“When people think of physical therapy, they often think of us treating muscles, joints, pain – those traditional things,” Cotey said. “But one thing that physical therapists can do is treat symptoms of dizziness, vertigo, and imbalance. And that’s what falls under vestibular physical therapy.”
Cotey then asked: “Has anyone here had any episodes of dizziness or vertigo?” Heads nodded all over the room. “Its fairly common,” she continued. “I think not many people know that physical therapists can treat it. The big thing is: It does depend on what is causing it. Now some things have to be treated medically, but there is a whole list of different conditions that a physical therapist can help treat to help improve your dizziness, vertigo, or the sense or feeling of imbalance.
“This past June I was lucky enough to get to fly down to Tampa Bay in Florida and I took a three-day course in Vestibular Physical Therapy and Concussions. I haven’t seen a single person since I have been here with a concussion and I have seen a handful of vestibular patients, so I chose to talk to you guys more about vestibular.”
Cotey then gave the Lunch and Learn attendees an in-depth look at the functions of the vestibular system.
“Your vestibular system gives you your sense of where you are in space,” she said. “So if someone were to pick you up and tip you upside down and your eyes were closed, you would still know that you were upside down because you have this system in your body that tells you where you are in relation to gravity. It is kind of a weird concept because we don’t say, “Gravity is pulling me this way, so I know I am over here.” It is kind of an intuitive system that is working behind the scenes. But when that system is off, you can start getting that dizziness or vertigo.”
Cotey then shared that three components are involved in keeping a person’s equilibrium – vestibular, visual and somatosensory. “Your vestibular system actually contributes two-thirds of the information to your brain, and it is giving you that sense of balance and spatial awareness to allow you to coordinate your movements.” The other two systems – visual and somatosensory – make up the other one-third.
“Those three systems all send information to the brain, so that you can keep your balance and coordinate your movements,” Cotey said.
Cotey then told the crowd that the “vestibular system is actually located in your ear. It is very, very small and it is located behind the structures that allow you to hear.”
She then showed a video that allowed all to get a visual of the structures she was referring to, and answered questions about them as the audience members asked.
Cotey that gave a glimpse into the common disorders that can lead to symptoms of vertigo, dizziness, and imbalance – including ear disorders, Benign Paroxysmal Positional Vertigo (BPPV), head trauma, Meniere's Disease, toxicity, neurological diseases, Multiple Sclerosis, migraines, rheumatological and immune conditions, problems with cervical spine or neck, arthritis, or scar tissue from whiplash.
Also, Cotey shared that these symptoms can be the result of cardiac issues.
“If somebody has low blood pressure and they stand up, a lot of people get that lightheadedness. That’s not necessarily vertigo, but people might come in saying, “Oh I have vertigo” and then we check their blood pressure and then that’s managed a little more medically.”
Symptoms of dizziness can also be the result of pharmacological issues.
“If you have ever looked at the side effects of medication, a lot of times it says lightheadedness or dizziness,” Cotey said. “So if you are taking a list of 20 medications, and six of them have the side effect of dizziness, it may be worth it to have your physician to look at your list of medications and see if there is something that they can change… if you are having dizziness.”
Cotey shared that diabetes could also cause some issues with the vestibular system.
“That would be more medically managed, but with diabetes that is a macrovascular disease so the blood supply is compromised to the structures of the ear, you are going to have some problems. Not as common, but that can be the cause in some cases.”
At the conclusion of the long list of possible causes, Cotey then said it can be difficult to tease out where these symptoms are coming from. “So, it is really very helpful to have a full physical evaluation by your primary physician or neurologist and then if you get sent to me, I am also going to do a very thorough evaluation like we just talked about. I am going to check blood pressure and I am going to check a whole host of things and try to tease out where symptoms are coming from and whether or not I can treat them.”
Cotey then gave the crowd an idea of what physical therapy might look like if they came in for treatment of a vestibular system related disorder. While not a comprehensive outlook, Cotey provided an overview that educated all persons in attendance.
First, sit down and chat.
“Sometimes just sitting down and listening to what your problems are can narrow down what the root problem is, and how it is going to be treated. So basically, by talking to you, I would determine your symptoms. A lot of people use dizziness and vertigo interchangeably. But they are different. So dizziness is a sensation inside your head that things are spinning and often times if someone is dizzy that is a little more cardiac or blood pressure related. Vertigo is a sensation that the room around you is spinning, so kind of externally things are spinning. When somebody has vertigo that is more vestibular related. So it is always important to tease those two things out. And then the other one is imbalance. I have had a lot of people tell me that they are dizzy but come to find out they just feel quite off balance when they are up trying to move around. They are not having something spinning around in front of them or feel spinning in their head. So like I said, I spend a lot of time, sitting down and chatting to see what is actually going on before I do anything with a patient.”
Cotey the told the crowd that she likes to get her patients “up and moving” for various assessments – including postural stability, balance, and ocular motor assessment – so that she knows if there is an issue with the vestibular system or perhaps the somatosensory system or the visual system.
“I can’t look at your inner ear,” she said. “I can’t visualize that there is a problem, but between your ears and your eyes, there’s reflexes. So if I can look at those reflexes and say either they are normal or abnormal, then I know what to work on from there.”
Cotey then shared the treatment options for a patients that is diagnosed with the number one cause of vertigo – BPPV. “With BPPV it happens when you look up quickly, so if somebody goes to wash their hair, or if they turn over in bed, bending forward, and other quick movements in the head,” she said in explanation. She then showed a video that exhibited the techniques utilized in the Epley and Semont maneuvers, and how they corrected the problem.
“A good analogy for this is if you think about your shoe if you get sand in it, and you get that sand out of it,” Cotey said. “You don’t just tip over and dump it out, You kind of tip it over get it into the heel and then dump it out. That’s exactly what we are doing with the ear. We are manipulating your head to get the crystals back into the right spot where it should be.”
She then asked if anyone had ever tried to do the maneuver themselves, and a few people said that they had.
“I do highly recommend seeing someone, because they can walk you through which maneuver to do to correct it,” Cotey said. “It could take one treatment session, and then the person is clear. It could reoccur again in the future, but generally it is just one to three treatments with me if it is BPPV and it is cleared up, which is nice.”
She then addressed other treatment options that could be used for vestibular disorders other than BPPV – including vestibulopathy, adaptation, habituation – offering detailed information for all those in attendance.
Since the Oct. 31 event was the last session of the Gouverneur Hospital’s monthly Lunch and Learn program until Spring 2019, Cotey concluded the program by providing detailed, step-by-step instructions on some chair exercises that all those present could do to keep them moving even during the winter months.
Keep an eye on the Gouverneur Tribune Press community calendar for the announcement in Spring 2019 of the next Gouverneur Hospital Lunch and Lean Program session. The topic will be determined at a later date.