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New HRH Therapy Correcting Poor Balance and Dizziness in Patients

July 17, 2014

These days, Rob Brugger is a busy guy. By day, Brugger, MSPT, is a skilled physical therapy provider and a highly-respected manager of Therapy Services at Holy Rosary Healthcare. After hours, he is the quintessential family man: a devoted husband and loving father to three young children.

Despite his many personal and professional successes, Brugger has decided to go one step further. Having recently completed vestibular rehabilitation training, Brugger is now certified by the American Institute of Balance (AIB) in Vestibular Assessment and Management. He is teaching his colleagues what he has learned, and demonstrating the therapeutic techniques and exercises on patients who are desperately seeking relief from dizziness, vertigo, and other debilitating balance issues.

Brugger is taking on a dizzy world, one patient at a time.

Vestibular Rehabilitation Therapy, or VRT, is a systematic progression of exercise protocols, which reduce or extinguish the hallucination or exaggeration of motion. At the same time, the coordination of head and eye movements is restored, while balance and equilibrium are greatly improved. The vestibular system tells the brain where the head is in space, along with the direction of movement and acceleration. The visual system is the brain’s external reference regarding the outside world, while a person’s peripheral vision provides information about motion.

Brugger is passionate about promoting the positive outcomes of VRT, so much so that he practices these techniques on his own family.

From Redfield, SD, Brugger’s grandfather, Richard Crawford, 88, had felt dizzy and light-headed for several years. His symptoms only seemed to grow worse with time, robbing him of his hobbies and enjoyments. “I had trouble walking; I couldn’t look directly up or down,” recalls Crawford.

Brugger administered a few simple treatment exercises, which took only minutes, and repeated the process the following day.

Afterward, “I couldn’t believe how good I felt,” Crawford exclaimed. “The treatments really worked for me, it was like looking out at a different world.” Crawford is grateful for the opportunity to once again devote his attention to two of his great loves – his family and fishing. When he speaks of his grandson, his pride is evident: “Rob is a very special man.”

As it turns out, Crawford’s symptoms are not at all peculiar. The AIB reports that dizziness is the number one complaint of persons over the age of 70, and 50 percent of this age group will experience Benign Paroxysmal Positioning Vertigo, or BPPV, at some stage. The most common cause of vertigo, BPPV affects 1.6 women for every 1 man. BPPV may disrupt patients for years, contributing to imbalance and falls. For those struggling with BPPV, calcium carbonate crystals, or stones, typically present in the utricle, or gravity detection area of the inner ear, move into one or more of the semicircular ear canals. BPPV may occur for multiple reasons, one of which involves blunt force trauma to the head, such as with a fall. Sadly, doctors often tell patients that the symptoms of BPPV will go away on their own, or that they will “just have to learn to live with them.”

A former RN of 49 years, Miles City resident, Mary Jo Stein, was unwilling to accept her symptoms as a lifestyle. Stein, now 84, suffered a bad fall that left her with a concussion. When doctors informed her that the space above her brain had narrowed and was not permitting the proper draining of fluid, the solution was to have a shunt placed in her head. “Unfortunately, the surgery didn’t relieve my dizziness,” Stein laments. “For the next ten months, I experienced constant dizziness. I always had to hang on to something, and I couldn’t bend over to clean my house.”

A moment of clarity came when she read a newspaper article on the Epley maneuver. Showing the article to her doctor, he recommended contacting a practitioner. “I made an appointment at Holy Rosary and Rob got me in right away,” Stein continues.

As part of his evaluation process, Brugger often administers a questionnaire to indicate the severity of a patient’s symptoms and to determine the extent of vestibular involvement. Then, he performs the GANS SOP, or Sensory Organization Performance test, originally developed by Richard Gans, of the AIB. Patients may also undergo a Computerized Dynamic Visual Acuity Test, or CD VAT, to gauge if they are experiencing blurred vision. The sidelying and modified Dix Hallpike tests are utilized to determine if BPPV is present. Depending on which ear is affected, the Modified Epley Maneuver may be used to eliminate BPPV in the inner ear canals. This technique involves a patient transitioning from a sitting position to lying on their back. Next, the patient moves to a sidelying position and is finally returned to a seated position. During this technique, the head will be rotated multiple times, in order to reduce BPPV. After proper evaluation and treatment, Brugger may conduct a series of hands-on adaptation, habituation and substitution exercises.

Most are unaware that a primary function of the inner ear is to maintain balance. When calcium carbonate crystals, or stones, move into a different part of the ear, a person may experience an intense spinning sensation, or vertigo. As was the case with Stein, stone-repositioning maneuvers can correct BPPV. Based on research published in the Journal of the American Academy of Audiology, BPPV can be corrected 80 percent of the time with one 20-minute therapy session. With a second treatment, the success rate increases to an impressive 96 percent. According to Johns Hopkins University School of Medicine, 85 percent of vertigo cases are inner ear-related.

“Rob explained the maneuvers clearly before performing them. He was very professional and reassuring,” remarks Stein. “He performed several techniques and when I got up, I was shocked. I wasn’t dizzy at all!”

Following the appointment, as Stein’s husband drove her home, she sat looking out the window, marveling at how clearly she could see. “I just can’t say enough positive things about this therapy and the difference it has made in my life.”

While some patients experience dizziness and vertigo so severe that nausea and vomiting may ensue, others may experience more mild cases. Miles City resident, Terry Baldry, 52, is healthy and active, working out at a local gym 3-4 times each week. “I would lie down and become dizzy. For about 6-8 seconds, it felt as if the room were spinning,” Baldry describes. “When I stood up, I was dizzy for a second or two.” This continued for almost three weeks, until Baldry discussed his symptoms with the Therapy department at Holy Rosary. “I turned to Rob because he is an excellent physical therapist. He performed two treatments, and I was feeling much better.” Brugger also offered subsequent therapy solutions that could be performed at home. Taking his advice, Baldry implemented the exercises for three consecutive days. “Afterward, I wasn’t dizzy at all. It was miraculous!”

These three patients are among many who have benefitted from vestibular rehabilitation therapy. Ideal for those struggling with ongoing dizziness and balance issues, vestibular therapy is quite simple to perform, does not promote the use of unnecessary medication, and is highly-cost effective. The United States Congress finds that costs to Medicare and Medicaid programs continue to rise as seniors succumb to increased falls. It is estimated that by 2020, direct costs will exceed $32 billion, as a result of such falls. How many falls – not to mention the accompanying pain and discomfort –could be avoided with the proper therapy treatment?

For these reasons, Holy Rosary Healthcare is proud to support Rob Brugger in administering Vestibular Rehabilitation Therapy. Holy Rosary is currently in the process of becoming an affiliate of the AIB, promoting further educational and training opportunities, along with patient resources and support. To learn more about VRT or to schedule an appointment as referred by a provider, please contact Holy Rosary Therapy Services at (406)233-2719. To learn about the symptoms of BPPV and available treatment options, visit http://dizzy.com.