October is National Physical Therapy Month.
You may ask what Ear Nose & Throat has to do with physical therapy? The answer is, an ENT sees patients daily for problems with vertigo, imbalance, and falling. After all, the inner ear is an important part of the vestibular system that tells our brain where we are in space when we are turning quickly, rolling, or on an unsteady surface. Our vestibular system includes the inner ear, eyes, spinal muscles, sensation in our feet, and reflexes from our central and peripheral nervous systems. Dysfunction of any or all of these can cause dizziness.
Vestibular dysfunction can affect anyone. According to a 2009 study at Johns Hopkins, 34.5% of individuals older than 40 suffer from some form of it. Furthermore, the odds of vestibular dysfunction increase significantly with age. Patients with diabetes have a higher risk, up to 70% higher. Those who are symptomatic are 12 times as likely to fall. Based on data from the National Council on Aging, there is a fatality every 19 minutes from a fall in the United States.
Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. Evidence has shown that vestibular rehabilitation can be effective in improving symptoms related to many vestibular (inner ear/balance) disorders.
The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem(s). Therefore, before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder. Over time and with good compliance and perseverance, the intensity of the patient’s dizziness will decrease as the brain learns to ignore the abnormal signals it is receiving from the inner ear.
VRT is usually performed on an outpatient basis, although in some cases, the treatment can be initiated in the hospital. Patients are seen by a licensed physical or occupational therapist with advanced post-graduate training.
VRT begins with a comprehensive clinical assessment that should include collecting a detailed history of the patient’s symptoms and how these symptoms affect their daily activities. The therapist will document the type and intensity of symptoms and discuss the precipitating circumstances. The assessment also includes administering different tests to more objectively evaluate the patient’s problems. The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled. A customized exercise plan is developed from the findings of the clinical assessment, results from laboratory testing and imaging studies, and input from patients about their goals for rehabilitation. An important part of the VRT is to establish an exercise program that can be performed regularly at home. Compliance with the home exercise program is essential to help achieve rehabilitation and patient goals. VRT exercises are not difficult to learn, but to achieve maximum success; patients must be committed to doing them.
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