Vestibular / Balance physical therapy
 

So I had my visit at the UPMC Sports Medicine Concussion Clinic today (excellent state-of-the-art facility by the way). I took the IMPACT test which was a test on the computer that asked me which symptoms I was experiencing on a scale 1-6, then proceeded to test my memory, speed, and other skills using a series of 6 different tests. I then met with two neuropsychologists afterwards to discuss the results along with my history and current status.

The docs basically told me that my main weaknesses are in the vestibular area. He told me to hold out my thumb and follow it 180 degrees with my eyes and said my eyes jump to follow my thumb when it should be a smooth motion.

He wrote me a script and recommended I take balance / vestibular physical therapy and noted that it is going to help a lot with my foggy thinking and dizziness symptoms.

He also said with my injury being in crowds is going to make my symptoms much worse, which I can personally attest to.

He also gave me a few other suggestions:

1. Do not take naps. Go to bed and wake up at the same time everyday including weekends.

2. Exercise about 5 days a week using low weights and low impact such as stationary bikes or treadmills. But avoid going to the gym during times there are a lot of people there.

3. Repeat cycles of exposure and rest. In other words, do something active, and follow it up with rest. Basically don't be too active for too long or rest for too long. Exposure could be considered going to Costco, working at work, going to the gym, going for a walk, paying bills, etc. Rest would obviously include quiet time but NOT napping.

He told me that it is more difficult to recover from injuries with my personality type (Type A) because we like to push ourselves often beyond what we should. He also said that anxiety is typically what my personality type experiences with concussions, rather than depression. He re-assured me that my anxiety is normal.

He told me I will recover 100%. He sounded very confident that the vestibular / balance physical therapy is going to help me a lot.

Does anybody have experience with vestibular / balance physical therapy? Did it help you? What should I expect to go through?

My first appointment is this coming Monday (May 6) followed by two more visits (1/wk) until my follow up appointment with the neuro on May 23.

All in all I feel much more confident I am going to get through this thing. He recommended I continue with my 4 hour work days at least until my follow up appointment.

Sounds like you got some good advice. They know a lot about concussions but are still over-stating some of their claims. "He told me I will recover 100%" If you read their research, they admit that they do not have systems to measure recovery to the 100% level. Since their goal is Return to Play, this may be what they mean by 100% recovery. Even then, they also admit that they can not measure and predict if the brain ever recovers to its pre-concussion level of tolerance for another impact.

So, follow their instruction but remember to protect your brain from further impacts.

Way to go!!! Im glad you found someone that can pin point the problem and find possible solutions. Keep us updated on how the therapy goes.

I Can Relate
 

I have been doing vestibular therapy and PT with a TBI specialist since January.I was a little sick in the beginning and I practice both vestibular therapy and PT at home and see therapist twice a week.We are working on balance test again right now to see how I am coming along with therapy.

Wish you the best

Therapy
 

I read your post yesterday but didn't respond becca use I have difficulty writing well.

I went to dizzy and balance therapy and found it extremely helpful. Part of it was that I love my therapist. My symptoms were horrible a few months ago and now they are 90percent better, which makes life much easier. It took me eight weeks of therapy to get better.

I still go now but we are working on vision. I can't get in to see a specialist til late July.

I am also type a. My advise to you is to not try to do too much too soon. They would tell me to do thirty reps , 3 sets. So I would think, I can do twice that! And then I would get sick! You need to take things very slowly. Everyone would ask what my therapy was. And I would have to say that this week I am trying to stand in a corner and move my head without falling over. And they would say really, that's all? Yes, it's really hard. Then I rest and try to walk across the room while moving my head. Then I rest again.

But I really noticed the gradual improvement.

And luckily my therapist knew more about concussions than anyone that I had met and she had plent of time to talk to me.

Su seb

So Vestibular therapy is basically balance and vision exercise?
My chiropractic neurologist has been doing various balance exercises with me like one foot in front of the other arms crossed and eyes closed to check on my my balance. Before he does this he asks me to do a series of eye exercises where my eyes follow his finger to various places and then he will move his finger quickly and i have to shoot my eyes to his finger quickly. He will ask me to spread my fingers wide and he will try to push them in and then hold my arms up one at a time and try to push them down. Then I need to go home and do an eye exercise where I will follow my finger in a diagonal peripheral and then quickly shoot my glance to the opposite side and I will do this exercise on one foot and then the other. Another exercise he told me to do is stand stand one food in front of the other and my left arm will be doing figure eights in front of me.

My one post concussion symptoms are chornic headaches. I'm not really too sure what these exercises are doing and how they will benefit me?

Thank you for your feedback.

Not quite
 

It's a bit different. It is dizzy and balance therapy designed to work with the vestibular system. I go to the national dizzy and balance center in Minnesota.
Su seb

Vestibular Therapy
 

I went to it about 4 times and it really helped me.

I am pretty sure the balance exercises and the exercises I did with my eyes helped me get rid of that horrible, awful, dizziness.

I have now graduated from vestibular therapy and I am supposed to do the exercises 3-4 times a week on my own.

I hope it goes well for you!

My experience with vestibular therapy
 

I just thought I'd chime in and mention that I'm one of the few for whom vestibular therapy did not really work. I did it for about 4 months without much improvement. At that point, my therapist referred me to a neuro-optometrist, and he has been able to help me. If I'd known then what I know now, I would have gone to him sooner!

Great to hear feedback from everyone! It seems that this therapy helped the majority of people here. It sounds like the time frames for recovery do vary with this therapy.

Poetrymom - That's great you had results in only 4 sessions!

Su Seb - So glad to hear you are 90% better! Did you also have brain fog as one of your symptoms along with your dizziness?

DFayesMom - I will keep that in mind if the vestibular therapy does not work for me. I'm glad to hear you found someone who does help you!

MiaVita2012 - How would you rate your improvement since January? Excellent, great, okay, not good, etc.?

Thank you everyone else for the encouragement! I will keep you all posted on how it goes.

Tp
 

MiaVita2012 - How would you rate your improvement since January? Excellent, great, okay, not good, etc.?

I do not get dizzy anymore,or run into walls/stuff anymore, I do not get those kind of headaches anymore, nausea is min now~That is from the vision therapy benefits

I physically still cannot walk a line, or do anything with my eyes close for as long as open and balance on one leg, and cannot do anything on the pillow with eyes closed.So basically I can do everything with eyes open except a line and not anything with my eyes closed that is on one leg or on the pillow for very long.

I snowboarded for 25 years so my TBI vestibular therapist said it will help out a lot because I had excellent balance before.

I first started out in Jan with a therapist that was not certified and HORRIBLE!I had to stop him and wait to get in with my TBI specialist in mid Feb and she is great and I see a big difference.Since our winter has been bad we been hit or miss from weather for my 2 times a week. I would rate mine as good progressing.Could probably be a lot better if I did not have all my physical injuries from car accident getting in the way.

Symptoms
 

I still have lots of other symptoms. But before vestibular therapy I could barely walk. I felt as if I was floating and had very little control. If I moved my head while walking or had to turn a corner I would nearly fall over. And so mush nausea.

I still have vision issues, convergence insufficiency, some brain fog, not as bad as before ( I used to just stand at look at things like my makeup and not even know what to do with it), brain fatigue and stress, physical fatigue, headaches, head pressure, light sensitivity, sound sensitivity, sore eyes, light headed ness, verbal processing problems........

For me, the brain fog is managed best if I try to keep my stress levels low, not overdo anything, rest regularly...a lot like the advice your doc gave you.

But just starting to tackle some of the problems and understand the others was so helpful. Before that, my other doc was just telling me I was fine and I would be better in a week. That was of no help.
Su seb

Bad Brain Fog Today
 

Yesterday was my first appointment at physical therapy. The PT did a thorough evaluation and recommended a bunch of different exercises for me to do at home 2-3 times a day (7 exercises total). Most of the exercises have me focus on an object and move my head and eyes in different ways. A few other ones have me walking an turning my head or balancing with my eyes closed.

I've done the exercises 3 times total now, 1 at the PT's office and twice on my own. The problem is I woke up with pretty bad brain fog today. I feel a little less dizzy, but my brain fog is overwhelming.. definitely worse than usual. It almost feels like I'm high. Has anyone else experiencing anything like this when they began physical therapy? Do you think my brain is just getting used to the exercises and the brain fog will subside?

This just seems like a step in the wrong direction for me and it's very frustrating.

Yes, I've been there!
 

PT pushes your boundaries, and that is its nature. I think it's normal to have a reaction to it. I was told that as long as it is not creating headaches, it's okay, but if you have dizziness, let the dizziness subside before you start the next exercise.

That said, if you are nervous, call and talk to your therapist. He/she may reassure you or tell you to ease into doing your exercises. It does seem like a lot to me. I know I didn't start with 7 exercises, which isn't to say that there is anything wrong with it, but I could see why it's overwhelming to you.

I remember that high feeling. I had it for months. Do you feel like it's in part caused by how you are seeing things or is it just a feeling in your head?

I feel like its in part how I am seeing things. I guess I'm basically re-training my brain to see things differently with these exercises so maybe it puts additional stress on the brain until the brain can fully adjust. I definitely did not feel this "high" anytime recently. It does feel like its all right behind my eyes.. Sorta like my eye muscles are a little sore? It's difficult to explain.

Just to be safe I'm going to shoot my PT an email and ask if this is normal and if\when I need to stop. 5 of 7 of my exercises are 2-3 times daily so I'm just gonna do them 2 times a day now until I feel more comfortable to move to 3.

Neuro-Opthamologist?
 

When I was doing vestibular therapy, I had extreme troubles doing any of the ones that involved eye movements, to the point where I just refused to do them anymore. My head would immediately start hurting and my eyes would feel so strained. It got to the point where my physical therapist didn't know what to do with me and didn't know how to help me, so that's when she referred me to the neuro-opthalmologist.

If you wait and see how it goes with the physical therapy, just don't keep doing it for months on end without result like I did! Knowing what I know now, with your symptoms, I would go ahead and make an appointment with a neuro-opthalmologist. The only reason to wait would be financial considerations or lack of access to care, but if it's covered by your insurance and you have one in your area, there's really no reason not to go get checked out. That's just my two cents! Good luck!

P.s.
 

I forgot to specify that what concerns me is that you think that how you see things could be part of the problem and that your eyes are hurting. One of the more common vision problems after a head injury is convergence insufficiency and that could be part of what you are experiencing.

If you have any specific questions about any eye-related issues, let me know. I've been through the works and I'm still dealing with issues, so if I can help, I'm happy to be share what I know!

Yes
 

Your exercises sound very similar to mine. And yes that is exactly how I felt in the beginning. Try to think of the therapy as your job/priority and cut out other things. Don't go to the store, movies, tv... Do the exercises slowly and carefully.

My therapist helped me to recognize my symptom levels and keep them in check. For instance, if my symptom levels were at a 3, I would make sure that I didn't let my exercises raise my symptoms higher than a five. No more than two points was my goal. Sometimes I would do fewer, slower, or spread the exercises out throughout the day. If my symptoms were already over an 8, no exercises.

Talk to your therapist about this.

I agree that you should most likely see an eye specialist. But only a good one that knows concussions. I fell in October and my first appointment is at the end of July. Make the appointment now f you can. Long wait lists. Your therapist can do a couple of simple tests moving a finger or pen back and forth in front of you to tell if you have convergence insufficiency.

Ask more questions if you like.

Remember, this treatment helped me a lot.
Su seb

From My Experience
 

T~ I know what you mean by going backwards with this therapy.Yes it is bad at first but it wont last long.It is how this therapy works to get your vestibular in right balance.I just finished a series of test to see where I am at in progress with my vestibular therapist. My test results are SOOOO much better then in November 2012 but I did not start therapy till January 2013.

I was a snowboarder as well since I was a child, and this is a HUGE benefit for YOU!!!I made a faster improvement because my past in snowboarding and so will you. The PT part you need to push yourself a little but read your body so you know your limits now.It will get better once you get the starting of vestibular therapy.Just keep at it and keep positive.
Wish you the best

Great to hear that I'm not the only one who went backwards in their therapy at the beginning. How long did it take everyone before you started to notice some improvement and forward progress? It has only been 4 days since I started therapy and I don't see any forward progress yet beyond where I was 4 days ago.

Mia - Yes, my therapist told me the same thing! She also told me the shape my body is in and my health will help me tremendously. That was very encouraging.

Su & Dfay - The eye movement exercises do not hurt to the point that I cannot do them anymore. I did feel strain the first day or so but now I feel the exercises are helping. Should I maybe mention the neuro-opthalmologist to my physical therapist and see what they recommend?

It couldn't hurt to ask! My pt was pretty knowledgable.

Hi
 

I would say the first couple of weeks of therapy I felt overwhelmed. But I was still trying to work full time. It was my therapist who helped me to realize that I couldn't work full time. I was just getting worse and I didn't have any energy to put towards therapy.

There are a lot of different things that can be wrong with your eyes. Ask your therapist.
Su seb

I Just Found Out Today
 

I Found out today that my V therapist is probably going to be done with me in July because of my improvements.So that would be a total 6months vestibular therapy:D Then I can move on to next therapy cognitive therapy that I need.

Great news! Congratulations!