Monday, February 13, 2017

BalanceMD's Lafayette Office Turns 10 Today!

It was February 12, 2007 when BalanceMD (then known as Indiana Neuro-ophthalmology & Center for Balance) opened it's doors in Lafayette, IN.  We have grown from having an office manager and one front office staff to having an office manager, 4 front office staff, a nurse, 2 audiologists and a physical therapist.  We opened a second office in Indianapolis in 2011.  
We are proud to say that we have been privileged to serve patients from the entire state of Indiana as well as surrounding states, including Michigan, Illinois, Ohio, Kentucky and even Georgia.
We would like to thank our patients and referring doctors and all of those who have contributed to our success over the years.  We plan to continue to provide the highest level of care to patients suffering from vestibular disorders (dizziness, vertigo and imbalance) for many years go come.
Thank you!

Saturday, February 4, 2017

Vestibular Rehabilitation Therapy Works Best When Diagnosis is Known

Vestibular rehabilitation therapy (VRT) is a subspecialty of physical therapy (PT), focusing on treating vestibular system disorders causing dizziness and imbalance. Vestibular therapists (VT) have training beyond what is typically received in PT school and this additional training includes recognizing the symptoms and signs of vestibular system disorders, such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular nerve weakness (unilateral or bilateral), cervicogenic (neck-related) dizziness and central (brain) disorders. It is extremely important to recognize the various vestibular system disorders and have an accurate diagnosis because the type of VRTthat would best benefit the patient is dependent on the diagnosis. The ability for even a trained and experienced VT to diagnose a specific vestibular system disorder is limited. While VTs are trained to perform clinical tests to help determine the cause of a patient’s symptoms, the results of vestibular function testing is an invaluable tool in any VTs ability to design and implement the most optimal treatment for patients suffering from a vestibular system disorder.
Imagine, for example, a patient presenting with chest pain. There are questions and some basic clinical tests that could be performed to determine the cause of the chest pain, but laboratory tests, such as an EKG and blood tests would aid in identifying a heart attack, while a chest X-ray would help determine pneumonia or a broken rib as the source. In the same way, dizziness and imbalance may be caused by a variety of medical conditions and vestibular function testing is the best way to evaluate these symptoms when the cause is not obvious.
Results from vestibular function testing allows the skilled VT to begin the correct treatment sooner and treatment is more efficient and successful when the precise cause of dizziness or imbalance is known. Different VRT exercises are prescribed for vestibular nerve weakness (unilateral or bilateral), cervicogenic (neck-related) and central (brain) disorders. Having this knowledge leads to fewer VRT visits, which saves time and cost for the patient. In the same way, the patient with pneumonia as the cause of their chest pain may not improve as much or as quickly without the appropriate treatment with antibiotics. Unfortunately, we see many patients who have been through VRT elsewhere without significant improvement only because the proper vestibular exercises were not administered due to a lack of the correct diagnosis.
Stephanie Ford, PT, is BalanceMD’s vestibular therapist. She has extensive post-graduation training and many years of experience treating patients with vestibular system disorders. She utilizes the results of vestibular function testing in order to obtain maximal improvement in her patients.

BPPV is Over-diagnosed

What is BPPV?

BPPV (Benign Paroxysmal Positional Vertigo) is a common inner ear disorder that causes brief spells of vertigo (spinning sensation) triggered by a change in head position. For example, lying back or rolling over in bed, getting up from bed, looking up or down results in brief, 10-15 seconds of vertigo and usually no dizziness any other time. BPPV is caused by“crystals” normally present in one part of the inner ear, but become detached and displaced into another part of the inner ear where they cause vertigo with changes in head position. However, there are many patients diagnosed with BPPV who do not fit this description of symptoms or have a different cause of positional vertigo, yet are often diagnosed and unsuccessfully treated as though they had BPPV.

Why is BPPV Over-diagnosed?

BPPV has gained popularity as a diagnosis because it is a benign condition that causes vertigo and is readily diagnosed and immediately cured by a skilled healthcare provider. Patients often joke about “having a few loose rocks” in their head. BPPV is a common condition, but there are many more people diagnosed with BPPV than actually have BPPV.

How is BPPV Treated?

BPPV is treated by a “crystal repositioning maneuver” (CRM), which is designed to move the “crystals” by gravity back to where they originated, where they may be dissolved. The type of CRM utilized depends on the type of BPPV. For example, one form of BPPV is treated with a modified Epley or a Semont maneuver and another type with a Lempert roll. There is also a type of BPPV where the “crystals” are actually stuck to a membrane in the inner ear and is treated with a headshake of Gufoni maneuver. BPPV is no longer treated by the old fashioned Brandt-Daroff or Cawthorne-Cooksey exercises, or with medications, such as meclizine (Antivert). We are actually able to cure BPPV in one visit over 90% of the time with the appropriate CRM. Unfortunately, we see many patients incorrectly diagnosed with BPPV undergoing a modified Epley maneuver dozens of times unsuccessfully.

What else causes positional vertigo if it’s not BPPV?

Because migraine is the most common cause of dizziness/vertigo and can cause positional symptoms, the most common correct diagnosis in those mis-diagnosed with BPPV, is vestibular migraine. Other conditions which may cause positional dizziness include inner ear nerve weakness, blood pressure changes and even brain tumors. Obviously, it is very important to be certain of the cause of vertigo, as we don’t want to ineffectively treat for a condition that isn’t present and we don’t want to miss a more sinister cause.
At BalanceMD, we treat all types of BPPV on a daily basis and perform over 400 CRMs each year. We are able to quickly recognize BPPV and differentiate BPPV from other causes of positional vertigo. Patients with BPPV usually need only a single visit for their positional vertigo symptoms to be cured.