Vestibular Rehabilitation Therapist - Drew Hutchison
I was trained under the National Director of Vestibular Rehabilitation, Sheelah Woodhouse, and have consulted her on cases that are more complex. (Sheelah was on the advisory committee for the development and writing of the recently published clinical practice guidelines in Vestibular Rehabilitation for the American Physical Therapy Association and is Past-President of the Vestibular Disorders Association. She has a long history of educating the public, medical and insurance communities about the benefits of vestibular rehabilitation. )
I have worked for 6 years in the field of concussion therapy dealing with dizziness and have been trained on the most up to date techniques for assessment and treatment using Infrared goggle technology. This allows us to assess the cause of the dizziness if the balance issue has been happening for a week or longer and the body has already started to try to adapt/compensate for the balance issue. It is also a really useful tool to help rule out sinister causes of dizziness like a clot, damage to the brain or spinal cord/ Cerebellum.
I have successfully treated dizziness disorders for years and am happy to start offering this service to patients in Northwest Calgary.
Drew Hutchison, MScPT, BScH
|Vestibular Certified (Infrared Goggles)|
|Gunn IMS (Dry Needling)|
|Spinal Manipulation Certified|
|Certified Manual Therapist|
Vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate problems caused by vestibular disorders, primarily vertigo and dizziness, gaze instability, and/or imbalance and falls. A customized exercise plan is developed from the findings during the clinical assessment, laboratory testing and imaging studies, and input from patients. Different factors can impact the potential for recovery including activity level, pain, other medical conditions, medications, and emotional concerns.
If your physiotherapist feels that VRT is appropriate for you after your assessment is complete, they will prescribe a number of individualized exercises for you to regularly perform. These exercises will address your specific vestibular problem and the related symptoms. In addition, the exercises prescribed for you will focus on any everyday issues you are facing as a result of your symptoms. Some exercises will be performed with your physiotherapist at Interactive Health and others will be taught to you such that you can complete them independently as part of a home exercise program. Medications to treat your symptoms can be an adjunct to VRT and should be discussed with your physician.
The types of exercises used in VRT can be divided into the following categories:
These exercises work to force the vestibulo-ocular reflex (VOR) to adapt to movement of the head. In a way it is encouraging the eye-ear-brain connection to ‘reset’ itself.
A commonly used protocol of exercises which are based on this principle of getting the VOR to adapt to progressively more advanced motions of the head are Cawthorne-Cooksey Exercises. This protocol of exercises has been around since WWII when two doctors, Terence Cawthorne & Harold Cooksey, noted that soldiers with balance disorders due to head injuries improved more quickly if they were forced to be active rather than bedridden. Examples include doing eye and head movements in sitting, and once these have been mastered these movements are then done while standing. Cawthorne-Cooksey Exercises are most effective when used in combination with other individualized vestibular exercises prescribed by your physiotherapist.
The purpose of these exercises is to use visual cues and those coming from the joints and muscles, to make up for the loss in vestibular sensory cues. These exercises work to improve gaze stability and postural stability.
Gaze stability exercises improve one’s vision while the head is moving. For example, a patient may be asked to focus on a target, keep it in focus, and then move their head side to side, all the while maintaining focus of the target. Specific exercises, which vary the speed of the head motion and the position of the head, such as those done when lying, sitting or walking, will also need to be trained.
An example of an exercise that challenges postural stability would be one where you are standing on a soft mat and trying to balance. To advance this exercise, the exercise would first be done with eyes open and then eyes closed.
These exercises work to decrease the magnitude of the vestibular symptoms one feels by repetitively exposing the system to stimuli that bring on the symptoms. These exercises attempt to fatigue the vestibular response to the stimuli such that symptoms decrease over time. An example is putting your head down towards your knees in sitting and then back up. This exercise is repeated several times a day. The severity and duration of the dizziness felt after the exercise should be recorded.
These types of VRT exercises encourage other systems and mechanisms associated with balance in the body to work harder in order to counteract the diseased vestibular system. They can include substitution type exercises but also include more generalized central nervous system based strategies. Often patients have already developed their own compensatory strategies by the time they have visited one of our physiotherapists. It is the job of your physiotherapist to help identify which strategies are in use and to assist you to use these strategies more effectively to manage your disease and symptoms.
Canalith-Repositioning Maneuver or Exercises
These exercises are used when otoconia (also called canalith) have settled in the semicircular canals and are causing vertigo and other symptoms. The treatment of BPPV is often successful with this type of VRT. Common maneuvers your physiotherapist may use are called the Epley Maneuver or the Semont Maneuver (also called the Liberatory maneuver.) Both maneuvers involve your physiotherapist holding your head into a certain position and then lying you down onto your back or side. If successful this motion dislodges the canalith and moves it into the inner ear area where it no longer causes symptoms. When these maneuvers work to treat BPPV, they often work quickly, even in just one treatment session.
Your physiotherapist may also prescribe a set of exercises for you to do at home, which is similar to the canalith-repositioning maneuver that they perform with you in the clinic. The most commonly used set of exercises are called Brandt-Daroff exercises. These home exercises are generally used to treat BPPV but may also be prescribed for other vestibular disorders.
There are several machines that have been developed to challenge the vestibular system and therefore may be used in VRT if available. Examples include virtual-reality type simulators and moveable standing platforms. The benefit of these types of exercises is that the parameters of the exercise can be objectively set and measured, which allows objective improvement to also be measured. In addition, with some machines, once the program is set up, less direct therapist supervision may be required which allows more patient independence. With most types of VRT machines feedback is also provided, which enhances the learning ability. Home videos have also been developed for similar purposes.
These types of exercises work specifically on how you walk. Many people with vestibular issues develop an inefficient gait pattern. Your physiotherapist will assess your walking pattern and will prescribe specific exercises to address any issues you may have developed to compensate for your vestibular symptoms.
Many patients with a significant or chronic vestibular disorder avoid activity due to it bringing on their symptoms. These patients, particularly if of an elderly age, quickly become deconditioned. For these patients a general exercise regime aimed at improving cardiovascular health will be prescribed by your physiotherapist. The initial activity recommended is generally regular walking on even terrain, which should be done in a quiet and calm environment. As general cardiovascular health improves and normal walking is tolerated by the vestibular system then walking on uneven terrain and/or on a busy street where increased head movement is required can be initiated. Other general recreational activities such as golf, bowling, swimming or any other activity that you may enjoy can be discussed with your physiotherapist and added at their discretion.
Manual Neck Treatment
Some patients who experience dizziness or balance issues have a concurrent orthopaedic problem with their neck, which is causing or adding to their symptoms. In some cases this may be the original problem and in other cases a problem in the neck may have developed due to an existing chronic vestibular problem which in turn causes decreased voluntary head and neck movement. In these cases your physiotherapist at Interactive Health may also do some hands-on treatment for your neck in combination with the other VRT exercises described above.
Secondary injuries due to vestibular problems can easily occur due to frequent falls or near-miss falls. As part of your VRT your physiotherapist will ensure you are well educated regarding simple strategies that can minimize your risk for secondary injuries. For example, the use of a walking aid when you are tired or in a particularly busy environment, such as a grocery store, may be advised. Motion lights or night lights for during the evening hours or nighttime near the entry doors may be encouraged.