Dizziness & Vestibular Rehabilitation

If you are suffering from dizziness, wooziness, light-headedness or unsteadiness then you are not alone. It has been estimated that 65% of individuals over the age of 60 experience dizziness or loss of balance on a regular basis, and vestibular problems account for one third patients reporting to doctors with symptoms of vertigo and dizziness.1, 2 In fact, recent research out of Johns Hopkins University suggests that as many as 35% of adults over the age of 40 in the United States (i.e., 69 million Americans) have some form of vestibular dysfunction as measured by a postural balance test.3

Dizziness can result in an inability to work, leave the house, walk, or stand. It also contributes to falls and severe injuries. Physiotherapy and vestibular rehabilitation as part of overall healthcare plan can help provide relief.

Physiotherapy for dizziness typically consists of vestibular rehabilitation. This is an exercised-based program to encourage the central nervous system to compensate for problems with the Vestibular apparatus

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An assessment is typically carried out first to assess sensation, gather information about pain and severity, muscle strength, range of motion, posture, balance, coordination, and general abilities. Once this assessment is complete, a fully customized exercise plan is created aiming at decreasing symptoms and improving the function.

The treatment model contains Balance/coordination activities to retrain body awareness, Eye and head movement exercises which reduce dizziness & Flexibility and/or strengthening exercises.

At home exercises & proper counselling are the integral part of the treatment programme.  

A proper treatment model promoting a healthy lifestyle can help restore a person’s balance, mobility, and coordination. With vestibular rehabilitation, a person’s dizziness can reduce or get eliminated and they can return to their normal standard of living.

References:

1Hobeika CP. Equilibrium and balance in the elderly. Ear Nose Throat J. August 1999; 78(8): 558–62, 565–6.

2Neuhauser HK, Radtke A, von Brevern M Et al. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008; 168(19):2118–2124.

3Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009; 169(10): 938 944.

Special Needs & Nutritional Complexities

Good nutrition is critical from infants to teen to adults in order to sustain healthy growth and development. A healthy diet needs to meet the changing nutritional needs of a growing child and should prepare him/her for maintaining healthy eating habits lifelong. As Parents and/or caregiver We are obliged to inculcate healthy eating habits in children that meets their nutritional requirements and leads to proper growth as they are in a stage of continuous mental and physical development. But as children grow, they develop their own individual personality, tastes and preferences to everything around them including food. An exposure to various tastes, textures, combinations of food leads to development likes and dislikes towards certain food stuffs. Thus, making child meet their supply on nutrients is very difficult and thus requires a strict nutritional regime & discipline.

If you are a parent to special need child, then this becomes all the more difficult owing to complexities involved. For example, a child with autism spectrum disorder may have a deep negative reaction to textures, tastes or colours. Children with Down syndrome, prefer softer foods because of difficulties encountered when chewing or swallowing. Special need Children are often on prolonged medications which affects their food habits & weight gain. A child’s ability to consume is also a key factor in nutrition; Children with Cerebral Palsy often struggle, choke or worse on providing food hence absolute care is to be taken while feeding them. Issues like acid reflux or Gastroesophageal reflux disorder, Dysphagia, misaligned teeth, gum swelling, etc. can also impact a child’s nutritional plan as it dominantly affects the selection of foods. Some children can be overweight / obese due to mobility issues, reduced calorie usage or some might be underweight due to speedy metabolism, swallowing issues etc.

Overcoming the nutritional challenges in the children with Special Needs is a complex issue which needs co-joint efforts of family, pediatrician, therapist & nutritionist. It is very necessary to overcome the specific barriers children have, to help them create a healthy relationship with food & proper nutrition as nutrition & child development go hand in hand. 

Balance & Vestibular sense

Our sense of balance is determined by a complex system controls viz the vestibular sight, and other sensory sensations. the vestibular system detects our orientation to gravity and our movement through space even in the dark. The vestibular system helps us maintain our equilibrium while we walk, spin, rock, run, bend or swing. Additional vestibular system functions include assistance to control muscle tone, and language. Shifting head positions, weight, and using both sides of body leads to a better development of vestibular system.

 Kids with overactive vestibular systems prefer slow movement, avoid tasks such as climbing, jumping precisely they avoid activities that require good balance and fast movement. They are fearful of falling, going up and down and being tipped upside down. On the contrary children who have under Sensitive vestibular sense enjoy fast motions and are always in the state of motion like jumping, running and are always moving.

Intervention of the therapist is very important in these cases. They suggest activities which will help child’s brains organize and process information more efficiently and effectively by stimulating the vestibular system. This prevents them from falling, keeping body properly aligned, grounded and contribute to coordinated balance & movement.

Knowing the Vestibular System

Vestibular stimulation is the feedback/stimulus that human body receives due to any of its movement (linear & rotational) in gravity. The intensity of these stimuli range from mild e.g. nodding to severe e.g. sitting on a swing / any amusement ride.

 The vestibular sense is first to develop in the growing fetus, it develops only in 5 months in utero and is stimulated by the movement of carrying mother’s body. It is the only system that integrates sensory senses (acoustic, optic, tactile, smell) with brain activities, proprioception and muscle reflexes & tone.

 The vestibular system comprises of the two components viz. the semi-circular canals, which respond to rotational movements; and the otoliths, which are sensitive to linear accelerations. The vestibular system sends signals primarily to the neural structures that control eye movements and clarity in the vision; and to the muscles that keep us upright in position. The brain uses information from the vestibular system and from proprioception throughout the body to understand the body's dynamics and kinematics (including its position and acceleration) from moment to moment.

The activities of Vestibular Apparatus can be summarized as:

Moving ahead with Special Needs.

Being a parent is very overwhelming experience, it is a never-ending journey of joy, happiness, efforts, love and care. But, if you realize that your child is little less than normal the immediate moment you get surrounded by complex feelings shock, numbness, sadness, denial, blame, fear, confusion, rejection and grief. However, we should Keep in touch with reality and maintain a positive attitude throughout. Your love towards your child will eventually transform and heal your heart and will give you a hope for bright future and will always keep you moving.

Life teaches us at every moment to move on forward without looking backwards. And in the process of living, learning and realization are two things each and every one procures from …their own and others life well. I have been realizing that life at times seem to be too unjust to few people but I guess they are the strongest of us all as they are fighting a silent battle within themselves. Life of children and adults with special needs can be frustrating and sometimes it can be significantly important to get a little pick-me-up to keep from getting discouraged. There are many ups and downs in life and we all need some inspiration to keep us headed in the right direction.

The fact to understand here is a complex phenomenon which exhibits the interaction between features of a person’s body inadequacies/Special needs and limitations and features of the society in which he or she lives. Love, Compassion, sympathy, apathy, technological interventions and the transition between them will help us, families, society at large to create a strong supportive environment to keep us all moving ahead in life in a healthy manner.

Special Needs Education

Children with Special needs or who are differently abled require a specific way of dealing in all walks of life. Education is no different. These children find it very difficult to get accommodated in the traditional set ups & curriculum.  Hence, education modules should be so defined and designed taking into consideration such a child's needs and limitations. Thus, Special Education or special needs education is nothing but ways to the educated children whose learning needs cannot be met by a standard school curriculum. Within this stream of education, the child is involved using individually planned teaching procedures such as Special instructional methodology, techniques and materials and is monitored by a trained professional in a comfortable setting to ensure the comfort of the child. Also, adaptive equipment's and methods such as audio, visual, tactile (touch) and kin-aesthetic (by doing) may be used.

 As it is rightly said "If a child can't learn the way we teach, maybe we should teach the way they learn". Special needs institutions aim to promote the level of personal self-sufficiency in the lives of children to make them more successful. One such schools we are aware of is, SAARTHI School for Special Children in Mumbai. It is a Non-profit organization which provides academic, vocational, medical and psychological support to the exceptional children especially those coming from the lower socio-economic strata. SAARTHI aspires to provide integrated care to the exceptional children of all sections of society. To name a few more are ADAPT, Apang Maitree , Aseema School, Dilkhush Special School , Kshithij etc.

It has only been over the past years that special needs education has been gaining impetus in India and educational facilities provided to children with disabilities have grown gradually. These ones range from development of special schools to Inclusive education in the traditional setup. But have we given it the importance it deserves? Or Have taken the necessary steps to ensure that children with special needs are given the best education and trained on how to venture forth into the real world?

Summer Care for Children with Special Need.

India being sub-tropical country, summers are generally harsh & very humid. And almost everyone hates this and the heat makes everyone extremely uncomfortable; particularly this   time of May as heat & humidity are at its peak all around the country. Growing pollution & less greenery adds to our irritation. Adults are generally cranky throughout owing to discomfort however heat exposure is a cumbersome issue for children as their bodies are more vulnerable especially children with special needs like Cerebral Palsy wherein a child has limited mobility or is immobile.

Children with special needs often find it very difficult to communicate. Thus, keen observation about the symptoms of overheat/ temperature is needed by the guardian /parent. If you observe symptoms such as sleeplessness, excessive irritation, dryness in mouth, dull skin, dislike towards food, loose motions, vomiting, nausea, stomach aches, cramps, giddiness etc immediately consultant your pediatrician.  Over heat exposure, excessive dehydration, exhaustion can be extremely detrimental to the health of children. It may also prove fatal.

Take following precautions for enabling Children with Special needs to lead a healthy summer:

• Wear light clothing: Wear light clothes of heat friendly fabrics such as cotton so that your child feels comfortable. Full sleeves clothing will help you protect from sunburns.
• Avoid getting out from 10 am to 4 pm: Schedule the doctor’s appointment or therapy session for your child accordingly.
• Adequate Ventilation in the room: See to it that your child stays in a room where air is getting circulated properly.
• Sponge your child if he/she can’t move or give then bath before bed.
• Stay hydrated/Drink enough fluids: In summer, the body loses more water so everyone needs need to drink enough water. Avoid carbonated drinks as they make one even thirstier. The healthy choices could be coconut water, lemonade and fresh fruit juices.
•  Use Cooling mattress, cooling pillow or other helpful ‘temperature’ inserts which are made up of specific materials that promote temperature control
• Never leave your child alone in a car.

Other general summer Health Care tips such as vaccination, maintenance of hygiene, appropriate diet, use of sun screen etc.  have been shared in our earlier blog. General summer healthcare tips remain same for all and they work for all. However, a special care must be taken as the special need child can face prolonged health challenges even brain damage.