Cheryl: Balance and Vestibular Rehabilitation

Cheryl’s Story: Finding Her Balance After Years of Dizziness

While visiting her grandson at college in November 2021, Cheryl was walking the campus and started to have dizzy spells that would come and go. When she woke up the next morning, the room was spinning, and she could barely get out of bed.

Cheryl has a history with dizziness that goes back thirty years. She had been flying to visit her parents at the time, and during the plane’s descent, she had a disorienting episode where she couldn’t hear, and things seemed to be moving in slow motion. She soon got a cold, which turned into a vestibular or balance problem.

She went to see Joseph M. Furman, MD, PhD, neurologist and director of the UPMC Center for Balance Disorders. He conducted a series of tests, attributed the dizziness to complications from a virus, and prescribed exercises. Cheryl’s dizziness went away after several months when this happened thirty years ago, so when it started again in 2021, she assumed it would work itself out.

Vestibular Therapy at UPMC Rehabilitation Institute

This time around, Cheryl’s dizziness wasn’t giving up as easily. A friend who also suffers from a vestibular condition suggested Cheryl see Amy Cassidy, PT, DPT, NCS, physical therapist and facility director of UPMC Rehabilitation Institute outpatient rehab at the Oakland Balance Lab location. Amy is a Board Certified Neurologic Clinical Specialist through the American Physical Therapy Association (APTA) and specializes in physical therapy for dizziness and balance disorders.

Cheryl saw Dr. Furman again for an evaluation and imaging. He said her six-day post-onset sudden severe vertigo was caused by an acute neuritis and prescribed continued vestibular physical therapy with Amy. Including structures in the inner ear and connections to the brain, the vestibular system helps maintain your body’s sense of equilibrium, or balance. Balance and vestibular rehabilitation is a specific type of physical therapy that focuses on minimizing the effects of vertigo and imbalance disorders.

"In the beginning, I really had to hold on to somebody to walk. I was pretty debilitated,” Cheryl says. “I work a few days a week always on the computer, and so I'm looking down and I'm looking up and it was really hard. Coworkers and friends would notice me holding onto a wall while walking. I’ve always been able to catch myself, but I worry as I get older that I won’t be able to catch myself in a dizzy spell and could fall."

Balance Exercises Aim to Restore Stability

Cheryl went to physical therapy with Amy every other week for approximately 45-minute sessions and adjusted the cadence as needed.

Vestibular therapy consists of exercises tailored to help the patient’s condition so that they may return to a safe and active lifestyle. Exercises often incorporate eye-head movement, repositioning, and gait stabilization. Cheryl’s exercises targeted her acute neuritis, as well as benign paroxysmal positional vertigo (BPPV), a problem with the inner ear which she developed in conjunction with her existing balance disorder.

“Amy had me walk down the hall and turn in various directions, look to the left and to the right, walk over and around boxes, walk backwards, stop, and do it over again,” says Cheryl.

She would also test Cheryl’s BPPV using goggles to see her eye motion up close as it correlates with her dizziness. Cheryl would lie with her head turned to one side, quickly sit up after about a minute, and Amy would assess the same on both sides and in different positions. This was followed by specific maneuvers that, pending findings from the assessment, would help realign Cheryl’s BPPV.

Other exercises – including standing on a mat with feet together and eyes closed, wobbling while keeping your balance as best you can, and reading an eye chart while moving your head – were part of Cheryl’s biweekly visits with Amy. Many of these she could practice at home as well, like hall walking with head turns and head/eye exercises for her Vestibular Ocular Reflex (VOR) using a metronome for pacing.

Amy and Cheryl spent several months addressing fluctuating dizziness, eventually landing at a point of independence, where Cheryl is able to participate in her typical activities of daily living and return to her active social calendar.

Moving Forward on Steady Feet

Almost two years after Cheryl’s dizziness started again, she hopes she won’t have to encounter another “awful spinning spell” and feels 90% better than she did in 2021. Things were spinning out of control for her then – feeling nauseous and quite miserable – but now she shares that she can do just about anything she wants with minimal imbalance.

“I thought the care at UPMC was wonderful,” Cheryl says. “When I had to go to the ‘dizzy clinic’ as I call it, they were right there with me by my side all the time, were so kind, and made me just as comfortable as I could be in that situation. I’ve always felt really good about the care I received.”