By Tonia W. Hale, DNP, MAOM, BSN, RN
This month, I would like to highlight Blue Ridge Regional Hospital’s (BRRH) innovative Vertigo Rehabilitation Program at our BRRH Fitness and Rehab Center. Millions of Americans suffer with vertigo at some point, and it can be challenging to pinpoint the cause in order to determine the most effective treatment for a patient’s case. One thing is certain: Dizziness feels awful, because while you are still, the world around you seems to be spinning.
Our vertigo specialists are highly trained in finding the root cause of a patient’s vertigo, and devising their optimal treatment plan. The team includes doctors of physical therapy (DPT) Brad Basch, DPT, and Joshua Reeves, DPT, and Manager of Rehab Services Chuck Nettles, DPT, as well as physical therapists (PT) Susan Herman, PT, and Sarah Osborne, PT. All are experts on different types of vertigo. The condition has many complex causes, and they offer the most advanced, successful and safe treatments for it. In fact, this team has become so respected, patients are coming from out of state to seek their care.
In case there is any doubt about how common vertigo is, Dr. Nettles provides an illuminating statistic. “Treatment for dizziness is the No. 1 reason for primary care visits for patients older than 65,” he said. The two primary types of vertigo are central vertigo and peripheral vertigo. Central vertigo is related to the brain and can be fueled by a condition like multiple sclerosis or a stroke, while peripheral vertigo is related to an imbalance of the inner ear and is the most common kind of vertigo.
Dr. Basch related that the most prevalent form of peripheral vertigo they treat is benign paroxysmal positional vertigo (BPPV). “It’s a very mechanical form of dizziness that is triggered by changing your position, like when you roll over or get up out of bed,” he explained. “Patients typically feel acute spinning for 30 to 60 seconds and then feel better if they remain still, but moving again can retrigger it.” This type of vertigo can also be accompanied by nausea and vomiting. It has debilitating consequences, like causing people to isolate in their homes for fear of having an attack in public and increasing their risk for falls, both highly negative impacts on one’s quality of life.
BPPV is linked to a pencil eraser-sized vestibular organ and tiny crystals in the inner ear that are keys to maintaining balance. When this delicate mechanism is upset and crystals become displaced, it causes disequilibrium and vertigo results. This imbalance can be created due to something as minor as an abrupt sneeze or a serious problem, like a concussion sustained in a car accident.
Dr. Reeves noted that there are many factors that cause people to feel dizzy, so getting to the root of the problem is critical. “The first thing we try to do with a patient is piece together other symptoms they may be experiencing, as one could be the origin of the vertigo. Everything from cardiac problems and neuropathy to neck pain or stress can contribute to balance issues,” he declared.
To discover the origins of a patient’s vertigo, they undergo tests in the clinic, including ones that monitor a patient’s eye movements. Dr. Reeves shared that putting patients in positions that provoke vertigo also helps the clinicians reach a diagnosis and formulate an appropriate treatment plan.
The good news is that BPPV is highly treatable and often requires the patient to make only one or two visits to get long-lasting relief. “Balance and coordination involve the brain, eyes, head, neck and inner ear all working in concert with each other,” said Dr. Basch. “Our goal is to get vertigo patients back to a place of independence, confidence, pain-free movement and full functioning. Depending on what they need, we offer physical therapy treatments like the Epley Maneuver, where we perform gentle movements that relocate floating crystals in the inner ear so that they no longer cause dizziness.”
A patient’s treatment plan may also include strength training and gait training. “All in all, treatment is highly customized,” said Dr. Nettles. “There are a variety of repositioning techniques we use based on what symptoms the patient is experiencing.”
Dr. Reeves highlighted the fact that the BRRH Fitness and Rehabilitation Center offers any and every environment a vertigo patient might need to address their specific problems. “We plan a course of treatment according to the patient’s abilities and condition to ensure that it can be executed safely. For example, if they’re older or have mobility issues, we might treat them individually in a treatment room, or we may work with another patient in the gym using the equipment there, or even in the pool,” he said. “Treatments are not ‘one-size-fits-all,’ and are guided in part by each patient’s level of ability.” The physicians made it clear that while one patient might come in once for treatment and be all set, requiring just a follow-up visit, another may need a couple months of treatment to gain their footing — literally and figuratively.
As with all other departments within BRRH, all patients who receive in-person treatment are getting it safely, with the full range of COVID-19 precautions in place to protect them.
The BRRH physical therapy team works in conjunction with many other providers to serve vertigo patients, who are referred for treatment by their primary care physicians, neurologists, and ear, nose and throat physicians. The program doesn’t just provide diagnosis and treatment for vertigo, it offers patients important education about vertigo and dizziness prevention strategies, as well as ongoing support.
In closing, I want to remind you to stay safe. COVID-19 continues to be present, and it is important that we continue to practice social distancing, wearing a mask and washing our hands.
Tonia W. Hale, DNP, MAOM, BSN, RN, is Chief Executive Officer and Chief Nursing Officer of Blue Ridge Regional Hospital in Spruce Pine.