From balance exercises to gyrating chairs, the idea is to reprogram the brain
By Meredith Levine, CBC News
For those with chronic vertigo, there is hope. Studies show that vestibular rehabilitation exercises can often help the brain develop alternative pathways for motion sensing.
But the exercises aren't much fun.
Even the high-tech gyrating chair that Sidney Crosby made famous three years ago while recovering from a concussion is no amusement park ride, and doesn't work for everyone.
Todd Reed, a Washington State gym teacher with chronic vertigo, almost quit after his first spin in one of the chairs because it left him so nauseous and dizzy. But he stuck it out and eventually saw some improvements to his balance.
Vestibular rehab is a bit like a "hair-of-the-dog" treatment.
The dizziness and other symptoms that patients with extreme vertigo experience are, in effect, error signals sent to the brain to alert it to a problem with the motion system.
Vestibular rehab exercises intentionally provoke these symptoms again and again to help the brain figure out a way to adapt to the damage and turn off the error message.
This can take months or even years to accomplish.
Some patients, like Winnipeg video editor Joni Church, don't have access to trained vestibular rehab therapists and improvise their own form of brain retraining by carefully re-engaging in activities that are both demanding on the body's balance system and enjoyable — such as gardening, which requires bending and standing repeatedly.
Others, like Gary Nystrom, a retired firefighter from Stouffville, Ont., try more aggressive rehab at places like Toronto General Hospital.
There, his eye-ear balance was measured while he tried to stand on a rubber cushion — which is almost impossible for him. And he was given a series of brain and walking exercises to try to reprogram his balance system.
For people like Nystrom, though, with damage to both sides of the inner ear, the success rate is barely 20 per cent.
The rotating chair
The most high-tech form of vestibular rehab is the computerized rotating chair — not unlike the Zipper ride from a fair ground, or one of those machines used to train astronauts for space.
Patients are strapped into a chair encased in a large clear Plexiglas cage connected to a computer, which is specifically programmed for each patient.
The chair then rotates and tumbles in any direction or axis prescribed — up, down, left, right and sideways, slow or very fast.
These devices work on the same principle as vestibular exercises by trying to reprogram the brain in a demanding situation to create new pathways.
Sidney Crosby, the Pittsburgh Penguins star, brought almost worldwide attention to these rotational chairs when he went to Atlanta, Ga., in 2011 to be treated for his vestibular concussion at the Functional Neurology Centre, then headed by Dr. Ted Carrick, a chiropractor with advanced training in neurology.
There is much anecdotal evidence that the rotating chair can be more effective than vestibular exercises on their own (those treated by Carrick do both), but there is still a lack of published research.
When Todd Reed was at Carrick's clinic, not long after Crosby, he found himself waiting alongside football and hockey players to take a spin in one of these chairs.
A 39-year-old gym teacher from Zillah, a small community in central Washington, Reed has been living with the effects of superior canal dehiscence, or a hole in the bone in the inner ear, for several years now.
Surgery fixed the hole but it also intensified some of his vestibular symptoms — head pressure, disorientation, dizziness, bouncing and blurry images. His sessions in the chair helped with at least some of these.
Not everyone's solution
Not everyone who tries these rotational chairs benefits, however.
After travelling all over the U.S. seeking medical advice, Lisa Tanner discovered Dr. Carrick's clinic only 45 minutes from her home outside of Atlanta.
Tanner's illness came on suddenly when she was eight weeks pregnant with her second child.
Her obstetrician thought it was morning sickness, but it didn't disappear, and Tanner ended up with perpetual motion sickness while caring for a newborn and a two year old.
She spends a lot of time sitting still to reduce the symptoms.
And it is not just motion that causes problems, she has trouble reading — the words bounce around on the page and the computer.
At the Carrick clinic, she was first given an individually tailored set of vestibular exercises, and then went on to the rotating chair.
But that first try triggered a setback, and she never went back to it. Tanner has sought out treatment at other clinics in the last year — both conventional and alternative — but has yet to find anything that works.
Despite the lack of improvement, Tanner refuses to give up. "The first thing that I say every morning when I wake up is this is the day that I get better. I've been saying that for 10 years."
Worsens with aging
The sad reality for vestibular patients, though, is that whatever gains they make through therapy, surgery or other treatments, they are unlikely to be sustained with age.
That is because vestibular cells gradually die off as we get older, even in healthy people, and our balance decreases.
When the vestibular system is already compromised, the impact of the die-off can hit much earlier, sometimes with serious consequences.
Ann Stevens, a retired banker from Hamilton, Ont., was born with Chiari malformation — her brainstem doesn’t sit in the right location at the base of her skull — which can lead to significant vestibular problems.
Things were better for many years following surgery at the age of 13, but once Ann hit middle age her condition deteriorated to the point that she had to stop working a good decade and a half before she planned to retire.
"I loved my job," Stevens says. "My world has gotten very small, and I miss the social aspects."
These days Ann spends a lot of time on the floor. In fact, she falls often, several times a week, and these falls can be triggered by the slightest movement.
She was recently standing in her kitchen talking on the phone to her sister, "and I just turned sideways and I fell," she recalls. "My sister's going 'Ann, Ann are you okay?' I got back up and I said, 'It's okay, I just fell again.'"
Stevens laughs but she knows her situation is anything but funny. She also knows her condition will only continue to worsen.
But she fights hard every day to keep as much quality of life as she can. "I can still get my eyeliner on," she says with a smile. "If you ever see me without my eyeliner, you'll know something's gone wrong."
Source: CBC News