Vertigo & Balance Problems
What Makes the Functional Neurological Approach Different Than The Standard Approach to Diagnosing and Treating Patients with Vertigo, Dizziness and Balance Disorders?
We do not treat with medications.
Medications affect the brain globally as a whole and are not specific or able to bias certain neurological areas. Therefore, it is not possible for a chemical to only affect the specific areas of the brain causing a person’s vertigo and not the non-affected areas. For example, if only the left side of a person’s brain stem is affected (causing dizziness and poor balance), how could the chemical action of the medication only affect one side and not the other? It is for that reason we do not use medication and instead use specific brain stimulations to train and repair the specific areas affected. The most current research supports this approach.
In order to better understand this methodology it’s important to understand how a Functional Neurologist differs from conventional medical neurologist. The key difference between a Functional Neurologist and a conventional medical neurologist lies primarily in their approaches to treatment.
A conventional medical neurologist is typically focused on the diagnosis of structural pathology and utilizes only pharmaceutical and surgical interventions to treat disease.
A Functional Neurologist views the nervous system as a moldable, changeable entity that can be affected in its function through virtually unlimited types of environmental stimulation and specific therapies. This concept of the brain being able to change its function throughout life via environmental stimulation is termed neuroplasticity and is at the very core of a Functional Neurologist’s clinical methodology.
We look at overall brain and inner ear function:
It is important to understand that going to your medical doctor is a good idea to rule out a pathological cause of your Vertigo or Balance Disorder such as, tumor, stroke, MS, clogged carotid arteries, or other disease process. However, when your VERTIGO or BALANCE disorder is not caused by pathology and you are not responding to medicine or simple head exercises it is time to look elsewhere.
Your medical doctor may have diagnosed your condition as an “inner ear problem.” However, a large cause of dizziness is due to abnormal function of the circuitry in the brain. The most common area of the brain to be affected in vertigo or poor balance is the brain stem and cerebellum. A decreased or abnormal function of the cerebellum is not simply “an inner ear problem” and is usually the underlying cause affecting many vertigo sufferers. The cerebellum is the back part of the brain which controls your balance and movement. When there are decreased impulses in the cerebellum or an imbalance in it functions you will experience vertigo or poor balance. Sometimes your perception of the world may be tilted, you may feel very unstable when you walk, the environment may spin around you or worse you may feel like you are spinning. Please understand the inner ear AND the cerebellum are connected by the vestibular branch of the 8th cranial nerve.
Along with evaluating inner ear dysfunction we also look at each specific brain region that may be causing a person’s vertigo in addition to the individual’s specific functional capabilities and metabolic health as well. This is different than just prescribing medications to mask the symptoms and not looking at each individual patient from a functional model.
We combine the latest research-backed neurological examinations and advanced neurological testing for patients with vertigo and balance disorders
The advanced neurological testing procedures listed below allow us to pinpoint brain impairments that may be responsible for your vertigo or balance disorder.
Video Nystagmography VNG Video Nystagmography VNG
VNG is a computerized system used in the assessment of the oculomotor system (nervous system control of eye movement) and the function of those areas of your brain controlling these movements.
The Video Nystagmography (VNG) test is comfortably performed in our office. We simply place special goggles with an infrared camera on your head to record and measure your eye movements in both light and dark conditions.
Many sufferers of vertigo may have had the VNG test performed at their EENT office. The version of VNG analysis an EENT performs is typically done to rule out inner ear disease. This test usually includes caloric testing that blows hot and cold air or water into the ear to try to re-create the vertigo. This test can be pretty uncomfortable. We do not typically perform that aspect of the VNG testing because we as functional neurologist are focused on analysing brain malfunction that may be causing a patient’s vertigo or poor balance.
Specific areas and pathways of the brain are activated during different types of eye movements. During the test, computer software is recording and graphing your precise eye movements as you follow the visual target with your eyes. By measuring your recorded eye movements and displaying them on the computer screen, you can see your own eye movements and how they compare to normal measurements.
The following eye movements are measured by VNG:
1. Gaze Stability: It is essential that the brain stabilizes the gaze of the eyes for proper equilibrium and balance. One of the most common ocular motor deficiencies seen in neurological based vertigo and poor balance is poor gaze stability. This can be seen on the VNG tracing.
2. Pursuits: Pursuits are slow and steady eye movements that allow you to track a moving object. Good smooth pursuits are essential to everyday functions. The pursuit mechanism is commonly altered in patients that have poor stability and dizziness.
3. Saccades: Saccades are fast eye movement used to shift a person’s gaze from one object to another. Saccades need to be fast and accurate. Sub-optimal brain function can alter the speed and accuracy of a person’s saccades causing vertigo and poor balance.
4. Optokinetics (OPK): This is an essential eye movement that allows for visual function as the surrounding visual environment passes by. When these are dysfunctional it can indicate poor brain function.
5. Vestibular Ocular Reflex: When you move your head your eyes should move equally in the opposite direction if this reflex is functioning properly. When this reflex is disrupted it also can create many symptoms especially dizziness and poor gait.
6. Positional testing (Dix Hall Pike testing) for BPPV: For patients with positional vertigo caused by BPPV or otoconia crystals or debris in the canals of the inner ear proper testing is essential. There are 3 different inner ear canals on each side of the head. Each canal is associated with specific eye movement abnormalities when debris is within them. We use the VNG system to pinpoint which canal or multiple canals are the affected ones. This is essential in determining what specific positional maneuver is indicated to give the patient relief.
The VNG eye movement tracings provide invaluable neurologic information concerning specific areas of your brain affected. We are experts at analysing these specific eye movements and determining if they have been disrupted in their proper function. We correlate the VNG findings with our other testing and examination procedures to develop a specific therapeutic program for each individual.
We measure your saccades using saccadometry. Saccades are quick movements of your eyes that allow you to voluntarily move your eyes quickly from one object to another or to react by moving your eyes to a suddenly appearing target reflexively. Saccades can be measured using a device called a saccadometer. The saccadometer is strapped around a patient’s head using an elastic headband. Within the unit, there is a laser that projects targets onto the wall that a patient will look at quickly or saccade to. The saccadometer will measure the eye movements at the same time.
Studies have shown this test to be a very accurate way to detect brain dysfunction caused by injury or neurological disorders. This test cannot be altered voluntarily by the patient because you cannot consciously control the speed of your eye movement during each saccade; your eyes move as fast as they can. The purpose of your saccadic eye movement is to aim the part of your eye with the best vision (fovea) at the thing you want to see most, and then hold your eye there as you examine it.
Saccades are the only human physiological function that uses every area of the brain. It is for this reason that we can evaluate a person’s saccades to determine what areas of the brain are not functioning up to par.
Some of the brain areas you use in controlling saccades involves three main cortical areas: the frontal eye fields, the parietal eye fields, and the supplementary eye fields; and several subcortical areas in the basal ganglia, thalamus and brainstem.
Saccadometry very precisely measures these aspects of saccades:
1, Latency: This is the reaction time taken for the saccade to fire or activate after a new stimulus or target is presented. A normal reaction time should be less than 200ms. People who have had a concussion or suffer from neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease have pathological long saccadic latency times that are greater than 200ms.
2. Velocity: The speed of a saccade is highly related to health of areas in the brain stem commonly affected in neurological disorders.
3. Saccadometry Accuracy: The ability to make the eyes stop and land directly on the target they are saccading to or looking toward is essential to a person functioning in their environment accurately. If the saccade overshoots or undershoots the target it may indicate that the cerebellum or the area of the brain that makes the environmental grid may have been affected by injury or neurological disorders. Patients with these accuracy areas affected can have serious issues with balance, gait, equilibrium, movement and this may cause dizziness and nausea.
The saccadometer computerized graph shows leftward saccades that are generated by the right brain hemisphere as red and the rightward saccades that are generated by the left brain as green. This can be very useful in determining what side of the brain is most affected.
We use Computerized Assessment of Postural Stability (CAPS™) testing performed in our office for assessing how well your brain perceives your body position in space.
When a person has poor balance almost always their perception of where their body is positioned in space is disturbed affecting their balance. Important areas of the brain react to information that they receive from the nervous system’s sensors or receptors in the body. The brain uses this information to create a somotopic or body map that allows us to have good balance and function as we move through our environment. Damage or poor function in these important areas of the brain can cause a person to have an altered sense of where they are in space. This deficit can be devastating to a senior’s ability to walk and enjoy life. The CAPS balance and posture stability test uses an extremely sensitive force platform and specially designed software that can measure the otherwise imperceptible and undetectable changes in a person’s balance or what is known as their center of pressure and limits of stability. A person’s center of pressure is closely related to a person’s center of gravity and a person’s limit of stability is how far they can move off of this center without falling. The CAPS will generate a report that quantifies a person’s balance and stability. This will provide an objective score that can be compared to normative data for the patient’s age, height, gender or prior CAPS baseline. This test is essential in diagnosing poor stability and can be used to monitor progress through care. For more information go to: https://www.vestibtech.com/TBI.html
CAPS™ Balance Testing
Statistics show that falls are the leading cause of death from injury among people aged 65 and older. Optimal Balance is essential to prevent a devastating fall.
We use Computerized Assessment of Postural Stability (CAPS™) testing performed in our office for assessing balance and how well your brain perceives your body position in space.
When a person has vertigo or poor balance almost always their perception of where their body is positioned in space is disturbed. Important areas of the brain react to information that they receive from the nervous system’s sensors or receptors in the body. The brain uses this information to create a somotopic or body map that allows us to have good balance and function as we move through our environment. Damage or dysfunction to these important areas of the brain can cause a person to have an altered sense of where they are in space. These deficits can be devastating to a senior’s ability to walk and can cause a sense of disequilibrium.
The CAPS balance and posture stability test uses an extremely sensitive force platform and specially designed software that can measure the otherwise imperceptible and undetectable changes in a person’s balance or what is known as their center of pressure and limits of stability. A person’s center of pressure is closely related to a person’s center of gravity and a person’s limit of stability is how far they can move off of this center without falling. The CAPS will generate a report that quantifies a person’s balance and stability. This will provide an objective score that can be compared to normative data for the patient’s age, height, gender or prior CAPS baseline. This test is essential in diagnosing the cause of a person’s vertigo or balance disorder and can be used to monitor progress through care. For more information go to: http://www.vestibtech.com/TBI.html
We use Breakthrough neurological Therapies to improve brain function:
The neurological therapies or brain stimulations we use are specific and unique for each individual. These therapies are determined by the neurological consultation, the neurological examination and advanced neurological computerized testing. These therapies help restore impaired function by using the concepts of neuroplasticity and the brain’s inherent ability to repair itself. The therapies target affected areas with specific activities to rebuild neural pathways. These stimulations are aimed at reactivating the nervous system where abilities have been compromised.
Therapy regimens may include:
1. Specific eye exercises based on the testing
2. SSEP: somatosensory evoked potential
3. Vibration Therapy
4. Proprioceptive stimulation
5. Vestibular stimulation
6. Balance Therapy
7. Advanced muscle retraining
8. Interactive metronome
11. HemiStim Programs
12. Oxygen Therapy
We do specific Biomechanical spinal care:
Spinal joint dysfunction may further impair brain function, when the nerves in the neck that fire back to the brain are not working well. If necessary, spinal therapies may include:
1. Non-Surgical Spinal Decompression: NSSD creates a negative disc pressure and helps to reduce pressure on the nerves. It also provides a slow stretch of the muscles which fires up the spinal cord to increase firing of the brain.
2. ATM2 (Active Therapeutic Movement): For patients who have back, neck and/ or hip pain when bending or twisting. Your body has a protective mechanism that prevents damaged tissue from being damaged further. Pain prevents you from moving the damaged tissue into an unsafe position. If the spine is unstable, that defense mechanism will remain even when the damaged tissue is healed.
3. Laser/Light Therapy:
– Increases Circulation and Angiogenesis
– Reduces or Eliminates Acute and Chronic Pain
– Reduces Inflammation and Swelling
– Stimulates and Improves Nerve Function
– Strengthens and Repairs Bone and Soft Tissue
– Increases Mobility and Muscle Function
4. Biomechanical Chiropractic care and Core Stability Exercises: To correct a poorly aligned spine and to strengthen the muscles that support the structure of the spine.
We provide Metabolic Care using the latest advances in Functional Medicine to support healthy brain function and reduce brain inflammation:
There are specific dietary recommendations and nutritional compounds that can reduce brain inflammation and make a better environment for brain function. We combine these evidence-based, drug-free dietary recommendations and nutritional supplements with our specific brain therapies to achieve maximal benefit for our vertigo patients.
We base a patient’s specific nutritional needs on their preliminary lab results. The following are some of the lab tests we may run to determine the best nutritional approach each individual patient will need:
Preliminary Lab Testing
The effects of a concussion can be compounded by the person’s metabolic health prior to the injury.
1. A Complete Metabolic Panel (CMP)
2. A Lipid and Thyroid Panel
3. A CBC (Complete Blood Chemistry with Auto Differential)
4. Vitamin and Mineral Testing (Vit D, B12, Calcium, phosphorus etc)
5. Inflammation Testing: We test for Inflammation in your system by testing Homocysteine Levels and C – reactive protein (CRP).
6. Iron and Ferritin Testing For Anemia
We can assess your thyroid, adrenal, immune, blood and gut function. All can be affecting your brain health. By addressing any problems with your thyroid, adrenal glands, immune system, blood chemistry or gut function, we can help your nervous system to function more properly. The complete metabolic panel allows us to check your blood glucose levels since glucose and oxygen are needed by the brain to function properly.
Special Lab Panels and Testing
Intestinal Wall Micro CloseupYour preliminary blood testing will let us know if any of the special testing listed below will be necessary in helping you recover from your vertigo and improve your balance.
1. Cyrex array 2-Intestinal permeability (Leaky gut testing)
Many vertigo patients, especially those with an auto-immune induced Meniere’s syndrome, have a microscopic breakdown of their intestinal wall known as intestinal permeability. This breakdown, called leaky gut, will cause the small intestines and colon to become inflamed as well as allow the brain to maintain its inflamed state. An inflamed gut will cause an inflamed brain. A leaky gut is also associated with driving a hypersensitive immune system attack on the inner ear membranes causing the symptoms associated with Meniere’s syndrome. The Cyrex labs specialized immune testing for intestinal permeability will determine if you have leaky gut and if so, what specific type. There are 3 types of leaky gut, each have a specific treatment approach.
The Gut-Brain Connection:
The gastrointestinal system is known as the “Second Brain” and has just as many neurons as the brain itself. Our 2 brains- the one in our head and the one in our bowel- must cooperate. When they do not, then there is chaos in the gut and misery in the head-everything from “butterflies’ to cramps, from diarrhea to constipation. Michael D. Gershon, MD author of “The Second Brain”
2. Cyrex array 3- Advanced gluten sensitivity testing
Vertigo sufferers that are also gluten sensitive may have excess gut and brain inflammation from gluten sensitivity. Food sensitivities can drive the autoimmunity seen in Meniere’s syndrome.
3. Cyrex array 4-Food sensitivity and cross reactive food testing:
Vertigo sufferers may also be sensitive to multiple foods beyond gluten. This test will pinpoint what foods are causing excess gut and brain inflammation. (See CYREX Gut Brain Immune video tab on website)
4. Stool Microbial Ecology testing
for intestinal bacteria, yeast, parasites and dysbiosis. Eliminating intestinal inflammation will help to reduce overall body and brain inflammation
5. Adrenal Stress Index (ASI)
We can further test your adrenal glands with a test called an Adrenal Stress Index. Your adrenal glands are your “stress” organs, meaning that they react to stress. If you have been or are currently under stress, this test is a must! When your body’s cortisol levels are abnormal, it is a sign that your body’s sympathetic nervous system is over-firing. Abnormal cortisol levels can be corrected via specific neurologic and nutritional protocols.
Note: Not all of the special tests are necessary for every vertigo patient. Each patient will have specific recommendations for special tests based on their initial exam findings, preliminary blood work findings and their unique set of health complaints. Preliminary blood testing will help determine if any of the special lab panels explained above will be necessary for you.
Specific Nutritional Protocols
These specific nutritional protocols are based on your neurological testing, your blood work findings and your special lab panels. Our goal is to provide the brain with the best metabolic environment to support and obtain the best results from our neurological care. These protocols are designed specifically for you and may include any of the following:
- Anti-inflammatory diet
- Specific diet and supplement protocols to decrease brain and gut inflammation.
- Liver detoxification
- Specific diet and supplement protocols to decrease brain and gut inflammation and decrease chronic pain
- Non-drug protocols for high blood sugars, diabetes, hypoglycemia and high cholesterol
- Natural protocols for hypothyroidism
- Nutritional protocols for abnormal adrenal (stress gland) function
- Specific diet and supplement protocols for autoimmunity
- Food sensitivity diet recommendations
- Migraine trigger elimination diets
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