All posts in Vertigo

Prevent falls, promote health

Prevent falls, promote health

Falls cause 2/3rds of deaths due to unintentional injury in the elderly, which is the 5th leading cause of death of people over 65 years of age.

A fall by an elderly person can be defined as “a situation in which the older adult falls to the ground or is found lying on the ground” or “any unintended contact with a supporting surface, such as a chair, counter or wall”. (Shumway-Cook & Woollacott 2017)

We have your health in mind, and the prevention of such an adverse event, in our best interest and priority. We have decided to write a blog post to provide you with information to help minimise your risk of falling and increase your chances to lead a fit and healthy aging process.

The following list presents risk factors that are relevant to individual factors that increase the chance of falling:

Muscle weakness
History of falling
Walk with a limp
Poor balance (feel wobbly when walking)
Use of a walking aid (e.g. walking stick or frame)
Poor vision
Arthritis
Depression
Poor cognition (e.g. memory/ ability to problem solve)
Age greater than 80 years old

Are any of the symptoms listed above relevant to you?

It is difficult to attribute ageing as the sole reason for the development of the traits listed above, as older adults of the same age can demonstrate physical function ranging from physically elite to entirely dependent on others for all activities of daily living. However, there are some common trends of declining function to do with the neuromuscular system which occur in older adults, and although age may not be the main cause for these changes in the systems of postural control, it is likely, increasing age has a detrimental effect.

The aspects of the systems of postural control potentially detrimentally affected by age include:

Muscle strength
Range of motion
Static balance (ability to remain stable when you are not moving)
Dynamic balance (ability to remain stable with movement)
Reactive balance control (ability to sequence movement, time muscle activation and adapt to changing tasks and environmental demands
Anticipatory balance control (the ability to stabilise the body before performing a movement)
Sensation (the ability to detect change in the external environment through vision, hearing, touch, ability to sense vibration, and proprioception, or the ability to sense where your body is in space)

It is also necessary to comment on the loss of bone density associated with increased age (>50 years old). A loss of bone density increases your risk of fracture when falling and is something everyone can and should actively work to minimise.

Our Physiotherapists are pleased to guide you and minimise your risk of falling. Therefore, we have developed a very simple home exercise program for all readers, using equipment all should have access to, to enable you to take action to reduce your risk of developing risk factors of falling and consequently your overall risk of falling, immediately!!:

Sit to stand (to increase muscle strength)

Sitting upright in a chair
Lean forward with hands on chair
Push through arms and heels keeping back straight
Squeeze your buttocks to stand as tall as possible
Repeat 15 squats
Perform 3 x daily

Thoracic extension (to increase range of motion)

Sitting on a chair which has a high back
Place a rolled towel horizontally behind your shoulder blades
Place both hands behind your neck and interlock your fingers
Touch elbows together
Bend backward to a comfortable position and hold for 30seconds
Perform 3 x daily

SLS (to increase static postural control)

Standing next to a stable object
Place one hand on the stable object
Lift one leg off of the floor to form a L-shape
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat on the opposite leg
Perform 3 x daily

SLS – Eyes closed (to enhance sensation especially proprioception)
As above, however once stable, close your eyes and hold for 30 seconds

Tandem stance (to increase static postural control)

Standing next to a stable object
Place one hand on the stable object
Place one foot directly in front of the other, so that your toes of the back foot are touching the heel of the front foot, forming in a straight line
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat with the opposite leg in front
Perform 3 x daily

Tandem walking (to increase dynamic postural control)

Continue to get into the position as above, however, continue walking – like you are walking on a tightrope! (We recommend alongside the kitchen bench for safety precautions)
30 minutes of walking daily (to increase bone density, dynamic postural control anticipatory balance and importantly cardiovascular fitness – or heart and lung health!!)
This program is very basic and does not cover all of the aspects of postural control. Please make an appointment with one of our physiotherapists to extend your exercise program, so that we can make it more tailored to your needs and more interesting. We will use modern, exciting equipment and more fun movements!!

Finally, the following listed items are external factors that also increase one’s likelihood of falling. They are known as secondary factors and are easily controlled:

Stairs
Throw rugs
Slippery surfaces
Poor lighting
Clutter in the home
Uneven pavement

Please take a moment to consider how you can minimise your risk of falling through controlling these listed items, for example placing non-slip mats in the shower, reducing clutter in frequently used walkways, having a bedside lamp to use when going to the bathroom in the middle of the night.

We hope you have found this blog helpful and please do call us for any questions or comments.

Reference:
Chapter 9 Shumway-Cook, A & Woollacott MH 2017, ‘Aging and Postural Control’, in M Nobel (ed.)Motor Control: Translating Research into Clinical Practice, 5th edition, Wolters Kluwer, Philadelphia, pp. 206- 228.

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Vestibular Rehabilitation

Vestibular Rehabilitation

By Vanessa Service, Physiotherapist

What does my vestibular system do?

Your vestibular system’s job is to process sensory information that is required to control balance and eye movements. This means that information from the inner ear, the visual system, and from the muscles and joints is analysed by the brain. Integrating this information allows you to1:

– Maintain clear sight while you move your head,

– Figure out the orientation of your head in space in relation to gravity,

– Identify how fast and in which direction your are moving, and

– Make fast and automatic adjustments to your posture so you can maintain balance (stay in your desired position).

In other words, your vestibular system coordinates your movement with your balance, allowing you to navigate through and adapt to the world. It is this process that allows you to walk down the sidewalk, to step off a curb, to sit down and stand up again and to turn your head while walking. Anytime your head moves through space you’re depending on your vestibular system.

What are vestibular disorders and what are the symptoms?

If the vestibular system encounters disease or injury, such as a viral infection or head trauma, the result may be a vestibular disorder. However, aging, some medications, and genetic or environmental factors may also cause vestibular conditions.

Symptoms of damage to the vestibular system may include:

– Vertigo (a sense of the world spinning around you)

– Dizziness (feeling lightheaded or floating/rocking in space)

– Imbalance and special disorientation (stumbling, staggering, drifting to one side while walking)

– Difficulty with changes in walking surfaces

– Tinnitus (ringing or buzzing in the ears)

– Discomfort in busy visual environments (such as the grocery store) or when looking at screens/television

Examples of vestibular disorders include:

  • Benign paroxysmal positional vertigo or BPPV (a common condition where loose debris or “crystals” collect in a part of the inner ear)
  • Vestibular neuritis or labyrinthitis.
  • Migraine associated vertigo
  • Concussion
  • Endolymphatic hydrops
  • Acoustic neuroma
  • Meniere’s disease

How can a vestibular physiotherapist help?

The effect of a vestibular condition on a person’s life can be profound. Dizziness and balance problems are often a barrier to activities of daily living, to independence, and to engaging with the community. This negative impact on daily function and socialization may also contribute to anxiety and depression. As such, appropriate management of vestibular conditions is an essential component to improving quality of life for individuals and families affected by vestibular disorders.

A vestibular therapist will interview you about the history of your symptoms and perform a series of vestibular, balance, and visual tests. Treatment will depend on what is found in the assessment. For example, if you are diagnosed with BPPV, your therapist will perform a manoeuvre to reposition the associated crystals. Other vestibular disorders are treated with specific exercises and strategies that your vestibular therapist will teach you and help you progress through to reach your specific goals.

Although for most people a vestibular disorder is permanent, an exercise based plan can be designed to reduce dizziness, vertigo, and balance and gaze stability problems1. This is made possible by your brain’s incredible ability to adapt its other systems in order to effectively compensate for an improperly functioning vestibular system. Vestibular rehabilitation is a non-invasive and drug free intervention that helps to promote and maximize the amount of compensation that occurs. Current research supports the use of vestibular rehabilitation in the management of vestibular conditions2, demonstrating reduced dizziness, balance issues, and increased independence with regard to activities of daily living 3. Additionally, no adverse effects associated with vestibular rehabilitation have been reported2. As such, vestibular rehabilitation can provide a pathway to improved quality of life for those living with a vestibular condition.

References:

1. About Vestibular Disorders (n.d) Retrieved from https://vestibular.org/understanding-vestibular-disorder

2. Hillier SL et al., Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Cochrane Database of Systematic Reviews 3, 2011.

3. Cohen HS, Kimball KT Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003 Jan;128(1):60-70

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Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV)

Feeling dizzy? You Could Have a Vestibular Disorder

Do you experience dizziness? Perhaps when rolling into or over in bed, or turning your head to one side?

Dizziness can be more than dehydration, a big night out, or a compulsion to spin in circles on your office chair. It can be a symptom of asymmetry in your body’s sensory systems.

The most common condition that causes dizziness is benign paroxysmal positional vertigo, or BPPV. The brain has three main mechanisms for perceiving how we interact with the environment around us. These are the visual, proprioceptive, and vestibular systems.

The visual system is self-explanatory. The proprioceptive system is a network of nerves in all of your muscles and joints that relay information about the position of those muscles and joints back to the brain. It is how you can close your eyes and still accurately position your arms and legs in different poses.

The vestibular system is located in your inner ear and is used to identify the position and movement of the head in space. This is the system commonly linked to dizziness and vertigo.

The vestibular system is made up of three perpendicular fluid filled canals in each ear, which relate roughly to the planes of movement.

These canals each have sensory nerves at one end that are made up of crystals resting on fine hairs. When you turn your head, the fluid moves through the canals and pushes on the crystals. This causes the hairs to move and stimulates the nerves.

Your response in each ear should be equal and opposite, and work in tandem with your visual and proprioceptive systems. If things are not working in tandem, then dizziness, vertigo (room spinning), or nausea may result.

Have you ever felt nauseated in a car, or on a boat? This is because your vestibular system recognises that your head is moving but according to your eyes, you are still or moving a different way.

Someone may have suggested looking out the window or finding the horizon. This is great advice as fixating on something which the car or boat is moving relative to, provides a visual reference point and reduces or eliminates the disagreement between the visual and vestibular system.

In patients suffering BPPV, a similar disagreement occurs but it is completely internal. It occurs when crystals in one ear canal become dislodged from the hairs and drift down into the canal. This can happen as a result of trauma but is just as frequently unrelated to any incident.

When the head is turned, the nerve stimulation in one ear is different to the other and a combination of dizziness, vertigo, and nausea can result.

Generally, this resolves in seconds, or in more severe cases last up to two minutes. Usually only one canal will be affected at a time so symptoms are commonly worse to one side, and occur most severely in a single plane of movement.

If you are dizzy due to asymmetry, then your physiotherapist can assess and treat it. Assessment of specific movements can isolate which ear and which canal is causing the problem and treatment involves techniques designed to use gravity and inertia to relocate the crystals back to where they belong at the end of the canal.
NOTE: If you are suffering from severe, sudden onset headache, or persistent dizziness, double vision or nausea that seem unrelated to any particular movement then consult a medical doctor immediately.

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