Balance/Vestibular Assessment (Dizziness, Vertigo, Imbalance)

At the JFK Johnson Rehabilitation Institute (JRI) in central New Jersey, we use a team approach to help diagnose and treat balance disorders. It is estimated that more than 90 million Americans will complain to their physicians about dizziness at least once during their lifetime. The source of many balance problems is the vestibular system or inner ear. Vestibular disorders are common and can affect people of all ages.

There are many types of balance problems which can be caused by different medical conditions. A team of JRI specialists works together with the NJ Neuroscience Institute to identify the source of the problem and the best treatment approach. With state-of-the-art assessment, the team works together to identify the cause of the balance problem and determine the appropriate treatment plan.

Diagnosis

Vestibular testing may include hearing tests, the recording of eye movements in different situations, and balance testing.

At JRI, we work with the patient's primary physician during diagnosis and treatment. Patients have access to sophisticated vestibular and balance tests conducted by an audiologist. These tests may include:

• Hearing Tests (also called Audiological Evaluations) hold important clues to the diagnoses of balance problems because the vestibular system is close to the hearing apparatus.
   
• Electronystagmography (ENG) is the standard for measuring the vestibular system using infrared video recording of eye movements. This allows comparison of the function of each inner ear. During the ENG procedures, the patient is asked to do a series of tasks related to eye movements. Eye movements will also be recorded as you move through head and body positions. The final portion of the test is conducted with cool and warm air flowing into the ear canals. For most individuals, there is minimal discomfort during the procedure. Some experience slight sensations of nausea and, on rare occasions, vomiting.
   
• The Rotary Chair Test provides another means of assessing the inner ear. The patient sits in a computer-driven chair that rotates gently back and forth at several acceleration rates as specialized video goggles with infrared cameras measure eye movements.
   
• Computerized Dynamic Posturography (CDP) is a noninvasive procedure used to assess daily functional balance and stability under changing support surfaces and visual environments.  As the patient stands on a platform secured by a harness, he or she is exposed to various situations where either the platform or visual surroundings will move in vestibular, visual or somatosensory conditions. 
   
• The Audiometric (Hearing) Test evaluates hearing status. Both the hearing and motion-sensing parts of the inner ears may be affected by the same disease.
   
• Brainstem Evoked Auditory Response (BSER/ABR) testing allows assessment of the entire auditory pathway up through the brainstem. Electrodes are placed on the scalp or forehead and on or behind the ears. A series of sounds are presented through an insert earphone. As the electrodes pick up electrical energy produced by the auditory nerve, a computer averages the responses and produces a waveform that shows the response from the inner ear to the auditory nerve. There is no discomfort. The patient need not do anything but relax and not move around. In fact, many patients drift off into natural sleep. 
   
• Vestibular Evoked Myogenic Potential (VEMP) testing provides information about the saccule (an inner ear balance organ) and the inferior vestibular nerve. It is based on a reflex that occurs between the saccule and a muscle in the neck.
   
• Electrocochleography is used to identify an inner ear condition called cochlear hydrops (also known as Meniere's disease).  Electrodes are placed on the scalp or forehead and on or behind the ears. A series of sounds are presented through an insert earphone. As the electrodes pick up electrical energy produced by the auditory nerve, a computer averages the responses and produces a waveform that shows the response from the inner ear to the auditory nerve. There is no discomfort. The patient need not do anything but relax and not move around. In fact, many patients drift off into natural sleep.

These tests are painless and most people tolerate them well.

Treatment Options

JRI's Vestibular and Balance Rehabilitation Program is conveniently located in the NY/NJ metro area. Our specially trained physical therapists can evaluate and treat patients who are experiencing dizziness (e.g., vertigo, motion intolerance, lightheadedness) and balance problems. These services can be especially beneficial for patients with:

• BPPV (Benign Paroxysmal Positional Vertigo)
• Acute or chronic inner-ear problems such as labyrinthitis or vestibular neuritis
• Postoperative conditions including acoustic neuroma and Meniere's disease
• Neurological conditions such as stroke and head injury
• Age-related multisensory deficits
• Imbalance due to drug toxicities

Patients participating in this program are examined using a multi-sensory approach.  Along with the evaluation of the function of the inner ear, musculoskeletal components needed for postural control are also assessed.  Our therapists use the results of this examination to develop an individualized treatment program to meet the specific needs of each patient and to maximize his or her functional return. The Vestibular and Balance Rehabilitation Program may include:

• Canalith Reposition Maneuver (for the treatment of BPPV)
• Adaptation exercises to facilitate the recovery of eye-head coordination
• Balance retraining exercises
• Habituation exercises to help decrease the patient's sensitivity to motion
• General conditioning exercises
• Safety training

To participate in this program, patients must obtain a prescription from a doctor indicating the need for vestibular/balance therapy.

About Balance Problems

Dizziness is not a disease. It is a symptom that indicates a problem may exist somewhere in the body.  There are many causes of dizziness. In most cases, the problem is related to a change in the vestibular system: the parts of the inner ear and brain that help control balance, eye movements and body orientation. Regardless of the cause, early detection improves chances for a complete recovery.

In addition to dizziness, the most frequently reported symptoms of vestibular disorders are vertigo, nausea, and unsteadiness or imbalance while walking. Other symptoms may include increased sensitivity to noise and bright light; headaches; muscular aches in the neck and back; and problems with vision, thinking and memory.

In addition to muscle strength, normal balance requires the integration of three sensory systems: visual, vestibular (found in the inner ear), and somatosensory (sensations from the skin, muscles, tendons and joints). When these systems are not functioning well, individuals may experience episodes of spinning, light-headedness, trouble focusing their eyes, and/or poor balance or falls.

Aging can also affect balance. Approximately 40 percent of people older than age 65 fall each year. Most escape serious injury, but fear of falling may cause them to limit their activities.

Appointment Information

• For a physician appointment, please contact the NJ Neuroscience Institute at JFK Medical Center at 732-321-7010.
   
• For audiology/vestibular testing, please call 732-321-7063.
   
• For vestibular rehabilitation, please  call 732-321-7056.