Retraining the Vestibular System to Prevent Falls

One 80-year-old fractures a hip, which triggers a physical decline that leads to an early death. Another octogenarian still enjoys golf and tennis. What is the difference? Staying healthy--and a big part of that is maintaining healthy vestibular function.

Half of elderly people who fall have vestibular deficits. Falls are the number one cause of fractures and are associated with 40 percent of all nursing home admissions.

However, vestibular disturbances shouldn't be considered an inevitable part of growing older. The elderly also aren't alone in dealing with these problems. Young athletes with concussions, survivors of traffic accidents and other head injuries can struggle to regain a sense of where they stand in relation to the world around them.

"The neuroplasticity of the brain allows the vestibular system to be retrained," Carl Stephenson, MD, of Tuscaloosa Ear Nose & Throat Center, said. "Our physicians begin with a detailed diagnosis and examine other factors that may be contributing to balance and vestibular issues. Then we work with FYZICAL Therapy and Balance Center next door to design an effective therapy plan to address the individual patient's specific problems."

The center is part of a national group of centers that offer specialized therapy in balance as well as other physical therapy services. FIZCAL's patented protocols are aimed at helping patients improve faster in a safe environment where they can build the confidence to do more as they rebuild both their balance and their physical condition.

Dustin Clary, PT/span>

Dustin Clary, PT said, "The physicians at Tuscaloosa ENT use some advanced testing methods, and the results give us a clear picture of the patient's overall health and the deficits we need to correct. That guides us in designing a therapy plan to achieve the best outcomes.

"It's important to create an environment where patients can feel safe. We have a patented overhead safety support system so they don't have to worry about falling as they relearn the mechanics, correct their posture and work to improve.

"So often, balance problems develop after an earlier fall. People become apprehensive and stop challenging their balance centers. They lose strength, their posture changes and their sense of where their center of balance is changes with it. They become more inclined to fall. If they fall and get a vestibular concussion, this adds more balance issues."

Stephenson said, "Our ENT's see patients with everything from vertigo to Meniere's, stroke damage and injuries to balance centers. We also have to consider things like possible side effects from medication and problems with muscles, joints and bones."

Therapies to rebuild neural connections between eye, ear and the balance centers of the brain may include biofeedback and 3D virtual reality techniques. Retraining muscles, joints and posture includes physical therapy to improve strength and endurance, as well as gait training and coordination.

"We've been seeing more young athletes to help them regain their balance and coordination after injuries," Clary said. "There can be vestibular problems after concussions that need to be corrected. Otherwise, the athlete's sense of balance and coordination can be affected. It can throw off their playing skills and make them feel clumsy, which can put them at risk of more injuries."

Vestibular disturbances can also be linked to other health issues that may not be immediately apparent.

Stephenson said, "My wife was one of our first success stories. She had headaches that didn't seem to be linked to any of the usual causes. It got so bad that when she was driving she had to pull over. Dustin asked me if she had been tested for eye-vestibular mismatch. That turned out to be the problem. After therapy to retrain her eye and vestibular coordination, the headaches were gone."

"This is similar to the eye-vestibular mismatch that occurs in motion sickness," Clary said. "Some people begin to depend more on their eyes than their vestibular system. Receiving two different inputs can be difficult for the brain to process. But people can be retrained to trust their vestibular system again."

The physicians at Tuscaloosa Ear, Nose & Throat Center frequently identify patients who are at risk of falling or are in the early stages of developing balance problems.

"They often refer patients for our BodyQ evaluation," Clary said. "It can help people of all ages identify and track issues related to balance, fall risk, and overall fitness. Even in middle age, people can begin developing problems with strength, flexibility, posture and balance that can be corrected so they don't turn into bigger problems later."