& Continuing Education Courses
Sponsored by: Jordan Hearing and Balance, LLC South Jordan Utah
Lynn S. Alvord PhD
The subject of falling disorders is a broad one, the author having written a text dedicated to the subject (“Falls Assessment and Prevention” – Alvord, L.S., Plural Publishing). There are few body systems that are not potentially responsible for causing falls. Falls may be due to deficiencies or disorders in the peripheral vestibular, muscular, skeletal, joint, somatosensory, central nervous, visual, circulatory, respiratory (faint), cognitive, as well as other systems. The major systems responsible for falls, however, are the vestibular, nervous, musculoskeletal and visual systems. Falling is also a very behavioral disorder, with “rushing” accounting for a large percentage of falls. Many extrinsic factors also can be responsible for falls, including medications and environment. As a vestibular clinic, we recognize the importance of the vestibular system in causing falls; however, we recognize the importance the other systems to the extent that we include a screening of them all in our falls evaluations.
Rehabilitation of Dizziness, Balance or Falling
Rehabilitation for inner ear balance disorders is called “vestibular rehabilitation”. This may be the type to eliminate the “crystals” of BPPV (see above), or may consist of head movement exercises to readjust the balance reflexes. One of the best analogies explaining how this type of vestibular rehabilitation works is my own experience obtaining reading glasses. As I entered middle age, my need for reading glasses led me to try a method called “monovision”. I would wear a contact in one eye having a prescription for close reading, and in the other eye, a contact for distance. The brain, I was told, would adjust things internally so that my vision would seem normal in both eyes for distance as well as reading. This I found to be true and I enjoy this arrangement very much, however, it took a couple of weeks before my sight made the appropriate adjustments. Similarly, a person who has a weak inner ear for balance must perform exercises which train the nervous system to focus mainly on the non-impaired “correct ear”. Due to the tremendous plasticity of the nervous system, this adjustment of balance occurs similarly as with my experience with “monovision”. See the Additional Information section for more explanation on the theory of how vestibular rehabilitation works.
These exercises are usually directed by a therapist (audiologist, PT or OT), which are directed at reducing or eliminating feelings of dizziness or imbalance due to inner ear disorders such as vestibular neuritis. The exercises consist of various head and body movements during which the eyes are focused on a target. Exercises can usually be performed at home individually, but additional direction is typically given periodically since patients vary as to their exact needs. Exercises usually are required for a few months or more to fully be effective.