♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hello folks. I'm Brad Heineck, physical therapist.
- And I'm Shari Berry, physical therapist.
- And I'm exactly one half of the "Bob and Brad" team.
However, Bob is not here today,
but we're very fortunate enough
to have someone much better looking than Bob,
so this is a whole new experience
and I don't have to listen to Bob as well.
So I'm very happy.
So, we're extremely happy to have Shari Berry,
and she's an specialist,
I think she's an expert, but anyways.
We're gonna talk about the vertigo, dizziness, and she's,
this is the person you wanna hear
and get proper information for.
So, Shari, do you wanna do a little introduction
- Sure. - about your background?
- Yeah, yeah. I have been a physical therapist since 1994.
With a bachelor degree.
Then went back for my doctorate in 2007.
But in 2004, I became an official dizzy therapist.
I've always been a little dizzy,
but I became an official dizzy
- Okay. - therapist in 2004.
And so really since that time
I've been treating vestibular problems,
or problems with dizziness.
- Sure.
- In 2004 it wasn't very popular.
Now it's much more popular.
And so I have-
- You mean popular that more people have it,
or that it's more
the treatment. - People have had it.
It's just now we're understanding what people have
- Okay. - and we are better
at identifying it and treating it.
- Yes. Excellent. - So we've made
great gains that way.
- And she's very, very, being very modest
'cause she actually teaches classes to therapists like me.
I took a vestibular class
- Yes. from you,
- a couple, three years ago.
I don't know, maybe it's longer than that,
time flies. - Might be longer.
- But anyways, we'll get on with the program.
And we're gonna talk about
this wonderful ear in this model.
And it reminds me of that guy that on "Star Trek,"
that's got the big ears.
- Yes. Yes.
- Okay Shar, we're gonna talk about the vestibular system,
which is related directly to dizziness,
vertigo that everyone knows about now.
And we got a model, you,
and I'm gonna keep my mouth shut
so they can learn from the ex, oh,
specialist, I'm sorry. - Thank you, thank you.
Well, to try to simplify a very complex system,
your vestibular system basically keeps you up right.
It's what allows you to be balanced,
- Okay. - it's what keeps you
from falling down.
And there's three parts to it
that feed your brain information
so your brain makes a reflexive response,
or makes an intentional response.
And so, the first part are your eyes.
- Okay. - We're always looking
at where's the horizon, where we are in space.
Your eyes are constantly giving your brain information
about where you are.
The second part is your body,
your joints and your muscles
are constantly giving your brain information
about where you're sitting,
where gravity is pulling on you.
- So you could feel where things are.
- How you're moving, that you're sitting against a chair.
You're getting constant feedback from your body
about where you are in space.
- And we're not thinking about it,
it just happens. - No.
That is all reflex, or that is all automatic.
- Mkay.
- So then, the complex part,
is the inner ear vestibular system.
And you've got a large ear here,
and deep inside the inner ear is some apparatus
that is giving your brain information
about where you are in space,
based on information that it's sending.
Electrical information, if you will.
- Mkay.
- So, just like your eyes and your body
are constantly giving your brain information,
your ears are also. - Mkay.
- So as we're sitting here,
our ears are feeding our brain information.
- Mkay.
- When I turn my head to the right,
my right ear gets excited,
my left ear dampens a little bit.
And this message gets sent to my brain.
When I come back to the middle, I have this message.
When I go to the left, my left ear gets excited
and my right ear dampens.
- Oh, so the hands, if you're up high-
- That's indicating how much electrical activity
or excitement is being sent.
- Okay. - 'Kay?
When I turn my head to the right and I look at you,
this message goes to my brain.
And my brain says, "Oh, my ears are saying
that I'm turning my head to the right."
- Okay.
- And my eyes say, "I agree."
And my neck says, "Indeed,
we're turning our head to the right."
All three of those sensory inputs
are giving my brain information.
My brain says, "Okay.
She's turning her head to the right.
Do I need to do anything with that?
Do I have to offer a reflex to keep her upright?
Or do I want to intentionally do something
like move her eyes in a certain way
so that she can look at who she's talking to?"
All of that happens quickly,
without us having to think about it.
- So if some of that wasn't working you may turn your head,
and lose balance,
and fall possibly? - Yes.
Yes, so, some of the most common symptoms that you get
from people when it's not working right,
is people will tell you they're dizzy.
Now dizzy can mean so many things.
Vertigo, as you've mentioned a couple times already,
vertigo by definition is really true spinning.
The sense that you're spinning,
or that the world is spinning. - The room's going around-
Yes, okay. Mkay. - Either or.
Dizzy often can describe things that people are feeling
like nausea,
or wooziness, or-
- Light headed? - Light headed.
Or they feel like they're off balance.
Or they feel like the world is a little shifted.
Sometimes people have trouble with their eyes,
they feel like they can't focus their eyes on something.
All of those symptoms can appear
when something goes wrong with that system.
- Mkay. - And people
will describe that as feeling dizzy.
- What if you get low on blood sugars and you feel dizzy?
Does that has somethin' to do with this?
- That actually doesn't have anything
to do with your vestibular system.
But again, you get the sensation
- Similar. Okay. - of lightheadedness,
of dizziness,
and there can be a lot of other causes of dizziness
that do not involve
the vestibular system. - Okay.
- From medications, to blood pressure,
to just being hydrated.
- Okay.
- The most common problems that we see
with this system are two complex terms.
One is called a Unilateral Hypofunction
- Oh.
- or a Unilateral Vestibular Loss.
And basically I'm sitting here
and then one ear goes on vacation.
And now this is what's happening as I'm sitting straight.
And my brain thinks I'm turning my head to the right,
but I'm not.
- So this is- - And then it gets
very confused.
- Like you're scratching your head here
and they say you're not
scratching there so. - Right.
And this message goes to my brain
and my brain says,
"Oh, you're turning your head to the right."
And my eyes and my neck say, "Uh, no we're not."
- Yeah.
- And whenever your brain has a conflict
in information, - Yeah.
- meaning that it can't figure out
what the three systems are
telling it, - Yeah.
- it's responses is puke.
- Oh, you mean like vomit? - And you get dizzy.
Yes. Yes.
- Actually, I've had patients,
"I feel like I'm gonna vomit."
- Yes. - are going through this.
- Very common symptom.
- Okay.
- And the brain just doesn't like that either, so.
That's a very common problem.
The other problem
is called benign paroxysmal positional vertigo.
- Mm, yes.
- That's a mouthful. - Right.
- So we call it BPPV.
Two Ps. BPPV.
And with that, you probably can't see very well,
but you've got fluid filled canals in your ear.
And there's fluid. - Yeah, he can zoom in
on that if you want.
- Sure.
There's fluid that moves in those canals,
and it moves kinda slowly and it's a little bit viscous.
And then in this section of the ear,
there are calcium carbonate crystals.
So when you were little
and your mom said you had rocks in your head.
- [Brad] Sure.
- [Shari] She wasn't quite wrong.
She just didn't know she was right, 'kay.
So you have little calcium carbonate crystals
in your ear. - Yep.
- If those little crystals get out
into the fluid-filled section, that causes a problem.
- Sure. - It's like dropping
a pebble in a lake.
Causes a lot of electrical activity to the brain.
- Yeah. - The brain, again,
has a conflict.
Doesn't really know what to do with that.
And you feel dizzy.
- Yeah.
That's where you talk about the crystals,
- Yes. - and the therapist
or the doctor may mention that.
I always explain to my patients, just as an analogy,
maybe I shouldn't, that these are like a level.
- Sure. - And a level,
'cause I do - Yes.
- some, fix it around stuff.
- Yeah. You know where you put a level
for your
picture frame or whatever. - Yep.
- And then I say,
"We need to get those crystals out of that level,
and get it down, and get that bubble so these things
can tell- - It's back to the center.
- Yeah, there we go.
- That is just- - I'm okay?
- You're absolutely fine with that analogy. Absolutely.
Any way that you can describe fluid moving in a system,
and a little rock in there
that's not supposed to be in there.
- Sure. Okay.
- I like a pebble in a pond analogy,
where the fluid moves and then if you drop a pebble,
into a pond, you know how the pond
- Ripples. Yes. - Ripples.
That's exactly what's happening
in the fluid in your ears.
- We don't want the ripples.
- We don't want ripples, no. No, exactly.
So, if you have one of those problems,
they actually present a little bit differently.
So if one ear goes on vacation,
the most common thing you'll feel
is you'll be going about your day.
Maybe you're in a meeting.
Maybe you wake up out of bed
and you have severe, sudden onset of dizziness
to the point where you can't open your eyes.
You maybe can't sit up straight.
You might not be able to walk.
You're probably gonna vomit,
and you think you're having a heart attack or a stroke.
- Oh.
- And more often than not,
people who have that sudden onset,
end up going to the doctor,
- Yep. - going to the ER,
going somewhere.
And when they arrive,
we can take a look at them and we can identify;
this isn't a stroke, one ear took a vacation.
This is gonna get better, but it's gonna take a few days.
- Sure.
- The person will usually present with their eyes closed.
- Oh really? - Cause if
I can close my eyes,
it decreases that conflict to the brain.
- Sure, yep. - And it makes them
less pukey, so.
When you have the crystal problem,
that's very different.
Much more mild,
and your symptoms are only seconds to maybe minutes.
And they are very much associated with movement.
You lay down in bed, you spin for a little bit.
You get out of bed, you spin for a little bit.
You move your head too fast looking at a trainer
in the grocery store,
and you spin for a little bit.
It's seconds to minutes,
when you stop moving,
it stops bothering you and you go on with your day.
- So that's the BPPV
vertigo. - That's correct.
- And that's where therapists get involved.
- More, more often than not.
Therapists can get involved with both of those diagnoses.
- Okay.
- But with positional vertigo, people usually identify,
"Something's not right with me,
I should go get this checked."
Or, some people live with it.
- Yeah. - And they don't need to.
They can absolutely get it fixed.
As you've mentioned, you've treated people with it.
And all we have to do is spin them around a little bit,
or move them around a little bit, to get this fluid
to push that little crystal back where it belongs.
- Yeah.
- It's pretty easy to fix.
- Sure. - Once we identify
what's going on.
As far as who can fix it,
really there's a lot of options.
Vestibular rehab is taught in all entry-level PT schools
at this point. - Yeah.
- It was kind of new, way back when I was graduating,
back in 1994.
And when we learned about it my thought was,
"I'll send 'em to someone else.
If I see someone with this,
I'll just refer them on
to somebody else who knows how to fix this."
- Sure.
- Nowadays, we do a whole lot more in school
with practicing corrections,
and looking at videos of eyeballs,
and really identifying what's going on.
- Sure.
- Actually, I should probably mention one thing
related to that. - Okay.
- These little canals here are reflexively connected
to muscles around your eyes.
And so, when those canals are moving,
or when something is happening in there,
there's certain eye movements that happen.
And so we can tell if there's a problem
by watching your eyes.
It's just that simple.
- That's where you might put the funny glasses on
in the clinic? - Yes.
We have specialized equipment
that are goggles that block all the light out
for the patient.
And then they magnify your eyeball
into a big, giant eyeball on the screen.
And then the therapist can actually see
which way your eyeball is moving.
Is it twitching one way, is a twitching a different way.
And depending on the movement of the eye,
we know what's going on in the
inner ear. - What do we call
that little twitching again?
- Nystagmus. - Nystag, yeah.
- Nystagmus.
- It's rather interesting to see (Brad mocking thumping).
- Yup, and it is not anything the patient can stop.
- Mkay. It is not anything
the patient can create.
It is all happening reflexively.
- Okay. - And so there's
a really easy way for us to diagnose that.
A therapist who has that equipment
is going to be far more accurate
at diagnosing what's going on.
- Sure. - Than someone who doesn't
have that equipment. - Right. Right.
- So preferably, if you're gonna see someone,
you'd like to see someone who has that equipment.
- Yup.
- And I always like to say,
"You wanna see the provider who's interested
in what's wrong with you."
- Sure.
- Because they've seen a thousand eyeballs
and the more eyes you look at,
the better you are
at diagnosing things. - Sure, sure.
- So, you can really go to anyone, but a specialist is nice.
- Right. Right.
I mean, I've treated a number of people with it,
and I didn't have the glasses in the clinic.
- Yes. Makes it a lot harder.
- Right.
But it was amazing.
It was pretty successful.
- Yes. Yes.
- Using judgment and stuff like that.
- Absolutely, yeah.
- Anyways, are we going to show what we do next?
- I think in the next segment
we're gonna talk about things that you can do at home,
- Okay.
- as well as some things you might expect if you go get,
- Alright. - if you go
to see someone for it.
- Good, so we're gonna show the,
this is kinda the theory,
the background. - This is the anatomy
and the pathology
- Alright. Good. - of what's going on
and then we'll give you some tips.
- Good, so we're gonna have Shari on again,
another video showin' you how,
what the options are, at least one or two options
- Yes. - on how to take care
of yourself, or what's gonna happen to you
when you go see someone.
- Yeah.
- So you're familiar with it.
Alright. Thanks for comin' and well,
you have anything to comment?
Yeah, this is a lot better than with Bob.
I can tell you that right now.
- All I know is it's awfully fun to do this
instead of teaching a whole classroom at this point, so.
- I hope your students won't hear that.
- Oh, that's true, I probably shouldn't have said that.
- Alright. Take care.
(cheerful tune)