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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Getting Acquainted with My Vestibular System

Published September 19, 2011 7:59 AM by Rebecca Mayer
Following my bout with sea sickness last week, I went to a physical therapist to assess my vestibular system and rule out vertigo.

My parents have told me that my first encounter with motion sickness happened when I was 4 months old, travelling in the backseat of our Wagoneer. The dog and my two brothers sharing the space were none too pleased.

The vestibular system determines our body's ability to judge the effects of direction and gravity by providing balance and equilibrium. When functioning properly, our vestibular system allows us to stand, move, walk and run.

Motion sickness-thought to be a conflict between visual and vestibular information sent to the brain-involves the onset of vomiting or nausea and impaired function when travelling by land, air, or sea.

Those who have never experienced motion sickness understandably have little empathy. Is it life threatening? No. Is it debilitating? It can be. Simply put, the disorder interferes with one's daily function.

I met with Mark LeBoeuf, MSPT, a physical therapist who specializes in vestibular rehabilitation at Hawthorn Physical Therapy in Dartmouth, MA. During my evaluation, we discussed my medical history including any related injuries or illnesses such as migraines; my general diet, sleep and exercise habits; and the symptoms I was experiencing.

Mark also wanted to hear specifically how I conducted myself on the boat for the 3-night trip:

Was I sleep deprived when I arrived? I was well rested leading into the trip and slept at least 7 hours each night on the boat.

Did I engage in any exercise or recreational activities? I ran, swam and/or kayaked each day we were on the boat.

Did I eat high sodium, fatty foods? Well, my diet was generally comprised of whole and fresh foods such as snap peas, carrots, grilled chicken, nuts and bananas. However, once I felt nauseous, I would reach for anything salty (no sweet tooth here!) I could get my hands on.

The physical examination Mark walked me through consisted of tests for gait/standing balance, oculomotor function, eye-head coordination tests and positional tests.

Based on the information obtained in the interview, Mark felt it was important to perform Dix-Hallpike and Roll tests to rule out any active signs of Benign Paroxysmal Positional Vertigo (BPPV) even though I wasn't presently exhibiting symptoms. After performing these tests and not finding any nystagmus, he felt confident that canal repositioning maneuvers would not be the most effective way to treat me at this point in time.

Next, I performed oculomotor tests such as smooth pursuits, saccades, head shaking and convergence tests and the results of all were normal.

Based on my past and recent history of symptoms as well as objective findings obtained during the physical evaluation, Mark concluded that the best way to treat my ongoing symptoms was through visuo-vestibular habituation exercises. He also suggested that we keep an eye on any signs and symptoms suggestive of active BPPV.

Mark prescribed a home-based program of visuo-vestibular habituation and balance training exercises to be performed two times a day and scheduled my next appointment in two weeks to discuss and measure my progress.

I have been doing my exercises twice a day and find the approach counter-intuitive. You see, for years, I have been doing my best to avoid activities and situations that aggravate the symptoms of my motion sickness. But, now that I have been challenging my vestibular system a bit, I understand the approach and am hoping that with time, my body adjusts to the new challenges.

For now, I've learned that next time I'm out on a sailboat-when we sail to Provincetown, MA, in two weeks for a wedding-I will be more mindful of my diet, exercise, and sleep patterns leading up to the trip and will make sure I am well armed with low sodium snacks and fresh fruits and vegetables to snack on. I think I'll pack the Dramamine and acupuncture bracelets this time, too!

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