Getting the Right Treatment

 

 

The onset of dizziness is a very traumatic and scary experience.  The first episode can bring on anxiety and panic.  Those that have dizziness and have not been tested to determine the cause may be living with it unnecessarily.

Since there are so many causes of dizziness, it is important to see a doctor specifically trained in balance and dizziness that can provide education and a clear plan of treatment.  Many people go from doctor to doctor looking for relief or, at the very least, an explanation that will put their fears to rest, but never finding it.  The field of balance and dizziness is a very specialized are with continual research and specific standardized tests that are not regularly taught to all physicians.  Therefore, there can be much confusion and uncertainty about the treatment of imbalance and dizziness.

The most successful treatment follows these simple steps:

  • Physician:  to rule out life-threatening conditions and provide proper medications.

  • Audiologist:  tests VNG, hearing and initial treatments.

  • Physical Therapist:  balance and dizziness exercises.

  • Reassessment by the physician to determine progress and changes.

 

Falling Results in Death

There is clear  evidence that falls pose a real threat to life in the elderly population.  Statistically there is a reason to do all we can to prevent falls.

  • 95% of hip fractures result from falls.

  • 25% of elderly fall victims sustaining a hip fracture die within one year.

How is falling reduced?  The answer is to treat the entire person.  It is very easy to assume that the elderly are fallers and there is nothing that can be done to minimize falls except for making their surroundings safer.  There is much more that can be done with the individual than is commonly thought of.  Medical research over the last 20 years has supported a specific approach to treating the elderly faller.  The most important aspect of the treatment is the assessment.  The vestibular, neurological, orthopedic, and visual systems must be assessed and a treatment diagnosis attained.  The most common treatment diagnosis are BPPV, unilateral vestibular loss, bilateral vestibular loss, central vestibular impairment, motion sensitivity, disuse disequilibrium and fear of falling.  Each one of these categories presents specific problems and requires a specific treatment.

The balance center can assess the entire person and apply the correct and effective treatment to help prevent falls and possibly death.  The best time to to enter a balance program is at the time of initial signs of imbalance.  Disuse equilibrium can easily occur after a fall or after the initial feeling of instability.  Once the fear of falling is present, the person's confidence plummets and the inactivity causes deterioration of general health, strength and flexibility until death.  This may sound harsh but it is the main reason that 25% of elderly fall victims sustaining a hip fracture die within a year.  It is not the hip fracture that results in death.  It is he fear of falling and disuse disequilibrium that deteriorates the once active body and makes it susceptible to other diseases.

Older Adults Do Not Seek Help for Dizziness

The elderly go to the doctor for many reasons but rarely go primarily for dizziness or balance problems.  A study of 100 consecutive patients referred to the Baylor Medical Center Geriatric Clinic showed that 61% had dizziness, although they were not seeking intervention for dizziness.  77% of these patients had balance disorders, 9% of which had BPPV (Oghalai JS et al, May 2000).

Why do older adults fail to seek medical attention for dizziness?  The fact is that many have sought help for their dizziness at one time but were told that as they age, dizziness and imbalance is normal.  Thereafter, they feel that is a condition that is not treatable and they must live with it.  The danger of this line of thinking is that they instinctively reduce their activity and begin to slide into a sedentary lifestyle that reduces social and physical activity.  Depression and anxiety are usually associated with this as are further visits to the doctor for management of the resulting progressive and chronic medical problems.

Early intervention is crucial and many times the patient must be asked if they have dizziness or imbalance in order to identify the need for further assessment.

 The Dilemma of Imbalance

Dilemma:  The state of uncertainty, perplexity, or difficulty.

The dilemma of imbalance is in the complexity of the balance systems and the uncertainty of the course of intervention.  The cerebellum and brain stem process balance sensory information.  Balance is a result of continuous muscular actions determined by a complex assessment of body position via the sensory systems.  The three primary systems are somatosensory, visual, and vestibular. 1  Without information from these systems the CNS cannot determine the direction that the body is falling and cannot formulate a corrective muscular response strategy.  These three systems must be assess in order to know how to treat imbalance.  Once the impairments are identified a care plan can be developed with an appropriate treatment program.

The CNS is very adaptive and can recalibrate and substitute sensory information to overcome impairments.  Assessment and training of the sensory systems and their integration into balance processing is the key to successful fall reduction and stability.  2   The important thing to realize is that people who fall or are unstable may become non-fallers and more stable with appropriate training.

1.  FB, et al:  Postural strategies associated with somatosensory and vestibular loss.  Exp Brain Res 82:167, 1990.

2.  Shumway-Cook, A. and Horack, FB:  Rehabilitation strategies for patients with vestibular deficits.  Neurol Clin 8:441, 1990.

Confidence and Fear:  Doing More to Keep People on Their Feet

Everyone has experience a moment of exhilarating confidence and a debilitating rush of fear.  They are very strong motivators.  Confidence promotes interaction and productive activity while fear inhibits interaction and encourages avoidance.

The most common phrase that I hear is "I have a fear of falling."  The more important thing to know is that most people do not want to feel that way.  They want independence and mobility.  Many times a fall will begin a spiraling cascade of undesired events if there is no attempt to improve the condition that initially caused the fall.  The fall instills a fear that leads to a restriction of activity.  Confidence in walking is decreased and a walking aid may be used.  Weakness and cardiovascular atrophy occur due to inactivity.  As de-conditioning progresses it is harder to get around and the desire to be active drifts further away.  Depression can also be a factor that strengthens the tendency to withdraw from activities.  The end result is a person that is very weak, dependent, and is at a high risk for falls.

This happens all  the time but it does not have to.  If a balance assessment is performed immediately after a fall and appropriate treatment is given, there can be an increase in confidence and a true reduction of subsequent falls.  Blaming age, neuropathy, eyesight, or inner ear problems on falls or imbalance and then doing nothing to improve what can be improved upon can sentence a person to a nonproductive, digressing condition.

The technology is available and the research is conclusive that balance retraining is effective and underutilized.  We understand balance and how to improve it while instilling confidence, activity, and safety.  Horizon Balance and Dizziness Center is dedicated to helping people live more fulfilling lives.