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Vestibular Neuritis: Navigating the Real World – A Case Study

On The Level – A Quarterly newsletter of the Vestibular Disorders Association
Vestibular Neuritis: Navigating the Real World – A Case Study
By Jennifer Liss, DPT (Editor: Sherron Laurrell, vestibular patient)

This case study outlines challenges facing clinicians when treating vestibular neuritis in patients who continue to work full-time in highly stimulating vestibular environments.

Jen Beasley, a 37-year old first grade teacher, was referred to me by her ENT in December, 2014. She had awakened a month earlier with severe dizziness and nausea. After attempting to push through, holding on to the walls at school as she went through her day, she was diagnosed with vertigo by her family doctor and sent home with anti-nausea medication. Two weeks later, Jen saw an Urgent Care doctor who saw fluid in her ears and attributed it to allergies. Jen eventually ended up in bed as the dizziness and nausea exhausted her. Her ENT referred her to me with a diagnosis of BPPV.

During our first meeting, we spent time talking about her symptoms and situation. I suspected Jen was not dealing with “simple” BPPV and was likely suffering with either vestibular neuritis or labyrinthitis.

The most important component of any patient evaluation is getting a good history.

Key subjective elements a clinician should look for to differentially diagnose vestibular neuritis include:
•    Onset – 2 to 4 days extreme nausea, vertigo, and imbalance. By the time they see the physical therapist they should be  SLOWLY improving. Episodes usually follow a cold/flu or sinus infection.

•    Hearing loss distinguishes labyrinthitis from vestibular neuritis. Treatment plans from a PT perspective are the same. An    ENT/ audiologist should be consulted about the hearing loss.

•    Increased symptoms with movement in visual fields, such as computer use, crowded places, TV.

•    Balance – impaired stability with gait especially with un-level or darkened environments.

•    Motion sensitivity – increased symptoms with position changes, quick turns. THIS IS USUALLY THE ONLY SYMPTOM WITH A BPPV PATIENT.

•    Dizziness Handicap Inventory (DHI) – usually in the moderate disability range.

Key objective elements include:

•    Most important tests are Head Thrust and Dynamic Visual Acuity (DVA). If these 2 tests are positive and you have normal oculomotor & neurological exams; this is usually a peripheral vestibular insult verses a central insult such as stroke.

•    Frenzel goggles to rule out BPPV with Hallpike maneuver, performing the test at slow to medium speed. Hallpike test is negative if there is no sign of a torsional nystagmus.

•    Dynamic Gait Index (DGI) After a comprehensive work up we concluded that
Jen’s diagnosis was vestibular neuritis.

As we put together the plan for her vestibular rehabilitation, the biggest challenge was limiting stimulation in her work environment. Jen’s job responsibilities involve constant head movement, frequent turning and excessive visual & auditory stimulation.

Early on, she had to modify her work duties as much as possible. One of her “extra” responsibilities was supervising children during bus duty. A medical excuse note eliminated this from her daily schedule. Because her work environment was heavily loaded with vestibular stimulation, it was difficult to progressively load her vestibular system during therapy as I would normally recommend. I had to be careful with her home program. Visual retraining is essential to recovery of normal function but it has to be progressed more slowly for active patients like Jen than for patients who are retired or in less stimulating work environments. I taught Jen strategies such as limiting head movement and focusing her eyes when she felt “overloaded.”

It is essential to teach patients that vestibular exercises should increase dizziness for 5-10 minutes but if the symptom increase lasts, they are overloading an impaired system.

Jen needed to accept that this would not be a smooth recovery because of her work environment. She hit her first setback at week 4, which is common. Many patients are driven to see steady weekly progress. At about week 4, they increase their home exercise program and try to do more at work because they are feeling better. Consequently, they will have a 2+ day spike in symptoms from doing too much. This is when we have “emotional chat” days for encouragement and counseling to accept that the road to recovery isn’t always easy and modifications need to be made along the way.

Jen has learned to modify her activities while continuing her VRT exercises in my office and at home. She has seen overall improvements and is feeling hopeful. Although it may take longer than she would like, I expect Jen to make a full recovery of normal vestibular function.

I want to emphasize that patient education is essential for ALL vestibular patients. They need to know the reasoning behind what they are doing, be warned about pitfalls that may happen along the way, and most importantly, that compliance is key to vestibular success!

Editor’s Note: Jennifer Liss is certified in vestibular rehabilitation by Susan Herdman’s VRT certification course at Emory University. TheraSport Physical Therapy offices are located in New Jersey, where Jennifer has practiced for 16 years. Jennifer can be reached at JLiss@Therasport.org


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March Madness at TheraSport Physical Therapy!

March Madness at TheraSport Physical Therapy

March Madness is in full effect at TheraSport Physical Therapy!

March Madness 2015 is NCAA basketball’s prestigious championship tournament, and now it is in full swing!

Basketball players are susceptible to Achilles injuries. The Achilles is the strongest and longest tendon in the body. It attaches to the heel bone, and causes the foot to push off the ground when the calf muscles tighten. When overused, your Achilles can become inflamed and cause tendinitis.

Make an appointment at TheraSport today to find out what preventative measures you can take to avoid tendinitis and other injuries!

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Knowlegde. Experience. Results. Let Our Expertise Expedite Your Recovery!

What is Physical Therapy?

Physical therapy is a form of treatment for when health issues make it hard to move around and do everyday tasks. Physical Therapy regularly helps you move better and may relieve pain that you have from an injury or illness. It also helps improve or restore your physical function and your fitness level to get back to your daily activities.

The goal of physical therapy is to make daily activities easier after surgery or ease the issues of a chronic illness. For example, physical therapy may help with walking, going up stairs, or getting in and out of bed.

Physical therapy can help with recovery after some surgeries. Your doctor may suggest physical therapy for injuries or long-term health problems such as:

•  Back pain or injuries/illnesses of the Back such as a herniated disc.
•  Tendon or ligament problems, an example would be an anterior cruciate
ligament (ACL) injury, a meniscus tear, or plantar fasciitis.
•  Arthritis conditions such as Osteoarthritis and rheumatoid arthritis.
•  Injuries of the spine such as Spinal stenosis
•  Neurological disorders such as Parkinson’s disease
•  Vestibular issues such as vertigo or post concussion syndrome

What does a physical therapist do?

At TheraSport Physical Therapy, our highly skilled physical therapists will examine you and create a treatment plan. Depending on your health and condition, your therapist will help you with flexibility, strength, endurance, coordination, and/or balance.

If you have an injury or complication from an illness, your therapist will first reduce your pain and swelling if you have any. Then he or she will work with you to increase your flexibility, strength, and endurance.

Physical therapy almost always includes some form of exercise. Stretching, core exercises, moderated weight lifting, and walking are some physical therapy methods we use at our facilities. Your physical therapist will also construct an individual exercise program so you can keep up with your therapy at home.

Our therapists may use manual therapy, and techniques such as heat, cold, massage, ultrasound, and electrical stimulation during your therapy program.

Contact TheraSport Physical Therapy for a consultation at one of our two New Jersey locations.

14 Parke Place Blvd Ste D
Sewell, NJ 08080
(856) 256-8393

30 W Maple Ave
Merchantville, NJ 08109
(856) 661-0200

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Let TSPT Help Keep Your New Years Resolution!

People try to get a jump start on their fitness as the New Year rings, however, many of are going about it the wrong way. Unfortunately some injuries don’t get better with just working out, or without a proper physical therapy routine. The main reason for most injuries lingering, of this nature: too much repetition or stress to the injury in too short of time. At TheraSport Physical Therapy, we know it is important to communicate to the individual how crucial it is to build up a fitness routine slowly and carefully, keeping in mind proper nutrition and adequate rest.

Keep your New Years Resolutions with these tips:

Eat Well. Stay Hydrated. After the holidays you may be reaching for cold weather comfort food, but eating fruits and vegetables while drinking water throughout the day can provide you with improved energy. Proper nutrition will also give your muscles the right nutrients they need to limit inflammation and facilitate increased metabolism.

Warm Up. Stretch. Give yourself at least 10-15 minutes prior to your workout to warm-up your body. Dynamic stretches are also a great way to start a workout and get your blood flowing before you move into your cardio or workout routine.

Build Resistance. Recover. If you are sore for more than 3 days following a workout than you probably went a little too hard a little too much. To avoid injury you must build up your routine and recover properly. At TheraSport Physical Therapy we provide a proper exercise program that will give your body exactly what it needs to build strength, stamina, with time for recovery.

Call TheraSport Physical Therapy today, to make an appointment with our skilled physical therapists. Our therapy team will discuss a program that is suitable for you to keep those New Year’s Resolutions! Even if you aren’t prone to injury, your therapist can give you some education on proper technique and form in order to keep you injury-free.

Let TSPT help you with your fitness New Year’s Resolution plan. Call one of our two conveniently located New Jersey facilities now, to get you started! Ring in the New Year by being healthy and injury-free and let us help you every step of the way!

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Staying Active Over The Winter Holidays

The holiday season is all about tradition, fun, and family, but if we’re not careful, the holidays can also lead to injury. Typical holiday activities, such as shopping, lifting heavy boxes, snow shoveling, and countless hours of cooking, can cause muscles to work harder than usual.

The added demands of the holidays stresses the body, which may increase the risk of injuries related to the extra activities (neck, shoulder, and back pain). The best way to ensure a pain free holiday season is to use proper body mechanics to help prevent muscle and joint discomfort this holiday season.

Taking precautions this holiday season would help avoid injuries—from distributing the weight of shopping bags, to being more aware of your body posture and positioning when shoveling the walk.

Contact TheraSport Physical Therapy for a consultation at one of our two New Jersey locations.

14 Parke Place Blvd Ste D
Sewell, NJ 08080
(856) 256-8393

30 W Maple Ave
Merchantville, NJ 08109
(856) 661-0200

From our family to yours, Have a very Happy and Healthy Holiday Season!

TheraSport Physical Therapy

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Put a little Spring in your step at TheraSport Physical Therapy!


Spring is right around the corner, which means it’s time to tend to that garden! However, getting down on your hands and knees to plant can be difficult and hard on your back.

If you experience this kind of trouble, try warming up before you start gardening by walking or stretching. Don’t do the same task in the same position for too long as that can lead to muscle and joint pain or repetitive-motion injuries.

At TheraSport Physical Therapy, we can show you stretching techniques that address stiffness. We also teach core-strengthening exercises that can help reduce low back pain, common in prolonged kneeling and bent over positions.

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Happy Holidays From TheraSport Physical Therapy

TheraSport Physical Therapy is an independently owned, private practice Physical Therapy facility located in Merchantville, New Jersey and Washington Twp., New Jersey. Our physical therapy practice is driven to make your rehabilitation, therapy and recovery a success.

Physical Therapy aids in pain relief, improved motion and a greater quality of life. At TheraSport Physical Therapy, our approach is friendly, evidence-based and innovative. You will get direct attention and hands-on treatment from our highly-skilled Physical Therapists during every visit. Being an active participant in the treatments you will become more educated about your body, so you will understand how to manage your condition or treatment routine.

TheraSport Physical Therapy concentrates on your wellness and provides exceptional therapy services.
We look forward to getting to know you, helping you achieve results and becoming your preferred Physical Therapist.

At TheraSport Physical Therapy our Doctors of Physical Therapy and Physical Therapists are experienced with the following:
Arthritis | Back pain | Balance dysfunction | Bursitis | Carpal Tunnel Syndrome | Chronic pain | Dizziness | Dislocations | Fibromyalgia | Fractures | Hand injuries | Headaches | Herniated discs | Incontinence | Knee injuries | Neck pain | Osteoporosis | Pelvic pain | Plantar fasciitis | Posture
dysfunction | Rotator Cuff injuries | Sports injuries | Strokes | Musculoskeletal disorders | Sprains | Tendonitis | Walking dysfunction
Vestibular Therapy | Therapeutic Exercise | Therapeutic Activities | Electrical Stimulation | Ultrasound | Moist Heat and Cryotherapy |  Iontophoresis | Neuromuscular Re-education | Fitness Conditioning | Sports Therapy

Call us today to set up a consultation. We have to convenient locations in the South Jersey area.
Or visit our website: http://www.therasport.org

TSPT Washington Twp. – 14 Parke Place Blvd Ste A Sewell NJ 08080  (856) 256-8393
TSPT Merchantville – 30 W Maple Ave. Merchantville NJ 08109     (856) 661-0200

Orthopedic Injuries:
Post Acoustic Neuroma Removal
Sacroiliac Joint

Sports Injuries:
Temporomandibular Joint Disorder (TMJ)
Vestibular Neuritis/Labryinthitis
Vestibular Rehabilitation Therapy (VRT)

Other Treatments Available:
Bell’s Palsy
Benign Paroxysmal Positional Vertigo (BPPV)
Degenerative Joint/Degenerative Disc
Difficulty with balance training
Falling Episodes
Facet Joint
Herniated Disc
Ligament Sprains/Tears
Low Back Pain
Meniere’s Disease
Muscle Strain
Muscle Tears
Neck Pain
Adaptation/Habituation Exercises
Aerobic Conditioning
Assisted Stretching
Balance Retraining
Brandt-Daroff Exercises
Core Stabilization
Electrical Stimulation
Epley Maneuver
Ergonomic Advice
Fall Prevention
Joint/Soft Tissue Mobilization
Manual Physical Therapy
Moist Heat
Muscle Energy Techniques
Postural Education
Range of Motion
Therapeutic Exercises
Vestibular Rehabilitation

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