ICU – “I SEE YOU” PODCAST
Vestibular Rehabilitation: What Works, What Doesn’t
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Vestibular rehabilitation therapy, or VRT, is a specialized form of exercise-based therapy designed to alleviate both primary and secondary symptoms of vestibular disorders. VRT uses specific head, body, and eye exercises designed to retrain the brain to recognize and process signals from the inner ear and coordinate them with information from our eyes and muscles. Physical therapists are challenged with creating a customized therapy plan for each patient. While VRT is an evidence-based approach for treating many types of vestibular problems, it’s not always the miracle-cure many patients are hoping for. In this episode of the ICU (“I See You”) podcast, hosts Cynthia Ryan (VeDA Executive Director) and Kimberly Warner (Unfixed Media Founder & Director) explore what works and what doesn’t when it comes to Vestibular Rehabilitation Therapy. They invite Physical Therapist Matt Whitaker and vestibular patient Ashley Chin to discuss this topic, bringing together the patient and healthcare provider perspectives.
About the Guests
Ashley Chin
Ashley is from Greenville, SC. She is a former Emergency Room RN turned home baker after many medical issues, including vestibular migraine and PPPD. She enjoys baking, crafting, and really anything nerdy including Disney, Star Wars, board games, etc. She and her husband have been married for almost 5 years, and have a sweet Wire Fox Terrier puppy named Luna.
Matt Whitaker, MPT
Matt is a physical therapist with over 20 years of experience. In 1998 he earned his degree from Loma Linda University where he co-founded the vestibular rehabilitation program for the outpatient neurological clinic. He was also a guest lecturer and vestibular instructor for doctoral physical therapy students and neurology residents. For the first decade of his career, he treated patients with neurologic conditions, working in all settings including acute and ICU care, inpatient rehabilitation, home health, and skilled nursing. Over the past fifteen years, he has focused on orthopedic care but remains passionate about helping patients with vestibular issues. Today, Matt is a co-owner of Evolve Physical Therapy, a clinic with two locations in the Portland metro area where he lives with his family.
Hosts:
Cynthia Ryan, Executive Director of the Vestibular Disorders Association (VeDA) https://vestibular.org/
Kimberly Warner, Founder and Director of Unfixed Media https://unfixedmedia.com/
This podcast is a co-production of the Vestibular Disorders Association (VeDA) and Unfixed Media.
TRANSCRIPT
VeDA uses otter.ai to create machine-generated transcripts. This transcript may contain errors.
Cynthia Ryan – VeDA
Welcome to the ICU Podcast where we explore the vestibular experience through conversations between patients and the health professionals who care for them.
Kimberly Warner – Unfixed Media
During this podcast, we invite patients to share their stories and healthcare professionals to ask questions, so they are equipped to better care for and truly see the invisible challenges faced by their patients. I’m Kimberly Warner.
Cynthia Ryan – VeDA
And I’m Cynthia Ryan, and we are your hosts on this journey of discovery.
Kimberly Warner – Unfixed Media
Welcome, everyone, to our next episode of the ICU podcast. I am really looking forward to today’s discussion where we explore vestibular rehabilitation, what works and what doesn’t. Vestibular rehab therapy or VR T is a specialized form of exercise based therapy designed to alleviate both primary and secondary symptoms of Vestibular Disorders. As many of you know, VR T uses specific head body and eye exercises to design designed to retrain the brain to recognize and process signals from the inner ear and coordinate them with information from our eyes and our muscles. Physical Therapists are challenged with creating a customized therapy plan for each patient. But while VRT is an evidence based approach for treating many types of vestibular problems, it is not always the miracle cure many patients are hoping for. We have two wonderful guests with us today and like always, one is a patient and one is a healthcare professional. I’m going to introduce our patient today, Ashley chin I Ashley. She is a former emergency RN from Greenville, South Carolina who retired her nursing career and turn to baking. After many medical issues including vestibular migraine and pppd. She enjoys being in the kitchen, crafting and doing anything she calls quote unquote nerdy, including watching Disney star wars and playing board games. She and her husband have been married for almost five years and have a sweet wire fox terrier puppy named Luna.
Cynthia Ryan – VeDA
Welcome, Ashley. We have so much in common in the baking and the nerdy stuff.
Ashley Chin
I’m a big nerd man. It’s at first when I was younger, it was like oh, do I really want to be but now it’s like, oh wait, I found my people like,
Kimberly Warner – Unfixed Media
embrace it.
Cynthia Ryan – VeDA
I totally I totally get that. Well, I’m going to knock them our next guest, Matt Whitaker, who is a physical therapist with over 20 years of experience. In 1998. He earned his degree from Loma Linda University where he co founded the vestibular rehab program for outpatient neurological clinic. And he also is a guest lecturer and Stigler, instructor for doctoral physical therapy students and neurology residents. For the first decade of Matt’s career, he treated patients with neurological conditions, working in all settings, including acute and ICU care, inpatient rehab, home health and skilled nursing over the past 15 years. He’s focused on orthopedic care, but remains passionate about helping patients with vestibular issues. Today, Matt is the co founder of Evolve physical therapy clinic with two locations in the Portland, Oregon metro area, which is where VITA is headquartered. And he where he lives with his family. So welcome, Matt. Thank you.
Matt Whitaker, MPT
Thank you, Kimberly.
Kimberly Warner – Unfixed Media
Side note, Matt actually treated me. We worked together for a good Gosh, Matt six or seven months and he did some really, we didn’t do VRT, we did more cervicogenic work together, but he’s an excellent PT. So I’m here to plug that.
Matt Whitaker, MPT
Thank you. That was, you know, I I saw Kimberly, your your article on Vedas website. And when I first saw it, I kind of wonder what she has done and wondered why because you had quite a quite a journey there. And so one day I read a pop up in my waiting room, I walked out and I said, I thought I know this person, but I don’t know. So that was
Kimberly Warner – Unfixed Media
like, I think I need to help this person.
Matt Whitaker, MPT
Maybe. So well. Good. Meet you. Ashley.
Ashley Chin
Nice to meet you, too. Matt.
Kimberly Warner – Unfixed Media
Ashley, actually, let’s start with you. Let’s hear a little bit about briefly. I know it’s a long journey for many of us, but briefly describe the onset of your vestibular symptoms. So we can all learn about that a little bit.
Ashley Chin
Yeah, so my first vestibular symptoms, was really just vertigo. was actually the day of my wedding. I was I got married and you We got married in Beaufort, South Carolina was was hot, it’s an October. So it’s it’s like, you know, it’s a little human. And I remember sitting down and just being like, really off like feeling like the world could like really start spinning and I was like meal, I’m in this giant dress, it’s hot there stress, like, it’s, it’s fine, just give me some water. And thankfully, like after that I was fine. Um, and then I ended up flying home to California, because at the time, that’s where I was living with my husband. And I was supposed to go back to work. And I called out one day because it just didn’t feel right. And then the next day I went to work and you know, busy er, nightshift nurse just running around, and all of a sudden, I’m talking to a patient, he and his wife are sitting there, and the world just like my world just started spinning. And I had to like grab onto his bed rail, and I put myself like sat on the ground. And I called for help on my radio. And that was the start. Really, that was like my big start. And at that point, they the ER, they put me in an ER bed to make sure I was okay. And the doctor ended up telling me I had laryngitis. And so that was like my first diagnosis because we all go through probably a couple before we find the right one. So so that was the start. And then throughout all that I went back to work as a nurse after I completed one cycle of VR T. Jimmy he was great out in California. He was a big Disney nerd too. So we got along. And then after unfortunately, after that, I got COVID in December of 2019. Right before everything happened, and it basically kind of they think it re activated, what was happening. And I think it hit my inner ear and my eyes. And so after that, I struggled a lot. And I now have VM and pppd. And then I have some eye issues as well. I go see a vision therapist once a week. So
Kimberly Warner – Unfixed Media
let me just clarify. So the VRT that you got prescribed was that because they thought you have labyrinth itis and that was that happened pretty immediately after that initial diagnosis.
Ashley Chin
You know, that’s a really great question, because I totally even forgot, because everything’s happened so much. I originally went to the e and t and the e and t said, Hey, like, I hate to tell you this, but you’re like fitting this category for VM. But you know, it could not be but I want you to go see, he prescribed PT for me. He said go see this, the doctor. And so we started that. And they originally got I had a little bit of BPPV. So they treated me for that. But that’s never happened again. So we’re not fully sure if that was actually a thing. But then we did VRT after that and then I saw a neurologist, and then we started meds and everything but the end was honestly the first person who was like, No, I think you have VM you fit the genetic profile like the young 20, mid 20s white woman is he’s like I’m sorry, but that’s that’s where you are.
Cynthia Ryan – VeDA
And for those who are listening who aren’t used to all of our acronyms, which we love. Vm is vestibular migraine. VRT is vestibular rehabilitation therapy. Those are two that we’ll use a lot BPPV people do often know about by its abbreviation, but it’s Benign Paroxysmal Positional Vertigo where the crystals in the inner ear are out of place, and then PP PD or triple PD. There’s just so many acronyms. Is perceptual postural perceptual versus this mat persistent. Yep. That’s it. That’s a persistent postural perceptual dizziness. Okay,
Kimberly Warner – Unfixed Media
well say that three times fast.
Matt Whitaker, MPT
That’s why they call it three PD. Yeah, exactly.
Cynthia Ryan – VeDA
But just wanted to make sure for people who don’t know all of all those acronyms, anyway, so um, so Matt, tell us what the typical intake for possible vestibular patients somebody who comes in with, you know, dizziness, or vertigo and is likely having something that is was tubular going on what when they come into a physical therapy office, what does their intake look like? How do you evaluate them to determine maybe, is it the stimulator or not? Is it inner ear or Central and And then what would you do with them afterwards? Or who else you might refer them to?
Matt Whitaker, MPT
Right? Well, I think, you know, Ashley’s story is very illustrated illustrative of the fact that you can’t necessarily go straight with the diagnosis that was given an orient your, your history and your testing around what’s written on the paper, you know, I would be curious as the, as to whether or not it was established that you truly had a labyrinth itis. And if it was, if it was something else, right. So in that, in that vein, listening is the key. I really, I really believe in that sincerely. Because knowing that the course and the journey that people take to come see us, it’s usually with an event like she had, she ends up in the ER, if you happen to be there that day, you probably had some testing done, you were probably in a waiting period to see the EMT, maybe you got to see a neurologist, somewhere in there, you probably had an MRI, and you go through all these hoops. And when patients come to us, we have the luxury of time. And, and most clinics, you’re going to get at least 30 minutes with the provider. We do it at 45 minutes to an hour. And I had a Menieres patient a couple of weeks ago, we spent almost the full hour taking the history. And part of that is cathartic, I think for the patient, and to be able to establish a good therapeutic alliance where you’re not telling but you’re you’re listening. And you can then start to ask questions around that story and around those specifics to that patient that can clue you in better as to what you actually need to test and to treat. And so that process might be a couple of visits in duration, just to get that history and then move in the direction of testing. The other thing that is interesting with this diagnosis as it relates to physical therapy, you know, our profession in the name, insinuates some sort of contact or activity. And activity is usually shunned by these individuals, they don’t want to do activity, and the component of touch. Unlike most things in medicine, or other conditions, let’s say this is a very test history heavy area to treat. Your EMT is typically maybe grabbing your ear and looking inside, and that’s about it. You know, you do follow and do some visual tests. But the actual touch component of what we are used to doing has been lacking up until that point. And I think touch is a very powerful thing. And so if a patient is presenting with a lot of tension, you can see posture lead, they’re just holding themselves in guarding, you know, with their movements, sometimes just in the initial session saying, hey, let’s check out your neck and spend three or four minutes there five or 10 minutes there to see if there’s a contributor can really diffuse and kind of ease the the anxiety that they come in with. And so from from a typical, you know, you ask what a typical typical intake looks like it’s going to be listening to that story, it’s going to be asking lots of questions that can guide you as to where you need to test. And then seeing if you can do something to give them immediately relief, I want to grab the lowest hanging fruit right away. And then from there, I’ll do a balance series of Balanced assessments. Because I want to know, their true baseline if they haven’t BPPV overlying some, you know, peripheral problem, other peripheral problems, then we want to actually get the real baseline, we don’t want to dilute that by treating the BPPV first, right, so then I’ll go through their ocular motor testing and their balance testing, and then assess those things that we can get right off the bat and provide relief for. So that’s that’s the typical
Kimberly Warner – Unfixed Media
work. I mean, I I remember Matt, the when we work together, I think I really appreciate what you said about just the listening because I think a lot of us actually you probably know this when we go in we have a lot of anxiety and we’re just we start to kind of have a higher baseline of anxiety because we’re just used to this sensation all the time and so to have finally be listened to for an hour. Yes, really, really comforting.
Ashley Chin
So I feel like I the relationship I had with my pts. And because I went through VRT a couple of times And then I also went through one specifically for pppd. But the relationship I had with them was much different and much closer than I had with my doctors. And I felt like they really listened to me, and really changed my outlook on things. I like Matt said, like, when you were saying the working on the neck, for probably the first like six months of each, well, the first time wasn’t six months. But like the last two times I did VRT, we started with the neck. And it really just because you’re trying not to be dizzy all the time. So you’re putting all this tension here, and I’m sure that you, you see it, and it just made it so much better. And learning those techniques, and just kind of like listening. And so then my husband could help me too. And mine were also great, where they would kind of pull my husband and and be like, hey, you know, you can do this at home. Which was really helpful. So
Kimberly Warner – Unfixed Media
it sounds like you had? Well, I don’t know, did you go in with expectations of what VRT was going to be like, actually, because it sounds like you’ve had a good experience. And
Ashley Chin
I had no idea what was happening when I went to be honest, I just know, I was like, I can’t walk to the bathroom. So if these people are going to help me be able to even get to the bathroom without having to like hold on to a wall or crawl there, then I am up for anything. Um, and they were great. I actually. So when I said I had I got sick the first time and then I went back to nursing. And then I went got sick again. I went back to the same PT office because I liked them so much. And they did. They were so great. And they listened to me, especially because you know how a lot of times testing will come back and be like, Oh, you’re at like 95% of everybody. And you’re like, but I still don’t feel like me, like I might be testing here. But my level, especially as an ER nurse, and I used I was a volleyball player throughout high school, my level was like up here. So I’m like, if I’m still here, that is not, that’s not me. Yeah, and that’s not where I live my life on the daily. So we I that was my big thing. And they understood that. And so they pushed me to make sure that we were not just staying at where like barely passing is where some people live, which is fine. But that’s just not where I lived. And so they were great about that. Awesome. Yeah,
Cynthia Ryan – VeDA
I think that the expectations is a big part of it. I know, I went to a physical therapist recently. And that is the first thing they ask is, you know, what are your goals and, and addressing those goals and, and helping you get back to what you consider, you know, your normal or is as close to that and and also maybe setting expectations for, for helping you set, reset your expectations. Because you know, like, for example, when I left the last physical therapy appointment, this is for, you know, different kind of issue a car accident, I’m like, Well, I it’ll be great to see if I can get back to 100%. And he’s like, Oh, maybe not 100? You know, and and it’s helpful to hear to hear that sometimes. Matt, you were you were talking about getting the information from the other health care providers, you know, actually saw an EMT and neurologists, how do you work with a patient’s healthcare team in to either, you know, gather information from them share information with them, you know, how’s that work?
Matt Whitaker, MPT
I think, you know, the, the first thing to do is to kind of medicine is so time intensive, the whole system, right? And so I don’t, I try not to pick up the phone unless I need to. And I kind of let the evaluation speak for itself. And if we find something a little bit differently than that’s great. And let’s explore that. Because these are going to be time intensive treatments. They’re not short term. You know, if somebody comes in with a knee problem, and it’s diagnosed with x, and I think it’s y, that might necessitate a different treatment plan immediately. With the stimulant problems, you have to do a little exploration. And so this is the arena to do that exploration, the position, the audiologist, they’ll do their assessment, they’ll do their diagnosis, and then we flesh it out a little bit and even with the same diagnosis with different patients, you’re going to have different different reactions, different responses, different progressions, right. So um I tried to be respectful of time if there is an issue, and we’re not progressing as expected. First off, we got to reevaluate what I’m doing. Am I missing the mark? In? And am I needing to redirect my treatment, and sometimes is good as we think we are with our explanations, we say, Hey, let’s go through this again, and what exactly are you doing at home? And there might be a real discrepancy between what would be ideal and what the patient is performing. And so we’ve got to go back and say, Okay, where did I miss the mark, in teaching, instructing to get a good outcome and a good home program? So that would be another another thing to evaluate? Before reaching out and taking other people’s times. And then there’s other conditions where other situations where yes, you do pick up the phone and you talk to the auntie or you talk to the neurologist, or last week, I called a PCP and said, hey, you know, this current patient has recurrent BPPV just cannot shake this, shake this loose. The opposite can’t stabilize this. And can we look at vitamin D levels, because some of the recommendations and the research out there says, hey, if you’ve got a really low threshold of vitamin D, you need to maybe like it’s supplementing and and utilizing calcium, to aid the absorption so that you can maybe influence that recurrence. And so that data is out there. So so that was great. I didn’t have to bother a specialist in the primary care said, Yes, send me send me what you got. And so I, I emailed a few articles over to them, and the patient went in, and they’re doing follow up now. So I think, you know, avoid the paper pushing, pick up the phone when warranted, and make sure you’ve done your your homework prior to taking other people’s time.
Cynthia Ryan – VeDA
So it sounds like you’re doing a couple of things. One is evaluating when, you know, what you what might be best for the patient? Is it within your scope of practice? And referring them then to the appropriate other health care providers, such as the primary care provider for evaluation of vitamin D levels? And and also, here’s a question if you had a patient, for example, that came in with a BPPV diagnosis, and you do an evaluation and you’re like this, I don’t think this is what it is, I think that they might have something else would you then refer them back to a specialist for to be reevaluated and maybe get a different diagnosis?
Matt Whitaker, MPT
Maybe not right away? I’m going to treat what I see. You know, luckily, in the state of Oregon, people can walk in the door and say, Hey, I’m dizzy. And, you know, I don’t hope to see those. But sometimes people walk in and say, I have BPPV. Can you help me and retract? Yeah, have you have BPPV? There’s you do in neurologic screen, you make sure there’s nothing else emergent, potentially, because that’s dizziness is not you know, it can cover a lot of ground and you have to be be safe with that. But I will treat, and if I know what it is, or I feel like okay, yeah, maybe it’s not a BPPV. Maybe you have something that is mimicking this. And it’s a vestibular problem, I’ll go ahead and initiate that treatment and certainly inform the referring provider as such. But I guess I’m not so dependent on a provider’s diagnosis as what can I do for the patient right now? Where can we go and get on the road to recovery? Because a change in a in a name of something on paper is not going to help them? And I think that’s, that’s kind of the everybody’s looking for the label, right? What is the problem? What do I have? And somebody you know, actually got labyrinth itis, which sounds like may or may not have been the case at that moment in time. So what can I do to help them in going back to your original question about referring out I think that intake process, that patient report that therapeutic alliance, you can start also having conversations about getting things like anxiety addressed, and getting life stressors that may be contributing and stacking on to their problem that amplify it, getting that addressed, and it’s very, that can be a very sensitive conversation for some people. Like Oh, you think this is causing this So you think it’s in my head is like, no, no, here’s how this, here’s how these things work together and amplify each other. So being able to, to have that conversation as in a way that makes them feel comfortable, and spurs them to action, as opposed to maybe makes them a little bit more defensive. Because when you talk about that component of care that is perceived sometimes by patient is, instead of something that’s wrong with with my body is something that’s wrong with me. And that’s a different conversation. And so I think you have to tread lightly, you know, over time. You know, and certainly the time I’ve been practicing, that is not so sensitive. And so we’re a little bit more open to discussing those things and being open to addressing him. But I still think you have to be careful in how you how you approach but but when you address it, it can have a wonderful benefit, and complement to making them feel better.
Kimberly Warner – Unfixed Media
Yeah, Matt, we’re all nodding our heads. I appreciate a couple different things you shared, but I want to especially it just your approach is patient centered instead of insurance centered, the fact that you would, you know, defer going back to the PCP to get the diagnosis, delay the process till it send the patient home without any treatment, and instead just look at them and say, Hey, let’s address right now, what I feel I can help you with, you know, and I think that’s just such a, that’s a that is demonstrative of your understanding of the suffering that that patient is walking into your clinic with. They want help. So, but now, so Ashley, I want to turn it over to you because what happens, and I know many of us have had this experience too, with VRT, you had some good things happen. Did you have anything that didn’t work?
Ashley Chin
Um, so I will say, I want to say there wasn’t really much didn’t work. My PTS were really good about trying to hit the like correct spots for me that I needed. They were also really good at identifying when they couldn’t help me as much as they could as much as I needed. So for instance, my PT realized when I told him, I was like, when I look at the stairs, the stairs don’t look like I can’t judge the distance between them. They all look like one when I’m walking up them. And he was an I mean, we were doing eye exercises we were I was twisting my head many, many times a day. And he sent me to the vision therapist, and I didn’t even know that vision therapy was a thing until then. And that’s when I started. And then when I moved, I continued. And it’s because of my original PT that told me that I should go was because is now where I am today. So I feel like nothing he did didn’t work. I feel like a lot of things that he and a couple of my other therapists they all did together helped me get where I am. I don’t think it was just one thing. I think VRT for me was a stepping stone into being able to accept the extra therapy that was coming afterward. For instance, as I said, vision therapy, but I also ended up doing driving therapy, like out occupational outpatient driving therapy, and I would not have been able to handle that without my VRT. And so yeah, interesting.
Cynthia Ryan – VeDA
Yeah, that’s a really great example and description of, you know, it’s not about what works and what doesn’t work. It’s that VRT is meant for certain things, but it’s not going to fix everything. And you saw out and we’re, we’re directed to other avenues to to look at and deal with it holistically. Matt, I’ve kind of two questions and one for you how the first question is how do you deal with a a patient who isn’t achieving their goals? And or how do you look at patients who maybe VRT isn’t what they need or isn’t all of what they need?
Matt Whitaker, MPT
Right. So going back to to what I said before about evaluating what we’re doing, and how we’re doing it, right and are we doing it right and are are the patient’s during the ride? Are they? Are their expectations? Correct? And are they implementing correctly if we kind of cover all those bases and check those boxes. It goes also back to what I said initially not to shun the diagnosis. But but because I want to help them right away. But to make sure that you are pulling in and going back to your provider or referring to an appropriate provider to say, Hey, can you please reevaluate or picking up the phone and talking to the auntie that referred and say like, this is not responding. As such, I had a I recall a patient that came to me with a presumed I can’t remember if it was a labyrinth itis that they were presumably getting over. Or if it was BPPV. But but she ended up having three PD. And so you know, we’re doing all this stuff. And it’s just like, this isn’t quite, this isn’t quite lining up. And, and so we were able to give them some strategies, we were able to give them some things that would help with some of the somatosensory inputs with some vestibular or some visual inputs. And dissuade some of those symptoms. But also dig down and figure out, you know, this person was under stress. And they just kind of said, well, this is my life. And that stress component was not even acknowledged to need to be addressed. And then when we said, Well, let’s look at what’s going on here. You know, multiple moves multiple jobs in these short timeframes and, and kind of reoccurring, reoccurring things that you look at any psychology book that says, These are major life stressors, this person is having it every three months sort of thing. And then they’re kind of wondering, why do I have this this problem? And so, oh, okay, let’s, let’s address it now from a three BD standpoint, and let’s get psych involved. And let’s look at maybe some medication complements, that really made a huge difference for this person. So you’ve got to be able to look at the diagnosis look at what’s what’s, what the patient is responding to, and then open have a broad scope as well to say which direction do we need to go in sometimes getting help with that? From specialists and maybe even more testing that that hasn’t been performed up to date? Up to that point in time?
Kimberly Warner – Unfixed Media
Is it safe to say that that generally the central Vestibular Disorders don’t respond to VRT classic VRT?
Matt Whitaker, MPT
I think classic. I guess I would also add that, that without getting too much in the weeds on this, the, you know, the nervous system, you look at something like multiple sclerosis, those folks are going to have dizziness. You look at some stroke patients, they’re going to have dizziness. And so there’s different different approaches to help with those conditions that may not fall within the classic VRT bucket. But did you can certainly help them overcome or improve. So so it’s not maybe as clear cut. But as by definition, yes, central this vestibular problems aren’t going to be as as responsive to a traditional BRT approach. But those overlap heavily but other other neurologic conditions. So I don’t think we can totally exclude the benefit. Yeah.
Kimberly Warner – Unfixed Media
Yeah, remember? Oh, I’m just gonna say I remember you giving me a couple VRT exercises early on. And I was like, these actually make me feel better right away because of the MdDS. And the motion that helped always helped me and so that was you couldn’t get a baseline with me because I was like, No, this isn’t making me dizzy or this is making me feel better. Right?
Matt Whitaker, MPT
Right. Yeah. And you know, sometimes the Jeffrey Maitland is a is an orthopedist, Australian based therapist that is kind of established a baseline of treatment and a certain paradigm. And one of the things I recall him teaching was always believed the patient. And so taking, taking Chem, you know, your example where you say, hey, look, I have meds. And I’ve got these other symptoms that are going on. I’m going to actually take that at face value, right? But I’m also going to try to prove myself wrong and maybe prove you wrong and confirm, right because again, if we go with just purely diagnosis, we might be missing the boat on some things that we can help you with. And so So I’m still gonna go through the, through the protocol per se, I’m still want to be thorough with the assessment. And if we do a little thing that you go, Oh, wow, yeah, that didn’t make it worse, that helped, well, then that’s a tool for you to maybe implement down the road. So that just makes you know, 5% better or 2%? Better. 10% better.
Cynthia Ryan – VeDA
Yeah. Go ahead, Ashley.
Ashley Chin
I was gonna say, Matt, do you ever? Do you ever see patients who actually know what vestibular things are? When they come in to see you? Or is it like, a whole other world? Like, because when I got sick, I had no I like, even as an ER nurse at I know, a little bit of everything. But I don’t know, a lot of like, one center thing. So when I went in, and they were like, oh, it’s, you know, your vestibular system? Like, okay, I’ve heard of that. But I don’t, I don’t know. What else is it? I know, it helps my balance. But that’s all I got. Like patients that say like, I actually know what Mr. Mueller is? Or do they usually come in kind of uneducated and mean, need that?
Matt Whitaker, MPT
Right, right. Well, I think, you know, gone are the days of the All Knowing, medical provider, right, you know, patients are very, very empowered. And, you know, thanks to websites, like beta, get tons of information at your fingertips. And, and so that, I think that’s actually a good thing. It helps, it helps accelerate the conversation, it helps accelerate, you know, getting where we need to go and maybe can truncate a little bit of that educational process. But then, of course, there are some that come in and are like, okay, you know, we go through this, this chart behind me, and we got to talk through it. And, and so you it is an educational process, but I think it’s actually favorable that patients come in with some knowledge and information, because it helps you get on the same page faster. Yeah.
Ashley Chin
Yeah, I feel like, I remember when it was, like, all first started. And I remember finding like Alicia, with Dizzy Cook, and I found Marina with parenting with migraine, and a lot of other people who are I was like, okay, like, they’ve had similar things happen to me, but it’s nice to pull from different, like everyday people and be like, Oh, you look like me. Like you didn’t have a giant accident where things just like something traumatic happen, you just up and walked out one day. And so I was just curious.
Matt Whitaker, MPT
I think, you know, the social media. There’s a there’s a benefit. And there’s a little bit of a curse, I think with that, but there’s a bit of support that can be recognized. You know, 20 years ago, you didn’t have that. And you probably felt like you were much more of an island when you run into these problems. And so being able to recognize, okay, yeah, there. I’m not the only one. And, you know, Kim, your unfixed series is, you know, very, very good illustration of how that how that can actually be embraced and help people in many ways, not just on their technical vestibular side. But yeah, I think, finding those resources, there’s so many available, it’s hard to even start that list. I’d say start at beta, and go from there. Yeah.
Cynthia Ryan – VeDA
Yeah, you both talked about lifestyle changes. And I think that that, you know, when I look at our communities, or peer support communities, I think that’s a big part of what, what people gain from that they, they gain validation. Number one, as you were saying, actually, that they’re not alone, they’re not the only person this is happening to, and they can also share, you know, this, you know, I tried this little thing, you know, and it worked for me, which is, you know, when you go to a medical provider, they’re going to present you with what they’ve learned and what is evidence based and supported, which is completely appropriate. But it also is just about figuring out what works for you in your life and sharing those little, those little things, you know, like, like meditation, for example, or, you know, other stress relieving practices.
Ashley Chin
Like what, when we were talking about it, I think it was last week, when we were talking about, would we avoid things or like lifestyle changes, and I remember being like, I can’t do this, and being upset about it, but then being able to see other people who once were aware why where I was, and then for a while, it wasn’t like, oh, I have to avoid this all the time. It’s my right now my body can’t handle this. So with that fact, maybe later it can. And, and that was a good MIP T’s were very, my PTS were very good at making sure that I understood that as well, that it’s not a forever thing and that, you know, some of these changes are going to be just right now, and then we can kind of scoot along as we go up, and then you could be able to handle more. And that’s basically good to also know,
Matt Whitaker, MPT
I think. I think you’re looking at what you just said, when you incorporate that component into a vestibular rehab program, it, it really makes it more effective. It sounds like you are a very active person, you played volleyball, and and now all of a sudden, maybe you cut back on your physical activity. So you’re, you’re limited there. And there’s your ask any runner that can’t run because they have an injury there. It’s way beyond just, oh, I’m not running. Right. So I think you can take that same, you have to take that same consideration when you’re talking to people and talking to patients, you know, as providers. Do you have three kids that you’ve got to run around to soccer practice? Do you have a job that is, you know, visually, physically demanding that for us to say, Oh, you need to implement your, your your BRT exercises four times a day in order to get the game? Well, they may be just overwhelmed in their environment. And so trying to pick that apart and say, Okay, do we really need to make a lifestyle change here, or maybe those that are more sedentary, that we know, hey, a little physical activity is gonna go a long way in complementing what you’re trying to do. And that is wake up the system again, and encouraging them to make a change there. So you know, that’s a luxury we have as PTS is to kind of get in the weeds on that. Whereas when you get a diagnosis, and you walk out of the audiologist office, or the neurologists office, you haven’t had that conversation. And so now you’re trying to figure out how to put it all together.
Kimberly Warner – Unfixed Media
It’s such a holistic approach. And it’s just it’s invaluable. Ashley, it sounds like you’re in really good hands with your pts. I know, I was in good hands with you, Matt. And it’s, you know, and I think in general, Pts are trained with to have an eye for that larger story of what the patient is walking in with. No,
Cynthia Ryan – VeDA
it’s this is such a huge topic. I have so many other everything that each of you has said, I can think of a million other questions to ask, but I want to, I want to just wrap it up by asking each of you, if you could share, and we’ll start with you, Ashley, you know, what would you say to someone who is just starting who has been just referred to physical therapy? Either they don’t know what’s going on? They’re starting, maybe they’re not getting the the gains that they’re hoping for immediately? What would you say to encourage them to, you know, continue.
Ashley Chin
So honestly, I would start with saying that, saying that this is not forever. This is today. And I always tell myself that when I have really hard migraine days to or just really hard PvP days where I just the like, the floor wants to move, and I have to use a wall. But I would, I mean, I also I tell myself, you’ve done hard things already, like so you can do this, like, you’ve already done the topless part. So you can definitely do the next thing that’s happening right now. And I would also tell them that it’s okay to not know what’s happening right now. But that doesn’t mean that it’s going to be that way forever. And that your team that you’re going to have is going to change, you’re going to have the RT, you may be a person who needs vision therapy, you might even be a person who needs to go to occupational therapy, and relearn how to do things. And that doesn’t devalue. You doesn’t devalue anything you once did, or that you can do later. It’s in that moment, and you’re trying to just get to the next one. And I would also definitely encourage, like Matt had said with the anxiety component, therapy CBT, which is I’m having brain fog, so I don’t remember how it is
Kimberly Warner – Unfixed Media
behavioral therapy.
Cynthia Ryan – VeDA
CBT
Ashley Chin
was great. I would I think that everyone should have a therapist, but definitely vestibular patients just even to just check in. And I really think that that will help your mindset so that you can take in all this stuff that’s happening, because it’s a lifestyle change. Really just depending on which diagnosis, you end up getting whatever label it is. But
Cynthia Ryan – VeDA
thank you, Matt, do you have a little nugget of wisdom? Well, I
Matt Whitaker, MPT
think VRT is in vestibular problems are one area where very few times when I say you have to get worse, to get better. In other words, you have to challenge yourself. And so you have to expect that this is going to be a little uncomfortable, but in a very controlled, deliberate, objective way. And the other is just understand that medicine, practicing medicine is a term that gets thrown around. But if you think about it, it’s really applicable. We don’t have it all figured out. We don’t know all the information, not all the data is in. And so these things that we have constructed are based on the best information possible, every patient is different. And we may have actually gotten it wrong. Now, I wouldn’t say that out front. But if you want to set the tone that this is not the ultimate solution, we’re going to do our best we’re going to help you. And here’s why we think you’re going to get better. And here’s where we need your help to making sure that we’re on the same page as we go through this process. And if you can kind of lay the land there that we’re in this together, and it’s not I know and I’m going to tell you, but we’re going to work together and I need your feedback, then you’re setting yourself up for a better a better outcome.
Kimberly Warner – Unfixed Media
Amazing and I would add if you don’t have that physician or care care provider that saying I’m part of your team, I have your back and they’re instead saying I know what the answers are. Find someone new ones around until you have somebody that you can really feel heard you intuitively in your gut you know that this person may not have all the answers but they’re there with you to do the detective work you know, they’re out there. You just got to keep searching go to VITAS website find them there.
Cynthia Ryan – VeDA
Well, thank you both for sharing your your experience and your expertise on this subject. That is one of the the top things that the stapler patients that come to me to ask us about so we’re gonna we’re gonna have to continue this conversation again later. But yeah, thank you. Thank you both again for taking the time today and sharing with the vestibular community. Thank you.
Kimberly Warner – Unfixed Media
Thank you so much.
Cynthia Ryan – VeDA
Thanks for tuning in to ICU this month.
Kimberly Warner – Unfixed Media
We hope this conversation sparked a new understanding of the vestibular journey. And for all of our patients out there, leaves you feeling just a little more heard. And a little more seen. I see