Goggles help physical therapists treat vertigo

People with balance issues can find relief with high-tech eye tracking

A male patient wearing goggles lies down on an exam table while a physical therapist adjusts the patients eyewear with her hands.

Vertigo can be downright scary. Physical movements normally so simple — walking, getting out of bed, bending to tie a shoe — become frustrating and even dangerous.

Sheila Agee had these symptoms. For two weeks she felt like she was “off her little rocker,” as she put it.

“When you’re feeling unstable your balance is off,” Agee said. “When you’re waking up or you’re laying down and all of a sudden the room starts spinning, all sorts of things come into your head as to what might be wrong with you.”

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For the second time in her life, Agee was suffering from benign paroxysmal positional vertigo (BPPV). As such she was in the uncomfortable clutches of a common problem. As many as 50 percent of the population deals with BPPV at some time in their lives. It is a condition that gets more common as one ages.

A new way of diagnosing

Increasingly, BPPV is diagnosed using goggles that help identify the source of the issues, thus speeding recovery.

BPPV is most often caused by misplaced calcium crystals — Agee called them “little rocks” — that normally reside within the utricle area of the inner ear. These crystals get jarred loose and end up in one of the semicircular canals.

Essentially, it keeps the brain from getting information it needs to make accurate decisions involving balance. When the crystals are back to where they’re supposed to be, the symptoms disappear.

After trying to treat it at home the second time, Agee met with physical therapist Jayme Watson at Sanford Health Outpatient Rehabilitation and Sports Medicine. Watson’s assessment included ICS Impulse goggles and led to finding the source of Agee’s dizziness.

Goggles pinpoint balance issues

ICS Impulse goggles were first introduced in 2011 with a comparatively limited capacity to assess balance issues. The dramatically advanced model Watson and her colleagues use now helps diagnose all varieties of vertigo, not just BPPV.

In Agee’s case, identifying the symptoms as BPPV was the first step. Finding the location of the condition can be more complex. It is one thing to know calcium crystals have wandered off somewhere, but then you have to track them down. It’s why the Impulse goggles are so valuable.

“The goggles let us know what ear was being affected,” Watson said. “It was the right ear for Sheila and there are three canals. It let us know it was the right ear and the bottom canal where the calcium deposits were stuck.”

Agee’s eyes shifted back and forth involuntarily at times during a series of tests Watson administered. The term for it is “upbeating torsional nystagmus” and capturing the eye movements on video provided Watson the information needed to get to work treating the patient.

Agee then engaged in a finely-tuned series of maneuvers, known collectively as the Epley maneuver, that sent the crystals back to where they belong. After two sessions, the dizziness disappeared.

Dramatic improvement

While BPPV is not life-threatening, recovery definitely qualifies as life-changing. Given the potential dangers involved, trying to live with it becomes a huge inconvenience.

“You just don’t go walking down a hall without holding onto a rail or the wall,” Agee said. “You’re never sure when you’re going to go down. You just have a feeling that you’re going to go down.”

Watson said she and the rest of the staff see three-to-five cases of BPPV a week. A great percentage of those respond quickly to treatment once properly diagnosed.

“Some people will just try to tough it out or they might not know what is going on so it might take them a while to decide to try physical therapy,” Watson said. “One woman I treated had been walking with a cane for five years before she came in. We did the maneuver and she left here walking just fine. She didn’t need to come in again.”

Agee resumed normal life. Thankfully, she no longer has to try explain her affliction to others. Many of her attempts to do so, she said, ended with friends responding, “We all knew you had loose rocks in your head.”

“The goggles were a breakthrough for me,” Agee said. “Otherwise I’d probably have been trying for months to figure out which procedure to use to get the crystals back into the right place. Jayme was so good at explaining it all to me from the beginning to the end.”

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Posted In Ear, Nose & Throat, Rehabilitation & Therapy

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