General:
What should I wear for treatment sessions?
Comfortable clothing that will allow you movement and flexibility. Please wear tennis shoes or soft soled shoes.
How long does a session take?
Each patient has different needs and a different treatment program. Typical treatment sessions will last from 30-60 minutes.
How do I make an appointment?
Call our corporate office (847-518-0442) and we will schedule a visit at the Center most convenient for you.
What do I need to bring to an appointment?
Please bring your most current insurance card, ID and a written order for physical therapy from your doctor, if available.
Does my insurance cover physical therapy?
We accept Medicare and most private insurance plans. Please call for a current listing.
Vestibular:
What are the symptoms of vestibular disorders?
The most noticeable symptoms of vestibular disorders are dizziness, vertigo, nausea, and unsteadiness or imbalance when walking.
Many symptoms are more obscure, including visual problems (e.g., objects seem to move, reading is difficult, glare increases). Hearing may fluctuate. Ear noises (tinnitus), such as buzzing, popping, or clicking sounds, may occur. Loud noises may cause discomfort. Memory may be impaired and forgetfulness may become a problem. Fatigue is common.
Depending on the cause of the disorder, these symptoms may occur continually or in recurring episodes brought on by changes in head position, by changes in altitude or barometric pressure, or by certain changes in diet or body fluid levels.
What is vestibular rehabilitation?
Vestibular rehabilitation is an exercise approach to the remediation of disequilibrium and dizziness symptoms associated with peripheral vestibular pathology. A common neuro-otological approach to managing a patient suffering from dizziness and balance problems is to administer medication designed to suppress vestibular function. However, many of the medications used for inner-ear disorders have the disadvantage of potential habituation and sedating side effects that frequently limit the patient's ability to perform useful activities.
Vestibular rehabilitation is an alternative form of treatment involving specific exercises designed to 1) decrease dizziness, 2) increase balance function, and 3) increase general activity levels. Patients are asked to exercise daily at home and to visit the physical therapist during an initial period of four to six weeks.
What causes vestibular disorders
In people under age 50, the most common cause of serious vestibular disorders is a blow to the head or neck "whiplash" injury, which damages either or both inner ears.
Inflammation of the inner ear, called labyrinthitis, may also cause vestibular problems. People who experience chronic middle-ear infections may eventually sustain damage to the vestibular and hearing structures of the inner ear.
Aging may cause vestibular problems. There is evidence that some parts of the inner ear degenerate as a person grows older, causing dizziness, vertigo and/or hearing loss.
High doses or long-term uses of certain antibiotics such as the aminoglycosides may cause permanent damage to the inner ear and result in loss of vestibular system function.
The use of aspirin, caffeine, alcohol, nicotine, marijuana, or medications such as certain oral contraceptives, sedatives, or tranquilizers, may cause temporary vestibular and/or hearing problems.
Occasionally, a slow-growing tumor on the nerve that leads from the inner ear to the brain may interfere with the normal function of the vestibular system.
Other causes, such as insufficient blood flow to the vestibular system or to certain parts of the brain, may also result in vestibular disorders.
The most common problem involving the vestibular system is motion sickness caused by exposure to unusual or conflicting visual or surface orientation references. For instance, someone who is prone to motion sickness may experience dizziness, nausea, and vomiting while walking on a floating dock, driving on a bumpy road, or riding on a merry-go-round.
What can be done about vestibular disorders
The treatment or cure for a vestibular disorder depends on the cause.
An episode of severe vertigo may be treated with medications. If nausea and vomiting occur, other medications may be used to reduce symptoms. However, long-term medication usage is discouraged.
If the inner ear has been damaged as a result of head trauma, physical therapy and exercise may be effective in helping the individual learn to compensate for the altered function.
With some vestibular disorders, symptoms occur when there is an imbalance in body fluid levels. An imbalance may result from dehydration or from eating too much salt or sugar. In these cases, symptoms may be managed by drinking sufficient fluids to replace those lost during exercise or hot weather and by carefully controlling the amounts of salt and sugar in the diet.
Some vestibular disorders may be treated surgically.
How might a vestibular disorder affect my lifestyle?
There are many things you can do to cope with the symptoms of vestibular disorder.
In some cases, careful control of fluid, salt, and sugar intake is important for lessening the severity and frequency of symptoms. Also, maintaining your ideal weight will make it easier to keep your balance.
It's important to remain physically active. If physical therapy is part of your treatment, its essential to perform your exercises consistently. These exercises are designed specifically to help you learn to compensate for altered function of your vestibular system.
If you are subject to sudden, severe attacks of vertigo, you can make some changes in your home to help ensure your safety. Because people with vestibular disorders rely on vision to help maintain balance, it is important to have good lighting in the home and keep some lights on at all times. Also, because people with vestibular disorders rely on their sense of touch to help maintain balance, it is important to have smooth, solid surfaces to walk on. High-pile carpeting, highly polished floors, and throw rugs are hazardous to people with vestibular disorders.
If changes in head position worsen your symptoms, you may be able to rearrange your kitchen shelves, your workshop, or your office space to eliminate frequent head and body movements that cause your distress.
Because people who experience dizziness or vertigo exhibit no outward signs of illness, they are often misunderstood by family, friends, and acquaintances. It may be difficult for others to understand why you are unable to participate in certain activities. Conflicts may arise within your family or at work. Neuropsychological intervention may be helpful in resolving these issues.
You can help others understand by learning all you can about your problem, your symptoms, and your treatment. Talk openly with family and friends about the problems you face, how you can best deal with them, and what they can do to help. It may help to talk with others who have similar experiences; they will be able to share the ways they have found to cope with the problems you face.
What happens in the exercise program?
The treatment of a patient with inner-ear disorders focuses on improving balance function, decreasing dizziness symptoms through vestibular exercises, and increasing overall activity levels for long-term retention of gains made in therapy.
Vestibular habituation exercises: Successful remediation of vertigo is dependent on determining the specific movements and/or positions that provoke the patient's symptoms. These exercises are based on the rationale that through repeated exposure to the specific stimulus causing the vertigo, the brain will habituate or attenuate the vertigo response.
Balance retraining exercises: Balance retraining involves exercises designed to improve coordination of muscle responses as well as the organization of sensory information for balance control. Again, the emphasis is on a home program of exercise, including gradual involvement in a daily aerobic exercise activity, such as walking or biking, to ensure the patient maintains improvements.
In addition to their home program, patients are seen in the clinic one to two times per week for an average of six to eight weeks. During therapy, progress is monitored, home exercise is modified, and specific balance retraining occurs.
Does therapy succeed
Several patient studies have been done to examine the effect of vestibular therapy on dizziness symptoms. These studies unanimously demonstrate a decrease in symptoms of dizziness and disequilibrium after therapy. One study compared the effectiveness of specific therapy to a general exercise program in decreasing vertigo complaints in patients with a variety of vestibular pathologies. Results supported vestibular habituation therapy over a general exercise program for the remediation of positional vertigo. However, best results appear to be attained when vestibular therapy is combined with general exercise to reduce deconditioning effects.
Is a physician's referral needed to enter therapy
Vestibular rehabilitation programs are designed to remediate vertigo and disequilibrium associated with vestibular abnormalities. There are many causes of dizziness, not all the result of vestibular deficits. Most referrals will come from otolaryngologists or neurologists. If there is some question about the nature of the underlying disorder in patients who are referred from other sources, an otology consult may be requested by the treating therapist.
How common are inner-ear disorders
The problem of dizziness and disequilibrium is very common, second only to lower-back complaints in frequency of occurrence in adult populations. Dizziness itself is not a disease, but rather a symptom of a problem within the peripheral or central nervous system. Although there are many causes of dizziness, it is estimated that 85 percent of dizziness is the result of a pathology within the peripheral vestibular system.
Who is at risk
Eighty-five percent of people suffering from dizziness or vertigo have vestibular disorders. Because the vestibular structures are closely associated with the hearing structures of the inner ear, many people with vestibular disorders also experience a change in hearing.
How will the therapist assess the patient's problems
Assessment of function in a patient with inner ear dysfunction focuses on three major areas:
- evaluation of the musculoskeletal system
- balance and gait assessment
- vestibular assessment
Musculoskeletal assessment includes general range-of-motion, strength, sensation, and coordination.
Balance and gait assessment includes an analysis of the walking pattern. In addition, static and dynamic balance skills are assessed, including balance during gait on level and unlevel surfaces. Finally, the patient's use of appropriate movement strategies in balance control is examined.
Vertigo assessment begins with a dizziness questionnaire to determine frequency and severity of dizziness symptoms and to document lifestyle changes resulting from balance and dizziness problems. In addition, the patient is asked to move into different positions requiring head and trunk motion in specific planes of motion. The patient is asked to report the presence and intensity of dizziness symptoms.
After the above assessments, a list of patient problems is generated, short- and long-term goals are established, and, if appropriate, the patient is started on a specific exercise program based on his or her individual assessment findings.