assessment and rehabilitation options and ultimately improve the health and quality of life for patients with vestibular disorders.
To learn more about the vestibular system and vestibular disorders in your patients—including the history, anatomy and physiology, pathophysiology, causes of dizziness, how to perform a thorough physical assessment, as well as proven treatment options—take our comprehensive course: Vestibular Rehabilitation.
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