By The Vestibular Rehabilitation Team
October is not only a time for autumn leaves and apple picking but it is also Physical Therapy Month. Physical therapists are medical professionals who help patients with their mobility, manage their pain and symptoms, and help them regain their functional independence. We rehab not only the orthopedic population, but dozens of other patient populations that may require specialty services such as neurological, lymphedema, and pelvic floor. One specialty we would like to highlight is our vestibular rehabilitation team.
Vestibular rehabilitation is a special form of physical therapy intended to alleviate the primary symptoms of vertigo, gaze instability, and dizziness caused by vestibular disorders. Secondary symptoms and impairments such as inactivity, fear of movement, falls and decrease balance are also addressed. The vestibular system is located in the inner ear and helps maintain balance and spatial orientation by detecting position and movement of the head in all directions. Vestibular disorders can occur through illness, trauma, or insidious onset (no obvious initial mechanism or symptom). Patients experiencing vestibular disorders may have brief or prolonged dizziness, unsteadiness with walking, or sensitivity to crowded spaces or visually stimulating environments. Most common vestibular diagnoses include BPPV (benign paroxysmal positional vertigo), vestibular neuritis/labyrinthitis, Meniere’s disease, and unilateral/ bilateral vestibular hypofunction.
Patients can feel better and improve their activities of daily living through a process called compensation. Compensation occurs as the brain recalibrates after a vestibular injury with vestibular rehabilitation at the forefront to ensure optimal recovery for each patient. Each rehab program is designed specific to the patient’s problems, requiring a comprehensive examination and may involve a combination of 4 different treatment approaches that include: Adaptation, Habituation, Substitution, or Canalith Repositioning
- Adaptation exercises include gaze and postural stability in order to normalize the vestibular ocular reflex, an essential reflex that help maintain visual stabilize during quick movements of the head whether sitting or walking. An impaired vestibular ocular reflex may result in dizziness or visual changes with head movement as well as imbalance or self-perceived movement with activities such as walking. Vestibular physical therapists are train to provide patients with exercise programs to help with adaptation of the vestibular ocular reflex
- Habituation exercises are indicated for patients who experience position or movement dizziness with repeated exposure expecting to reduce irritating or noxious responses. These exercises may help with motion sensitivity from certain movements, improvement in visually stimulating settings like the mall or groceries, or with improve duration or tolerance at school, work, or activities of daily living
- Substitution exercises are strategies to utilize the other systems of balance in order to navigate the world safely when the vestibular system is weakened or disrupted. Exercises prioritizing the visual and somatosensory system may help especially with ambulation, gaze stability, postural stability, and symptom management. The use of appropriate assistive device may also be considered in order to prevent falls and safety with walking.
- Canalith repositioning maneuvers (CRM) are treatments designed specifically to treat Benign Paroxsymal Positional Vertigo or BPPV. It is a common vestibular diagnosis that occurs when otoconia crystals get dislodged and enter the semi-circular canals of the vestibular system. These otoconia are important in helping to sense gravity and head tilting; however may enter the semi-circular canals, which help sense rotational head movement, resulting in positional vertigo. Patient may often experience symptoms getting in or out of bed, when bending down, or when reaching overhead. Vertigo is often brief with secondary symptoms of dizziness, nausea, and imbalance. Canalith repositioning is the standard treatment to reposition the displaced otoconia by moving the patients based on the orientation of the semi-circular canals. The Epley maneuver is one of several types with CRM having a high success rate.
The Vestibular Rehabilitation Team at the RWJBarnabas Health Ambulatory Care Center in Livingston, NJ. is highly experienced in the evaluation and treatment of vestibular patients. We utilize technology such as Infrared Googles, Biodex Balance System, and Cervical Joint Position Laser to aide with assessment and the development of a personalized treatment plan. If you or someone you know may be experiencing a vestibular disorder, then first reach out to your primary care physician or an otolaryngologist (ENT; a physician that specializes in the inner ear) for a vestibular physical therapy referral. Vestibular dysfunctions require an interdisciplinary medical team approach to ensure reduction in symptoms and return to functional independence. Stay active and healthy this Physical Therapy Month!
To learn more about the functions of the inner ear, please attend our Vestibular Community Event on November 13, 2024. More information can be found here.
________
Michael Heitzman, PT, DPT, CSCS
Clinical Physical Therapist and Supervisor
Concussion Program Clinical Team Leader
Educator MJM Health Assessment Center for Athletes Liaison
Mike Heitzman, PT, DPT, has worked closely with the management of concussion since 2015 and has been interested in the vestibular population since 2010. While completing his studies at NYU, he was given the opportunity to study at NYU Rusk Rehabilitation Vestibular Center. He honed his skills in multiple level 1 trauma centers before joining the RWJBarnabas health team in 2015. Mike continues his passion for PT through system education and publication on the concussion population as well as participation in the APTA and BIANJ. When not in the clinic, you can find Mike outdoors hiking and playing with his 3 children.
Vincent Brinas, PT, DPT
Senior Vestibular Physical Therapist
Vincent Brinas, PT, DPT, is the Senior Vestibular Physical Therapist, at the RWJBarnabas Health Ambulatory Care Center. He primarily treats patients with vestibular disorders, concussions and runners with running-related injuries. He completed his doctorate in physical therapy at the University of the Sciences in Philadelphia in 2016. He received his certificate of completion in vestibular rehabilitation at Emory in 2022. He is a member of APTA specifically for SIG Neurology and the NJ Chapter and a member of VEDA (Vestibular Disorders Association). Vincent is an avid recreational runner, participating in races throughout the country such as the Norvo Nordisk New Jersey Marathon, Tunnel to Towers Tower Climb NYC and the Red Bull 400. Outside of physical therapy, he enjoys hiking on the West Coast, board games such as Scythe and PC gaming such as DOTA 2 where he is a Level 30 Grandmaster Undying player.
Sonali Lalwani, PT, DPT
Physical Therapist
Sonali Lalwani, PT, DPT is a physical therapist at RWJBarnabas Health Ambulatory Care Center for 20 years. She has completed her Doctor of Physical Therapy from UMDNJ (Rutgers University) in 2002. She primarily treats vestibular disorders and musculoskeletal conditions. Sonali has taken numerous vestibular continuing education courses throughout the years in order to enhance her vestibular knowledge to treat patients. She is a member of APTA for SIG Neurology and the NJ Chapter. Sonali is also trained in CPR. Outside of the clinic, Sonali enjoys hiking, playing pickle ball, and traveling around the world with her husband and 2 kids.
Eugene Antunes, PTA
Physical Therapy Assistant
Eugene Antunes, PTA is a Physical Therapy Assistant at Barnabas Health Ambulatory Care Center for 14 years. He treats vestibular and orthopedic patients encompassing a wide range of ages and conditions. He completed his bachelor's degree at Rutgers University in 2005 with a double major in Criminal Justice and Psychology. He attended Essex County College where he completed his Associates as a Physical Therapist Assistant in 2011. He is also a member of the APTA - NJ chapter and is trained in CPR. Gene is married to Kelly Antunes and has three daughters and 1 son whom he loves to spend quality time with. Outside of the clinic, he coaches his children in soccer, softball and basketball. In his personal time, Gene enjoys staying fit by jogging and cycling.
The experienced and compassionate staff at Cooperman Barnabas Medical Center Rehabilitation centers, with locations in West Orange and Livingston, offers adults and children the specialized care they need to resume an active life after surgery, injury or illness. Staff is committed to providing patients with the most advanced services in a safe, caring and soothing environment. For high-risk patients who are unable to visit in person, telehealth is an option. Patients do not need a prescription for physical therapy services.
For more information, or to schedule an appointment, call 973-322-7500.