Michigan Balance: Vestibular Testing and Rehabilitation

At Michigan Balance, we provide comprehensive evaluation and management for patients with dizziness and balance disorders. We have a team of audiologists and physical therapists (PTs) with advanced training in vestibular testing and rehabilitation. Our audiologists and PTs work side-by-side to evaluate and provide up-to-date, evidence-based testing and treatment. We pride ourselves on excellent patient education so you can learn how to better manage your symptoms. 

We work closely with our board-certified ENT physicians who have specialized training in evaluating patients with dizziness. Our team has more experience than anywhere in the state of Michigan and is a national leader in the diagnosis and treatment of dizziness and balance disorders.

What is dizziness?  

Dizziness is one of the most common symptoms that leads people to seek medical attention. Dizziness can feel like different things to different people. Some people may experience vertigo (the sensation that you or your environment is spinning, tilting, or moving), lightheadedness, or imbalance. The degree to which dizziness impacts a person’s life can vary from one person to the next. Some patients find their dizziness to be a minor nuisance, while others are severely disabled by their symptoms and are unable to work, drive, or socialize outside of the home.

What are common causes of dizziness?

There are many potential causes for dizziness, including disorders that affect the ear, brain, eyes, or heart. Causes of dizziness may include the following:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Meniere’s Disease
  • Vestibular Migraine
  • Vestibular Neuritis
  • Vestibular Labyrinthitis
  • Acoustic Neuroma
  • Persistent Postural-Perceptual Dizziness (PPPD)
  • Superior Semicircular Canal Dehiscence Syndrome
  • Concussion/Traumatic Brain Injury
  • Medication side-effects

How do we normally maintain our balance? 

Three different body systems help you keep your balance and stay upright:

  • Vision: your eyes
  • Vestibular: your inner ear
  • Proprioception: the sensory feedback from your skin, your joints, and the muscles in your feet and legs

Why is the inner ear balance system so important?

The inner ear balance system, also called the vestibular system, helps us:

  • Keep our balance
  • Know if we are moving or if objects around us are moving
  • Keep our eyes steady on an object while our head is moving

What can I expect from Balance Function Testing? 

Our clinic has state-of-the art equipment that can provide important data to help reach the correct diagnosis and treatment. A balance function test is performed by an Audiologist and may last up to 2 hours.  It includes different tests that will measure how well you are able to use the part of your inner ear that controls balance, your vision, and your legs and feet to maintain your balance. There are several parts of the test. Your audiologist and physician will determine which parts of the test are needed: 

  • Videonystagmography (VNG): During this test, you will wear goggles with special cameras inside them. The cameras record your eye movements during different tasks while you are in the dark. You will use your eyes to follow a light. You will move into different positions while sitting and lying on an exam table. We record your eyes after we put warm and cool water into each ear. This is not painful, but it might make you feel like you are moving. The feeling of motion usually comes and goes within a few minutes.
  • Rotational chair testing: You will wear goggles while we record your eye movements. You sit in a dark room in a special chair. The chair turns from side to side during the test. We will talk with you during the test to let you know what to expect.
  • Postural control testing: You will stand on a platform that measures your balance. You will wear a harness to protect you from falling during this test. Motion sensors measure the sway of your body under different conditions while balancing with your eyes open and closed.
  • Video Head Impulse Test (vHIT): You will be staring at a target while a clinician moves your head quickly in a small range of motion several times.
  • Audiogram: You may also be scheduled for a hearing test. Because the same nerve controls both hearing and balance, your hearing is usually tested as part of a balance evaluation

What kinds of treatment are available for dizziness?

Treatment varies based on the cause of dizziness and can include vestibular rehabilitation therapy, dietary and behavioral modifications, medications (taken orally or injected directly into the ear), and-- in select cases--surgery.

What is Vestibular Rehabilitation?

Vestibular Rehabilitation is a special kind of physical therapy that focuses on exercises to decrease dizziness and improve balance. Vestibular Physical Therapists have unique training in this area.   

How does Vestibular Rehabilitation help to decrease my symptoms?

It is natural to avoid movement when you are dizzy.  However, it is very important to move so your body can heal, and you can return to all of your usual daily activities. By doing specific exercises and increasing movement and activity, your brain will make up for or compensate for an inner ear problem.  These exercises can also help with the communication between your eyes, inner ear, and sensory information from your feet.  

What are the goals of Vestibular Rehabilitation?

  • Decrease dizziness or vertigo
  • Decrease visual symptoms like blurred or bouncing vision
  • Improve balance and walking stability
  • Improve fitness and endurance
  • Learn how to manage your symptoms
  • Prevent falls
  • Improve your quality of life
  • Help you safely return to your usual daily activities

What kinds of exercises will I be doing?

Your physical therapist will provide you with a home exercise program specific to your needs. Some of the different kinds of exercises include: 

  • Coordinated eye and head movements aimed at decreasing dizziness
  • Strengthening exercises 
  • Balance exercises
  • Walking or aerobic exercise program 

How often do I need to perform these exercises?

Research shows that doing the exercises 3 times each day results in the best outcome. The goal of each exercise is to stimulate your brain by making you feel a little dizzy, then giving your brain and body a chance to recover. These exercises train your brain to tolerate activities. Your therapist with give you written exercise handouts and tell you how often the exercises should be done. 

How long do I need to do these exercises to notice improvements?

Some exercises may make your symptoms seem worse at first.  This is normal and it is important to be patient and continue the exercises.  Many patients do have significant improvement in their symptoms with the help of Vestibular PT.  Often patients are able to return to their normal day-to-day activities.   Your home exercise program is a key part of your recovery.  It is very important that you give your exercise program your best effort.

What else do I need to know about vestibular disorders?

  • Your symptoms may be worse when you are tired or under stress. Getting good rest and managing stress and anxiety is important.  
  • Staying physically active is also important. Walking daily can be very helpful. 
  • Avoid taking anti-dizziness medications like meclizine (Antivert). These medications may help you control your symptoms for the first few days of a severe dizziness attack. However, taking these medications for more than a few days can lengthen your recovery because they delay the process of central compensation. This means your brain won’t compensate as quickly and your symptoms will last longer.  

How do psychological conditions affect my symptoms?

Vestibular problems affect each person differently. The way you think, feel, and react can have either a positive or negative impact on your physical health and your ability to recover. Anxiety and depression may contribute to your dizziness and may result in slower progress with your vestibular rehabilitation program.  Managing anxiety and depression are important to your recovery.

How do I make an appointment?

Our specialized, dedicated team is happy to provide you with comprehensive evaluation and individualized treatment.  

Schedule an appointment by calling us at 734-936-8051, then press option 2.