Author Topic: My Appointment with the Certified Vestibular Therapist  (Read 9617 times)

lrobie

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My Appointment with the Certified Vestibular Therapist
« on: November 29, 2012, 11:14:25 am »
Hi Friends,

I wanted to give you an update on my appointment with the Certified Vestibular Therapist (CVT).  First off, I should say that I should have been going to her initially.   She started the appointment by asking about my surgery, asking me what types of symptoms I was still having and asking me what I've done thus far to try to correct it.  She then went on to do some testing.   I followed the pen with my eyes, but then she had me quickly move my eyes by telling me where to look...nose, pen, and then quick nose-pen-nose.  No one has ever had me do that.  I then sat in a chair about 10 feet from the wall.  There was a chart taped to the wall.  It was similar to an eye chart, but with many more lines.  She asked me to read the smallest line that I could.  It was the 3rd line up.  Then she stood behind me, held my head in her hands and began to move it side to side.  She asked me to start at the top and read the lines.  I read the first line, but could only get the first letter of the second line.  She stopped and told me it was no wonder I feel the way I do.  A person with no vestibular deficits would normally only have two lines in-between what they read at rest and what they read while head is being moved side to side.  I have ten lines in-between!!

The next test was wearing the goggles and watching my eyeballs after moving my head side to side.  She said I had a small amount of Nystagmus.  I then stood on a cushion with my arms crossed in front of me.  Within seconds of telling me to close my eyes, I was falling over.

After the testing was complete and she had me show her what exercises I was doing, I discovered that I've been doing it all wrong!!  :(   I don't need to look straight ahead and have my eyes follow an object.  I am perfectly fine with that while my head is stationary.  I do need to look at a target (letter on a piece of paper) and move my head side to side and up and down.  However, I was doing it wrong!  I was doing full head movement...shoulder to shoulder and ceiling to floor.  These movements aren't supposed to be big movements.  Instead, I am to move my head about the distance so that it seems my nose is lined up with each side of the paper.  Start slow and progress to a faster speed as long as the letter remains in focus.  You do each way for 60 seconds, 2 times per session and 4-5 sessions per day.  As always, these eye exercises will provoke some dizziness.  It lasts only about 10-15 seconds.  She said to work through it, but slow down if that helps.

The next thing I was doing wrong was when I would walk up and down the hallway moving my head side to side.  She said that I should walk five steps looking to the right, look ahead and then five steps looking to the left.  I should repeat that sequence 10-30 times, one session per day.  Do the same looking up and down.  The CVT said that I should be able to focus in on what I'm walking past.  If not, then I am going to feel out of sorts.  She said to also do this while in the mall and grocery store.

Lastly, the only standing exercise that she prescribed was standing on a cushion or pillow in the corner of the room.  Arms crossed, eyes closed for 30 seconds, repeat five times, one session per day.

I am sharing all of this with you because I know that there are those who cannot afford to go to a physical therapist or are not going to a "certified vestibular therapist".  If you feel like you're not getting better, try these and see how you do.  I will try to remember to update on this subject each week so you can see if it's working for me.  I pray that I have finally found the answer.

I truly appreciate all the support I get from this forum.   :)

Lisa

P.S.  Sorry for the long post.
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

Jim Scott

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #1 on: November 29, 2012, 12:33:54 pm »
Lisa ~

I'm delighted to learn that your examination/consultation with a CVT was so productive.  Thanks for explaining the exercises for those who may not be able to have a similar exam but need some help with regaining equilibrium.  Believe me, no apology for the length of your helpful post is necessary.  Here's hoping these exercises will be of great help to you (and others).   

Jim
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

CHD63

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #2 on: November 29, 2012, 12:42:30 pm »
Lisa .....

Great comments and suggestions!  I am a firm believer in the value of seeking the help of a certified vestibular therapist.  I went to a regular physical therapist first and it was a huge difference how much more beneficial the vestibular therapist was over the PT.

I no longer consciously do the exercises, but I did for months, with slow but eventually great results.

Clarice
Right MVD for trigeminal neuralgia, 1994, Pittsburgh, PA
Left retrosigmoid 2.6 cm AN removal, February, 2008, Duke U
Tumor regrew to 1.3 cm in February, 2011
Translab AN removal, May, 2011 at HEI, Friedman & Schwartz
Oticon Ponto Pro abutment implant at same time; processor added August, 2011

kixit

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #3 on: November 29, 2012, 03:01:24 pm »
I "finished" up therapy today. I still need to return every other week for assessment because......I get to go back out and work in the field!! The therapist and I agreed that being out and actually doing my job would greatly benefit my brain instead of office work (I am an animal control officer by trade). I am sooo excited. It's been 10 months since Ive been out in the real world.

When I fisrt started therapy 4 weeks ago, I could only stand on one foot for 2 seconds. Today..30 seconds! My exercises consist of:

Standing on a cushion, one foot, eyes open to gain balance then shut them, try to stay 30 seconds
Skipping
Bridges (for the core) lay on back, place feet on exercise ball, lift butt up for 20 times
Cones-place cones up on top shelf, then put back on lower shelf
Walking foot to foot, turning head left then right
Walking regular, turning head side to side then up and down
Card placement-follow an index card, the busier the background the better, same with ink pen
Gallops-side to side sort of skipping
Ball bounce- standing on a balance board, bounce ball of an erected trampoline (frontward, left sideways, right sideways) 30 times each (my FAVE!!)
Turn arounds-walk then quickly turn around
Running in place on trampoline for 30 seconds
Taps- jump up tap above door
Bends-bend at knees and tap an object (I had a milk crate to use), then repeat just bendin at waist
Finger taps- touch another persons finger tips after they move them

Not all these were done in one session. They seemed like baby stuff but as we that suffer from this wonkiness it's a major accomplishment to do these.

Also, in another post
someone had posted videos links of what its like. Mine used to be like video #3 now it's like your car door mirror that moves in the wind.
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

lrobie

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #4 on: November 29, 2012, 07:00:45 pm »
Thanks Jim and Clarice for your responses.  I forgot to mention that when doing the gaze stabilization, you need to tilt your chin down a little.  It has something to do with lining things up with your inner ear.

Kixit -  Wow!  You've been doing a lot.  I was doing a lot of physical type exercises to strengthen my muscles with my first therapist.  I also did the trampoline thing.  You're right...it was fun!  The CVT had me walk then turn around fast.  That wasn't fun.  I thought it was a test.  Maybe she'll progress to that later.  Were you seeing a CVT?

I was the one who posted the video.  I was also slightly better than the 3rd clip.  I'm glad to hear that you're getting better...although I'm not sure what a car's mirror that moves in the wind would be.

Another thing I forgot to mention is that I used up all but three of my physical therapy sessions that my insurance allows for the year.  So I can only go back to her twice before the end of the year and then can go more often in 2013.

Lisa
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

kixit

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #5 on: November 29, 2012, 07:42:43 pm »
Irobie-

I sent you a PM.

I also did bunny hops, the football thing (where they run through tires--minus the tires)--they threw my head for loop (I guess because of the bouncing up and down). It feels like my brain needed to catch up with my eyes. I still have to continue the exercises although therapy is over, prob forever-hopefully not. Ive heard if we catch a cold the brain forgets and we have to start basically over.

Anthem allows 80 phys therapy visits a year. I saw someone with vestibluar training, unsure of what the letters meant behind her name (it was 3 separate sets of letters).

I am surprised by the fact that therapy improved me as much as it has. My mindset was how can this baby stuff help, it's like cake? Boy did I get a lesson or two! It really works the ole noggin'  8)

Needless to say this whole adventure has been a wild ride--from AN resection, Baha surgery and therapy. How many people can say I had someone tickle my brain (translab), I have a screw in my head (Baha) and I needed therapy (ummm prob more than just the physical  :P)?
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

kixit

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #6 on: November 29, 2012, 07:45:51 pm »
and I forgot to undo the itallic button! sorry peeps
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

james e

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #7 on: December 02, 2012, 09:17:42 am »
They had me count backwards while I was doing it. It creates a HUGE distraction.

Shirley48

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #8 on: January 07, 2013, 12:14:19 pm »
I have been going to a regular PT and some of the exercises are the same. Definitely making progress. How do you go about finding a CVT?
1 cm AN removed July 2012
Retrosigmoid surgery
Vestibular nerve cut
65 years old
Summit, NJ

It is what it is

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #9 on: January 08, 2013, 09:55:55 pm »
Lisa, thank you!  I look forward to reading your updates every week.  The details are extremely helpful!
.7cm, left side AN , Tinnitus, Hearing preserved, Middle Fossa 8/1/12 at HEI, Drs Friedman and Schwartz, Sharing your story is extremely helpful to me.

sidecar Kathy

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #10 on: January 17, 2013, 10:06:41 pm »
Yesterday I had an appt. with the balance therapist.  She did all the tests mentioned and I was so amazed on how bad my balance was.  I guess I've been compensating pretty well all these years(w&w for 5 years).  She gave me some exercises to do at home to practice pre surgery.  Still don't have a surgery date yet but she said if I practice every day then after surgery it will be easier.  She told me that she wished more patients saw her before surgery.   

I sent all my stuff to "House Clinic" and talked with a Dr. Slattery last night.  Though I am grateful for his opinion and the time he took to look at all my MRI and reports I was put off a little that he suggested that maybe I should consider going to LA for my surgery.  I know that's all they do there and are experts on AN's but I don't want to travel 2,000 miles to have surgery.  I admire the people that have made the decision to travel so far for surgery.  I don't want to be that far from home and plus the added expenses of plane fare, lodging, food and any other expenses I've not thought of.  Dr. Slattery did bring up a couple of things that I will talk with the Neurosurgeon when I see him Tuesday.  House provides a great service of giving you a second opinion for no cost and that is something you can't get anywhere else. 

millie

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #11 on: January 22, 2013, 06:46:58 pm »
Thank you for the exercises.  If my heavy head continues I will ask for a cvt. 

It is what it is

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #12 on: January 27, 2013, 05:57:14 am »
Hi Lisa,  how is your vestibular therapy? Any change in your symptoms?
.7cm, left side AN , Tinnitus, Hearing preserved, Middle Fossa 8/1/12 at HEI, Drs Friedman and Schwartz, Sharing your story is extremely helpful to me.

wwarr

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #13 on: January 27, 2013, 11:55:22 pm »
Lisa,
I wanted to thank you for posting the vestibular exercises.  I have found them very helpful, as I'm sure others have too.   I had surgery 2 1/2 yrs. ago and still struggle with balance issues.  When I read your post, I was so grateful and elated at the details. 
I hope your doing well with your recovery.
Thanks again!
Wendy
4 mm x 8 mm 12/08
1.4 cm rt. AN middle fossa on 7/23/10
hearing and facial nerve preserved. Grateful for brilliant surgeons Dr. Friedman/ Dr. Schwartz @ HEI in LA, CA.

post op chronic headaches
”Faith in every footstep...let go and let God”

arizonajack

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Re: My Appointment with the Certified Vestibular Therapist
« Reply #14 on: January 30, 2013, 12:23:29 pm »
I'm also seeing a vestibular therapist and have a couple of exercises to add to the list.

Stand with one foot in front of the other, heel to toe, eyes open for 30 seconds, eyes closed for 30 seconds. Do that several times, a couple of times a day. That's the kind of exercise you don't have to set aside time for, you can do it as part of your normal activities walking from one place to another in your house. If you find you are getting good at it, do it for longer periods with your eyes closed.

Walk with on foot in front of the other, heel to toe. That's even more difficult but you can also do it at any time.

Has anybody tried a balancing board yet. One like this:

http://www.amazon.com/SKLZ-APD-BB01-02-Balanz-Board/dp/B0053C3NIQ

That's supposed to do wonders.

3/15/18 12mm x 6mm x5mm
9/21/16 12mm x 7mm x 5mm
3/23/15 12mm x 5.5mm x 4mm
3/13/14 12mm x 6mm x 4mm
8/1/13 14mm x 5mm x 4mm (Expected)
1/22/13 12mm x 3mm (Gamma Knife)
10/10/12 11mm x 4mm x 5mm
4/4/12 9mm x 4mm x 3mm (Diagnosis)

My story at: http://www.anausa.org/smf/index.php?topic=18287.0