Treating Vestibular Disorders

Author: Jess Hennell (Physiotherapist) – Special Interest in Vestibular Disorders

“Vertigo and dizziness affects more than 1/3 of people over the age of 50” – RACGP

It can lead to people requiring time off work, presentations to the emergency department and falls resulting in serious injuries or fractures. Vertigo is a type of dizziness that feels as though the room around you is spinning. The severity of symptoms can range from mild to severe and may involve nausea and vomiting. 

Upon diagnosing the type of Vertigo a person has, various Vestibular rehabilitation techniques can be recommended and prescribed. For Benign Paroxysmal Vertigo (BPPV), various canal repositioning techniques can be implemented to address the canal in concern. With other Vestibular conditions a range of exercises and treatments are prescribed after a detailed assessment. These treatments may include gaze stability exercises, habituation/compensatory strategies and balance/falls prevention exercises. (7) Time is spent to educate clients to ensure they are completing their exercises at the correct level and to encourage them to return to normal life activities. 

Clients are reviewed regularly during their treatment period and treatments will be progressed at the frequency that best suits the individual. Both research studies and our clinical experience indicate that the longer an individual waits for treatment the more an individual can develop activity avoidance behaviour. This can exacerbate their symptoms and impact on their quality of life.

Specific Exercises

Rehabilitation program can include gaze stability exercises, habituation and balance/postural control 

Reducing Symptoms

Symptoms that can be improved with vestibular rehab can include dizziness, vertigo and imbalance

Jess demonstrating a Hall-pike manoeuvre

Who benefits from Vestibular Rehab?

Clients who are experiencing:
 –  Dizziness
 –  Vertigo
 –  Feeling off balance
 –  Falls or near misses for falls
 –  Visual blurring with head movement (1)
 There is strong to moderate evidence that vestibular rehab is safe and effective for a range of peripheral vestibular conditions (1, 2) including:
 –  BPPV
 –  Vestibular neuritis or Labyrinthitis
 –  Post removal of Acoustic Neuroma

Vestibular rehab can also be used to assist with:
–  Persistent postural-perceptual dizziness (3PD) (3)
–  Post concussion syndrome (4)
–  Multiple sclerosis (5)
–  Meniere’s disease (residual symptoms between episodes) (6) 

3 reasons to refer for Vestibular Rehab

­1) Early initiation of Vestibular rehabilitation may result in improved recovery of balance, reduced symptom complaints and improved functional recovery (1)
2) For clients with BPPV, treating with an appropriate canal repositioning technique can reduce falls in this population by around 65% (8)
3) It can improve both symptoms and function and result in benefits to quality of life!  (1)

Are you ready to work from home?

As a business owner I’m sure like every other business owner out there you have been watching the COVID-19 updates religiously. After this evening’s (22nd March 2020) press conference from the Prime Minister to practice better social distancing, working from home for those who are able will become more of a reality from this week onwards.

So are you prepared?

Here are a few tips to help set you up.

Having a room dedicated to your home office will help you be less distracted and more productive. Moreover, having an adequately sized desk and clean desk will enhance your productivity. It will prevent you from constantly looking under piles of paperwork trying to find your mouse or constantly moving stacks of paper around then inadvertently losing an important document you are trying to cite.

2. Chair:
Having an ergonomic chair with good back and lumbar support, good seat cushioning and enough functions that you can tailor it to your size is important. After all, you could be sitting in your chair for hours on end and this is where most people end up with back and neck pain.

3. Correct set-up
Ensuring you have your screen, mouse, keyboard, desk and chair set-up ergonomically is crucial. You shouldn’t have to reach too far forward or reach up to your keyboard. This is another way to ensure you can work pain-free over the coming months. If unsure, we are starting to offer ergonomic assessments online given the social distancing restrictions. (We’re trying to do our part too!) Enquire with us further if you think this could be beneficial to you.

4. Accessories
There are boundless accessories on the market these days. Monitor screen arms, stand-up desks, foot stools the list goes on. Don’t underestimate a good mouse pad either! There are plenty of things on the market that will help you ensure your desk set-up is tailored to your size and job description.

5. Webcam and Headset
There will be plenty of tele-conferencing in coming months so make-sure you have access to a webcam or think about purchasing one if you are client facing. There is nothing worse than trying to impress someone with a pixelated version of you.
Get an external mic or headset. Often the computer mic is ineffective and will make you sound like a robot. It won’t help you much if you’re trying to get a deal over the line.

I hope this post helps you in a small way. At On Track Physiotherapy we know the average 21st century worker is a desk jockey so we are passionate about keeping with the times and ensuring people are able to work productively and pain free.

A Case-study: To prescribe or not to prescribe?

One of the most commonly asked for items are standing desks but this does not always mean it is the correct solution. 

Finding out why a client wants a standing desk is important. More often than not, they are in pain whilst working and need a solution to their pain. Pain and injury can decrease productivity and also cause time-off work. Besides, pain can often make people irritable not only to clients but also towards fellow co-workers, family and friends. This can quickly cause resentment and negativity in a work place.

In my last few workstation assessments instead of standing desks I have actually looked at other things such as keyboard and mouse, screen set-up and office chairs. Often educating my clients on how to set their workstation up goes a long way as it often solves their problems quickly. This is important as you can have the fanciest tools but if you don’t know how to use them it won’t fix your problem.

Contact On Track Physiotherapy if you would like more information on how our individually tailored assessments might benefit your workplace or workers.

September Challenge

As a Physio and a person I always believe in doing as you say. So this year I decided to join my colleagues in the Steptember challenge. If you haven’t heard of Steptember it’s trying to do 10,000 steps each day to raise awareness and money for Cerebral Palsy. It’s also a great way to hold yourself accountable to how much you move. This morning I got to work 1/2 hour early, made use of the sunshine and went for a walk. How mindful are you of the amount of activity you do each day?

Find your 30

Have you heard that a sedentary lifestyle is possibly worse than smoking? For years the Heart foundation has encouraged people to do 30 minutes of exercise a day. Now Sport Aus wants every Australian to commit to doing 30 minutes of exercise everyday. Not only does it help your physical health it also helps with your mental health, bone and brain health and even gives you an opportunity to socialise with friends and family. Check out the website for fun ways to get active at home, work and on the weekend.