October is Physical Therapy Month and time is running out to hug your PT…or, even a kind “thank you” will do. This year’s awareness campaign for PT Month is on the ever increasingly use of opioids for pain. America is in the midst of an opioid epidemic. According to the CDC, in 2012 health care providers wrote 259 million prescriptions for opioid pain medication, enough for every American adult to have their own bottle of pills. In America, every 25 minutes a baby is born in opioid withdrawal.
Physical therapy is a safe and effective alternative to opioids for long-term pain management and prevention. Physical therapists (PTs) and physical therapist assistants (PTAs) have a responsibility to understand the full scope of the epidemic and its potential impact on their patients and clients. Click here to print out a handout on the opioid epidemic and the potential for physical therapy to be part of the solution.
DID YOU KNOW? Next to pain and headaches, dizziness is one of the most frequent symptoms reported to physicians. And, the most common treatment is medication. Studies find that medications are used between 60-90% of the time with antivert (or meclizine) being the most widely prescribed(1,2). Yet, in the general population only 31 percent of patients receiving this medication for dizziness found it helpful(3).
Medication to lessen the effects of dizziness (known as vestibular suppressants) should ideally be taken in the acute (or early) phases – typically no more than 5 days of the initial onset of symptoms. Also keep in mind, various studies have shown that vestibular suppressants can actually increase symptoms of dizziness and often result in sleepiness and/or feeling groggy. These medications can also increase the time for recovery and increase the risk for falls(4,5).
Vestibular therapy, a specialized form of physical therapy, has been found to improve vestibular symptoms 85% of the time compared to vestibular suppressants resulted in <50% improvement(6). In addition to dizziness, other vestibular symptoms may include blurriness, unsteadiness, nausea, foggy headedness and/or fatigue. Other symptoms of inner ear problems can include fullness in the ears, tinnitus and/or hearing changes.
Symptoms due to vestibular disorders can diminish quality of life in everyday activities. They also contribute to emotional problems such as anxiety and depression. Additionally, one of the consequences of having a vestibular disorder is that symptoms frequently cause people to adopt a sedentary lifestyle in order to avoid bringing on, or worsening, dizziness and imbalance. As a result, decreased muscle strength and flexibility, increased joint stiffness, and reduced stamina can occur.
Treatment strategies used in rehabilitation can also be beneficial for these secondary problems. Successful treatment begins with a thorough evaluation. At our 360 Balance & Hearing Center, we use a comprehensive clinical assessment starts with a detailed history of the patient’s symptoms a medical history review. Additionally, information about medications, hearing and/or vision problems is gathered. The assessment also includes administering different tests to more objectively evaluate the patient’s problems. The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled. Testing assesses sensation, pain, muscle strength, range of motion, coordination, posture, balance, and walking ability.
At our 360 Balance & Hearing Center, we have over 85 years of combined clinical experience and have received a number of rewards for our services. However, one principal remains: Once you have seen one patient with dizziness, you have seen one patient with dizziness. The treatment plan MUST be customized to each individual. If you or a loved one suffers from dizziness, balance and/or hearing disorder, we would be honored to be your provider of choice. If you are not able to access our clinic here in Austin then you can look for a provider near you at http://vestibular.org/finding-help-support/provider-directory.
And, remember...PT Month or not, we always welcome hugs!
Click here for a snapshot of the numbers at 360 Balance & Hearing Center. YOU CAN COUNT ON US!
Why the Need for a Balance Awareness Week?
According to the National Institutes of Health (NIH), 40% of the US population age 40 or older will experience a balance disorder in their lifetime(1). Dizziness is the third most common major medical symptom reported, yet the majority of cases remain unexplained. It has been estimated that more than 12 million people over 65 experience a dizziness or balance problem that significantly interferes with their life. Annual spending on patients with dizziness in emergency departments exceeds $4 billion(2).
The vestibular system includes the parts of the inner ear and brain that process sensory information involved with controlling balance and eye movements. Dysfunction of the inner ear can result in dizziness and balance problems. As for treatment of dizziness, customized vestibular rehabilitation shows >85% efficacy in peripheral vestibular disorders(3) yet meclizine is prescribed as high as 89% of the time but results <50% improvement(4). Also of note, the average time between the initial visit and receiving a vestibular disorder diagnosis is 1 month when the physician suggested the dizziness might be inner ear related at the initial consult vs 8 months when not considered(5).
We, at 360 Balance & Hearing, know you have a choice of providers and your trust is on our services for dizziness, balance and/or a hearing disorder is always greatly appreciated. If you are in search of such specialty services but do not live in the Austin area, you may find a provider closest to you at the following link: http://vestibular.org/finding-help-support/provider-directory.
References: (1) Johnson, EG Rehab Manag, 2007. (2) Saber Tehrania et al. Acad Emerg Med, 2013. (3) Horak et al. J Otolaryngol Head Neck Surg, 1992. (4) Kroenke. Arch Int Med, 1990. (5) Haven L. VEDA On the Level, 2011.
Concussions do not discriminate and can happen to anyone! 360 Balance & Hearing is raising awareness of mild traumatic brain injury as part of National Concussion Awareness Day. National Concussion Awareness Day® is recognized on the third Friday of each September yearly and is registered with the United States Patent and Trademark Office. On Friday, September 15th National Concussion Awareness Day® will raise awareness across the United States through local educational events, social media, fundraisers and expert discussions in the media.
According to a poll by the University of Pittsburgh Medical Center nearly 9 out of 10 adults in the US can’t correctly define a concussion. The Center for Disease Control defines a concussion as “a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”
Up to 50% of concussions go undiagnosed and untreated. Symptoms commonly last 7-10 days, and include any one or more of the following: headache, confusion, difficulty remembering or paying attention, balance problems or dizziness, feeling sluggish, hazy, foggy, or groggy, feeling irritable, more emotional, or “down”, nausea or vomiting, bothered by light or noise, double or blurry vision, slowed reaction time, sleep problems, or loss of consciousness. For some people concussion symptoms can persist longer, called Post Concussion Syndrome. Post Concussion Syndrome can last for weeks, months or even years.
A concussion is a mild form of brain injury and should be taken seriously. Culturally, many Americans view a concussion as no big deal, perhaps having been told themselves to “shake it off” or “play through it.” However, returning to situations where an injured person faces another potential blow to the head before a concussion fully heals can result in “Second Impact Syndrome” which can be serious and potentially life threatening.
If you have suffered a concussion, share your story on social media Friday, September 15th and use #NationalConcussionAwarenessDay to tag it. Donations to the Brain Injury Association of America can be made at www.biausa.org.
I have fallen off the blog wagon – not writing one since May. I was so busy assisting with our Concussion Health Summit in Columbus, OH that I kept putting writing on the back burner. I set September 1st as my date to launch a renewed commitment to writing blogs on our website and posting on the 360 Balance & Hearing Facebook page. Although there are so many topics that are relevant to talk about regarding our specific services, the one that invades my mind is Harvey. I find myself being deeply saddened by the loss of lives, homes, health care facilities and businesses but also am deeply moved by the outpouring of so many every day people acting as heroes – from all over the world, of all ages, beliefs, cultures, etc. I simply cannot find the words to describe both the heartbreak and blessedness that I have watched unfold over the last week.
Here is a link to Harvey in Images by Morrigan McCarthy of the New York Times.
Please know that our thoughts and prayers continue to go out to all of those affected. I have attached a link to an NPR story that list a variety of ways you can help in the disaster relief efforts: http://www.npr.org/sections/thetwo-way/2017/08/28/546745827/looking-to-help-those-affected-by-harvey-here-s-a-list.
Did you know hearing loss is the 3rd most common physical condition after arthritis and heart disease? You should learn how your hearing health and quality of life are closely related to these common medical conditions?
Dizziness is one of the most common symptoms reported to healthcare providers, but 40-80% of patients do not receive a diagnosis (Neuhauser et al, 2008). The most common treatment for dizziness is medicine yet only 31% of patients thought it was helpful (Kroenke et al,1990). It can be challenging to identify the underlying cause(s) of dizziness. Remember, dizziness is a symptom – not a normal part of aging – and should be evaluated by a qualified health care provider.
If you should need to seek medical care for dizziness, describing your dizziness can be very helpful. Dizziness is considered an umbrella term – a vague term with various meanings. We encourage our patients to think of their dizziness in 3 categories:
The following can also be helpful information to share with your healthcare provider:
Write the information down and share it during your visit, especially if a nurse or medical assistant is seeing you first. Understanding your symptoms can be very useful in identifying the cause or causes of your dizziness. The time with your doctor is typically very limited, on average between 13 and 16 minutes (Medscape Report, 2016). The current health care model also relies heavily on medications to treat symptoms even without knowing the cause. Studies find that 61-89% of patients seen for dizziness receive meclizine, also known as antivert (Zee, 1985 and Sloane, 1989) but so few find it helpful. Medication can also slow the recovery process (Shepard & Smith, 1990) and increase the risk for falls (French et al, 2006).
In general, dizziness is poorly understood and often results in many visits to different providers without a known cause. In 2011, the Vestibular Disorders Association (VEDA) conducted a survey of over 1,000 people who had seen a doctor for dizziness and some of those findings are listed below:
What can you do if you or a loved one suffer from dizziness? The best advice is to seek care with a health care provider who specializes in dizziness. One way to find a specialist is to visit VEDA’s website at: http://vestibular.org/finding-help-support. If you are in the Austin area, we would be honored to be your provider of choice. Our staff brings over 75 years of collected experience in the area of dizziness, balance and hearing disorders. We have been a comprehensive testing and therapy center since 2002.
If you cannot visit us, we encourage you to read and comment on our ongoing blogs and/or be involved in our Facebook page for 360 Balance & Hearing.
Current law in Texas prohibits you from directly accessing your physical therapist for treatment. You can go to a chiropractor, podiatrist, acupuncturist, massage therapist, personal trainer and more for treatment, but the law prohibits you from going directly to your physical therapist without a referral from a doctor, chiropractor, nurse practitioner, physician assistant or dentist.
47 other states allow consumers to begin physical therapy treatment without a referral. This means that 200 million Americans have better access to care than Texans. Texas should be a leader in the healthcare arena, not the last one to give Texans a right they deserve.
Texas consumers seeking alternatives to prescription medication and surgery are choosing physical therapy for the prevention and treatment of conditions affecting movement and function, only to find arbitrary, unnecessary, and costly access barriers.
It is time to allow Texans direct access to physical therapists for treatment so that consumers can benefit from the real cost savings associated with conservative management of movement and function-related conditions.
It is time to allow Texans direct access to physical therapists for treatment so that consumers can benefit from the real cost savings associated with conservative management of movement and function-related conditions. We, the undersigned, call on Texas legislators to give Texans the right to choose physical therapy without a doctor's order.
CLICK HERE TO SIGN THE POSITION NOW!
It is that time of year for new year’s resolutions and so often we think of our health. Well, have you ever thought about your inner ear health? Inner ear or vestibular health is related to quality of life issues in many important ways. It is estimated that as many as 35% of adults aged 40 years or older in the U.S., approximately 69 million Americans, have experienced some form of vestibular dysfunction. By learning more, you help us to help you and your loved ones to lead a well-balanced life.
During Aristotle’s time, the vestibular system was thought to be merely be an entry way or “vestibule” to our hearing system. Now we know the vestibular system is both a pathway to healthy hearing and vital body mechanism which enables us properly take care of daily living activities. Perhaps our vestibular or inner ear system is less understood due to its “silence.” Our vestibular system’s importance is harder to recognize than the loss of vision, hearing, touch, smell or taste. That is… until it does not function properly.
Myth: Dizziness, falls and hearing difficulty are a normal part of aging, for which our helpful options are limited.
Fact: Dizziness from inner ear disorders, including those from head trauma, can typically be reduced or eliminated. Falls can be prevented, and just like glasses help us see better, properly fit hearing aids can help us hear and communicate better.
While normal inner ear function enables healthy hearing, our complex vestibular system coordinates eye and head movements, as well as proper balance. The 3 primary “sensory organs” that send information to our brain about balance are our eyes, body and inner ear.
Did you know that 3 (sight, touch and hearing) of our 5 human sensory systems are highly integrated with vestibular system?
Common symptoms associated with a vestibular disorder include dizziness, unsteadiness, blurriness, nausea, concentration problems, fatigue and anxiety. Proper inner ear function can be affected by noise trauma, head trauma, and disease processes. Individuals with a history of auto-immune disorders, allergies, difficulty sleeping and/or migraines are more likely to suffer from dizziness. This is in addition to the fact that hearing health is also closely related to the risk of falls, diabetes, dementia, vision loss and heart disease.
The accurate diagnosis of dizziness, balance and/or hearing related issues results in the best outcomes. However, we equally value early detection of these issues. Just as you would have your vision checked or visit the dentist on an annual basis, it is also recommended to have your balance and hearing checked. With decades of personal patient experiences, we truly know “an ounce of prevention is worth a pound of cure.”
Be Better. Live Better.
We are heading into football playoff season. As many of you know, there is an unprecedented amount of media attention regarding the concerns of sports related concussion. Just a few days ago, an article was published in the medical journal, Pediatrics, suggesting that high school football should be banned. Certainly, the discussion is quite controversial but what is agreed upon is that concussions should be taken seriously. It is also agreed upon the importance to RECOGNIZE, to REST and RECOVER from a concussion. We should continue these conversations around concussion, including that concussions are not isolated to sports. The majority of concussions actually occur from falls and are much more prevalent in individuals 65 years of age and older compared to those age 5-25 years. It is also important to increase the focus on the recovery of concussions and rethink concussions as a manageable injury that more frequently than not results in a complete recovery when treated appropriately.
A concussion can result from a direct blow to the head or indirectly to another part of the body that results in a jolting force through the head. Because a brain injury does not require direct contact to the head, whiplash injuries can result in a number symptoms associated with concussion. Just ten years ago, we categorized the severity a concussion by a loss of consciousness (LOC) and the length of time having a LOC predicted the recovery.
Now, we know that LOC occurs less than 10% of the time. Standard imaging (e.g., MRI or CT scan) is typically normal. Such testing, however, is often performed in the emergency department in those 65 years of age and older due to the life threatening concerns of a more traumatic brain injury.
The most common symptoms include headache, dizziness, difficulty with concentration and memory, vision problems, decline in balance, mood changes and/or poor sleep patterns.
Any severity of head trauma warrants a comprehensive neurological examination that should include gathering information of symptoms and past medical history along with an assessment of vision, balance, inner ear function and cognition. Other areas to address are headaches/migraines, neck pain and anxiety. If there are hearing changes associated with the concussion then a comprehensive hearing test should also be performed.
The brain can heal, and rest in the early phase is critical as is proper rest and nutrition. Lingering symptoms can be addressed in a customized rehabilitation program. One of the ongoing questions of debate is clearly defining when to begin rehabilitation. We have been managing patients with concussion for 20 years – both sports related and non-sports related. There are times that our assessment indicates that starting a recovery program as early as 3 days is appropriate. At other times, we are more conservative and may wait 7-10 days before starting visual or vestibular (inner ear) exercises.
As with all types of recovery programs and maintaining health, we know that staying active is important. Identifying what activities and at what intensity varies among individuals. In other words, once you have seen one concussion, you have seen one concussion. Every individual is unique in their presentation and, above all, in their recovery process. It takes a comprehensive approach that is customized.
A time to be thankful.
A time to be with loved ones.
A time to be understanding.
There are a number of health problems that make the holidays less desirable than enjoyable. Hearing loss is one of those problems. Dizziness is also one of those problems. These conditions are “silent” – you cannot see hearing loss nor can you see dizziness yet the implications of these disorders can feel disabling. If you are spending the holidays with a loved one who has dizziness and/or hearing loss, please keep in mind the anxiety and even depression that can be a result of these problems. Make an extra effort to include them in activities. Also, let them know there is help. Hearing devices, especially with newer technology developed in the last 3 years, can be extremely helpful. Vestibular therapy can also be very beneficial for most types of dizziness. If you are an individual that suffers from dizziness or hearing loss, please share this message with loved ones to help them better understand your needs.
We, at 360 Balance & Hearing, are dedicated to improving the quality of life for individuals who suffer from dizziness, hearing loss and/or balance disorders. If you are visiting our site and not in the Austin area, we encourage you to visit the Vestibular Disorders Association (VEDA) to find a specialty provider near you or click here for more information.
We wish you all a blessed and enjoyable Thanksgiving holiday!
We Can Help.
We provide expert care for dizziness, balance, tinnitus and/or hearing disorders. We offer both testing and treatment services with more than 75 years of combined experience. Call us today at 512-345-4664!