Since the inception of the Dizziness & Balance Disorders Centre in the late 1980s, our mode of operation has been based on the important model of taking a multi-disciplinary team approach, which is a core theme of this year’s Balance Awareness Week.
We argue that this multi-disciplinary team approach is not just ideal, but it should be obligatory.
This is because no one professional has all the skills to satisfactorily diagnose, assess, treat and manage the dizzy patient, whether they’re a neurologist, neuro-otologist, neuro-ophthalmologist, rheumatologist, ENT specialist, audiologist, clinical psychologist, vestibular physiotherapist, optometrist, orthoptist, or occupational therapist, just to name a few.
For you, as a dizzy patient or their carer, I believe it should be heartening to hear how our related professions are embracing this approach of working together for your best outcome. And this team-based approach is sure to increase after participants learn from Dr. Habib Rizk in his special presentation to allied health professionals about how multiple specialities – neurotology, audiology, and physical therapy – are working together to promote better outcomes for people with dizziness, vertigo, and imbalance.
In the meantime, as my contribution to Balance Awareness Week 2023, I’d like to catalogue some of the many tools and approaches available to me and my fellow practitioners today, ranging from Infra-red Video Frenzel Goggles (Vestibular First), the ICS head impulse system (GN Otometrics), Virtual Reality Rehabilitation (VirtualisVR), and more recently the Balance Mat (Balance Metrix), the Balance Belt (Elitac), and Urban Poles for people with neurologic and vestibular disorders, and other disorders causing balance and walking problems.
The truth about falls, balance, and vestibular patients
The sad fact is, falls can cause much damage to the brain and our balance systems and that a fall, or falling, can happen to anyone. None of us is immune.
In my experience, vestibular patients are particularly prone to falling in darkness and low light, as well as on uneven surfaces, because the vestibular system orients us in space when our eyes are closed (e.g., shampooing our hair under the shower and we close our eyes), and when we are walking in a dimly lit or dark environments (e.g., theatre or cinema), and on uneven surfaces. It is our vestibular system which is responsible for our dynamic balance – moving on uneven surfaces like surfing the waves, trekking in the bushland and so on.
The other sense that plays a big role in balance is hearing.
Hearing orientates us in space in both light and darkness. This is why it’s so important we as physiotherapists ensure our patients are wearing their hearing aids, have their hearing checked at a Diagnostic Centre, and that they continue to wear their hearing aids instead of leaving them in the drawer.
The little appreciated risk of ignoring hearing is that our brains require sound to remain healthy and stimulated quite apart from communicating with others. Without it, our cognition deteriorates, which means dementia develops as a result.
Hearing health is vital to our wellbeing.
I hope the picture is becoming clearer and you can grasp why I believe the multi-disciplinary team approach between professionals is so important?
Walking poles, goggles, VR, belts – our vestibular toolkit is impressive
For several years, we have been using Urban walking poles for our patients who have balance and mobility problems due to many different causes such as polyneuropathy, Parkinson’s disease, spinal lesions, vestibular disorders, musculoskeletal issues.
I have personally put the Urban trekking poles to the test, courtesy of Juliette Fritschi. Juliette is a physiotherapist, is an Urban Poling Master Trainer with a PhD in the health benefits of walking, and with her support, and these wonderful poles, I have been able to trek in Australia’s outback with a cohort of 17 walkers (average age 65 years).
As a result of this first hand experience, I have been able to advise on the use of poles with neurological and dizzy patients, coupled with the heartening message that “it is never too late to trek or exercise safely”.
Another very useful tool is The Balance Belt developed by Elitac in Denmark.
It is very helpful not only for people who have lost the balance organ in each ear (bilateral vestibular loss) but also patients with some loss of vision and bilateral vestibular loss due to a systemic infection, resulting in bilateral vestibular loss. This means the person only has the sensation from their muscles, joints and skin.
The Balance Belt is sometimes used in tandem with the Balance Mat.
The Balance Mat is an Australian made product, which is very easy to use, portable and non-threatening to patients. It provides objective results immediately and shows whether the patient’s balance is improving or not.
This tool is versatile and can be used for assessment and training.
Meanwhile, the wonders of technology have also made possible a virtual reality tool.
VirtualisVR solutions make it possible to simplify and speed up the creation of wide-ranging assessments, with their virtual reality tool. Virtual Reality (VR) is often seen as a way to take care of a patient through visual input, especially when management of visual dependency seems to be an obvious part of the situation. Through VR we can stimulate the vestibular system by means of active head movements by controlling speed and amplitude. Patients suffering motion sickness and Visual Induced Dizziness (aka Visual Vertigo) can benefit from other programmes offered by VirtualisVR. It is a valuable tool when used judiciously.
And the final technology I’m showcasing in this article is the ICS Head impulse system.
This system provides comprehensive objective data of the vestibular system and is superior to the bed side head impulse test developed by Professors Ian Curthoys and Michael Halmagyi in Sydney, Australia.
The Dizziness & Balance Disorders Centre purchased this equipment as soon as it was released on the market in June 2012.
This is particularly helpful for children and bed-ridden patients, let alone any patients who have been struggling to understand why they suffer dizziness when performing one or more basic activities of daily living such as bathing, dressing, or simply getting around inside the home. There are many more causes of dizziness than Benign Paroxysmal Positional Vertigo (“your crystals are loose”).
From ICS Impulse software-video to Infrared Video Oculography Frenzel Goggles, your earlier diagnosis can lead to quicker rehabilitation, and importantly a customised vestibular rehabilitation programme.
While some of the technology in this article might seem like cutting-edge equipment, it is an essential part of the modern assessment of vestibular disorders, taking the guesswork out of diagnosis and treatment. One hat does not fit all!
I use the equipment discussed here because it offers objective, accurate, reliable data (information), which enables us to design a patient-centred vestibular and balance rehabilitation programme. Moreover, it is an efficient use of time for all involved.
I hope you find Balance Awareness Week the perfect opportunity to raise this topic with friends or familiy for the benefit of all.