Dizziness and Vestibular

Dizziness is associated with many different symptoms. The most common symptoms are vertigo (or feeling of the room spinning) or a general feeling of unsteadiness and decreased balance. These symptoms can create difficulty with such things as maintaining visual focus and balance when standing or walking. In the general population the occurrence of dizziness increases with age but it is important to realize that dizziness is not necessarily a normal part of aging. Dizziness and decreased balance is a major predictor of falls in the elderly. These falls can lead to further injuries to other body parts.

As we age, degeneration that occurs in different nerve and muscular structures can influence your balance. These structures include your brain, eyes, vestibular system, nerve pathways, and muscles of your trunk, arms, and legs. If you are experiencing dizziness it is important to be evaluated by a health care professional to determine the cause of your dizziness. On a positive note, most types of dizziness and balance issues can be improved with a vestibular rehabilitation program designed by your physical therapist. These rehabilitation programs are individualized to your needs and work to improve your balance and vestibular function. If you are wondering if physical therapy can help your dizziness please reach out to any of our offices to speak with our qualified physical therapists.

Concussion Baseline Testing

Every year, according to the Centers for Disease Control and Prevention (CDC), an estimated 1.6 million to 3.8 million sports-related concussions occur in the U.S. Unfortunately, concussions can often go undiagnosed or incorrectly treated. Many people do not know that a concussion is a type of brain injury and thus impacts every patient differently. One tool that can help with the above is a concussion baseline test. The assessment is often completed on a computer and tests a variety of skills. This includes looking for any concussion-based symptoms, as well as testing memory, attention, reaction or processing time, ability to learn, and other executive brain functions. A commonly used baseline test is called ImPACT test or Immediate Post-Concussion Assessment and Cognitive Test. The test is ideally given prior to participation in any sport including both games and practice. If a concussion is suspected during that season, the test is administered again. The results between the two exams are compared and can help identify a concussion diagnosis and determine the best course of treatment including any participation restrictions in both school and sport. If no baseline test is given, the results can be compared with national averages based on patient age, however it is more beneficial to compare results within the same person.

The test can then be administered throughout post-concussion treatment as a way to track patient progress. It is useful to help determine when a patient is appropriate for returning to any prior activities or sports. It can also be used to help determine the need for follow up with a specialist such as a neuropsychologist, optometrist, or physical therapist. Post concussive PT focuses on improving activity tolerance and any balance, endurance, oculo-motor, and vestibulo-ocular deficits. Patients will receive a personalized program addressing the above which can include cardio-vascular, balance and coordination, and eye exercises.

Luckily, concussion baseline tests are now more routinely given to both professional and high school athletes. For more information about concussion baseline testing or other concussion-based questions, contact a Strive Physical therapist.


Rebecca Furrer

Rebecca Furrer completed her undergraduate degree in biology at LaSalle University in 2010. She graduated in 2013 with her Doctorate of Physical Therapy degree from Thomas Jefferson University. While a graduate student, she completed an affiliation with Strive at the Marlton location and grew to love treating patients with orthopedic and sports injuries utilizing a hands-on clinical treatment approach. She is very happy to be continuing her career at the Strive location in Delran. Rebecca is currently an American Physical Therapy Association member. In the future, she plans on expanding her clinical skills by becoming certified in McKenzie method and in other manual therapeutic techniques including soft tissue mobilization with Graston and Active Release Techniques. She enjoys working with patients of all ages and focuses on a patient centered treatment approach to enhance patient care.

Contact Rebecca Furrer, PT, DPT, Cert. LSVT BIG

Vestibular Migraines

A vestibular migraine is a type of migraine that can cause both vestibular and migraine symptoms. A typical migraine will cause a severe headache due to stimulation of nerves, blood vessels, and pain receptors in the brain. They can be caused by a variety of triggers such as food, stress, hormones, medication, and sleep disturbances. That being said, not all migraines have to involve a headache.

Vestibular migraines are actually very common. According to recent evidence, 1% of the world's population will get a vestibular migraine. That's 74 million people! This condition will often cause symptoms that mimic an inner ear dysfunction. Symptoms of vestibular migraine include dizziness, motion intolerance, loss of balance, headache, symptoms of vertigo, sound sensitivity, light sensitivity, and neck pain. So you may think something else is going on, when in reality it's a migraine causing your symptoms.

Treatment for a vestibular migraine can involve multiple sources. Of course, physical therapy and vestibular rehabilitation has been proven to be an effective method of treatment. This will involve balance exercises, ocular (eye) exercises, and conditioning/endurance exercises. Specifically, physical therapists will provide eye exercises to work on gaze stability and visual tracking, Along with physical therapy, both medication prescription and diet changes can help prevent, improve, and manage symptoms and help you return to full function.

If you are having any of these vestibular symptoms or have had recurrent symptoms in the past, please feel free to reach out to your physician or contact any one of our Strive locations!


Matt Koster

Matt began his education at Rutgers University in New Brunswick by completing his undergraduate degree in exercise science in 2012. He then continued his academic career at Drexel University in Philadelphia where he received his Doctorate of Physical Therapy in 2015. During his last year of graduate school, Matt completed his final clinical affiliation at the Strive Burlington clinic where he continued to pursue his passion for outpatient orthopedics and sports-related care. Matt loves sports and enjoys working with athletes in particular. He is very excited to begin his career with Strive Delran. In the near future, he plans on expanding his skill set by becoming certified in both dry needling and the McKenzie method.

Contact Matt Koster, PT, DPT

Benign Paroxysmal Positional Vertigo and Dizziness

Feeling dizzy? This can often be a sign of a condition treatable by your physical therapist. One of the more well known and most common causes of dizziness is from a peripheral vestibular disorder called Benign Paroxysmal Positional Vertigo (BPPV). BPPV causes the brain to interpret your changes in position as rapid or unsteady, and thus produces a sense of spinning. Though this disease is relatively harmless, BPPV has been correlated with a higher risk of falling in elderly patients who are diagnosed with the condition. Research conducted shows that an individual with BPPV are more than twice as likely to experiences falls resulting in fractures2. The good news is BPPV is easily treatable once correctly diagnosed!

The first step to effectively treating BPPV is recognizing the common characteristics. Common complaints from patients with BPPV are difficulty with rolling over in bed, showering, changing a lightbulb, and other activities that require constant head movements in relation to gravity. When patients describe their symptoms, it will be a sudden onset of "dizziness" lasting 30 seconds to 2 minutes. Though each person's symptoms can last varying durations of time, it will be important to elaborate on the type of "dizziness" you are experiencing. When talking to your primary therapist, try to use one of the three following words to described your dizziness: faint, unsteady, or spinning3. This will help your therapist interpret where your symptoms are coming from. It should be noted, that "spinning" is a true sense of vertigo and is the most closely related to BPPV.

For some people, it can take just one session with your therapist before you feel back to your normal self. Contact a Strive Physical Therapist today to learn more about BPPV treatment and how we can help you.

Citations:

  1. Kollén, L., Frändin, K., Möller, M., Olsén, M. F., & Möller, C. (2012). Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds. Aging clinical and experimental research, 24(4), 317-323.
  2. Liao W L, Chang T P, Chen H J, Kao C H. Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study. J Orthop Sports Phys Ther. 2015;45(5):406–412.
  3. Walter, J. Vestibular Rehabilitation: Vestibular Disorders.[Powerpoint Slides]. Retrieved from medbridgeeducation.com

Inner Ear Infections & Vestibular Conditions

Vestibular neuritis and labyrinthitis are impairments of the inner ear after an ear infection. The inner ear becomes inflamed as well as the nerves that transmit the necessary information the brain. There are two types of information transmitted from the inner ear to the brain, hearing and balance. The inflammation can cause only balance trouble (neuritis) or both hearing and balance trouble (labyrinthitis). Both can cause dizziness and vertigo but only labyrinthitis will cause hearing difficulty. The most common cause of these conditions is an inner ear infection with viral causes being more common than bacterial causes.

Symptoms of both conditions include dizziness and vertigo (spinning sensation) as well as nausea, vomiting, and balance difficulty. Only labyrinthitis will produce tinnitus (ringing in the ears) or hearing loss. The symptoms can last up to 3-6 weeks during the acute phase. Medications may be prescribed by your physician during the acute phase to suppress the dizziness or fight the viral or bacterial cause.

In some people, symptoms completely subside without the need for additional treatment. There are cases where symptoms can persist. These symptoms can include some remaining dizziness/vertigo, difficulty in busy environments like a grocery store or shopping mall, or balance trouble to name a few. Symptoms in this phase are generally not as severe as the acute phase, but can be very frustrating and activity limiting to the person experiencing them. The reason for the persistent trouble is that there is an imbalance between our ears and our brain has not adapted yet. There is some good news though. There is a solution!

A vestibular rehabilitation program can help speed the recovery during the chronic phase. A physical therapist specializing in vestibular rehab will take you through an initial evaluation focused on your balance and a few vision tests. The program can help our vestibular system adapt and recover to help those daily activities that may increase symptoms become much easier. To summarize, vestibular rehab helps our brain adjust to the imbalance which reduces symptoms!

If you are experiencing some of these symptoms, especially if you remember a recent ear infection before the problem began, do not hesitate to speak with your physician or contact any of our Strive locations!


Gerard Smith

Jerry graduated from Arcadia University in 2013 where he was a Division III Baseball Catcher. He then went on to earn a Doctorate in Physical Therapy from Arcadia in 2016 and completed his final 6 month clinical rotation at Strive Physical Therapy in Marlton. Jerry has taken his baseball experience to help enhance his approach to pitchers and other baseball players.

In the near future, Jerry plans on completing an Orthopaedic Residency Program and furthering his education in vestibular therapy. Fewer than 5% of physical therapist complete a residency as this is a program designed to improve his clinical thinking and mentorship with some of the best therapists in the field of orthopedics. His clinical interests include a wide variety of orthopedic diagnoses including low back pain and lower extremity injuries. Jerry uses a patient-centered approach where he empowers his patients and provides excellent care to help them reach their goals. In his free time, Jerry enjoys spending time with his family and friends and coaching a youth baseball team.

Contact Gerard Smith, PT, DPT

Ménière’s Disease

There are a few symptoms that set Ménière's Disease apart from other causes of vertigo: hearing loss, ear fullness and the recurring nature of this disease. Structurally this diagnosis comes with a buildup of fluid in the inner ear. Symptomatically it can cause dizziness, off balance, lightheadedness, headache, ear pressure, sound sensitivity, hearing loss or increase in tinnitus/ ringing in the ear. Symptoms are going to vary throughout the course of the disease preceding, during and after an attack with the most violent symptoms occurring during an acute attack.

The cause is generally unknown; however, theories include circulation problems, viral infections, allergies or immune reactions, migraine or a genetic condition. Ménière's Disease is incurable and progresses into late stage where hearing loss is more significant and symptoms are more persistent and pronounced. This includes violent vertigo requiring a safe environment or hospitalization depending on the duration of the episode/ attack.

Treatments include medications during and in between attacks, a low-sodium diet, vestibular rehabilitation therapy, or in rare cases, surgery. Vestibular rehabilitation therapy aims at assisting the brain in adjusting to the new balance signals following an episode. A vestibular trained Physical Therapist will challenge the patient in a safe and controlled way to increase safety and independence.

To learn more about Ménière's Disease and other causes of vestibular disorders visithttps://vestibular.org/ for more information.


Stasia Bahring

Stasia Bahring, PT, DPT
Clinical Director - Sewell

Stasia graduated from the Richard Stockton College of New Jersey in 2009 with her Doctorate degree in Physical Therapy. With undergraduate degrees, Bachelor of Fine Arts in Dance Performance and Bachelor of Science in Biology, she has been dancing, performing and teaching throughout her scholastic studies. She has advanced teaching certifications through the Cecchetti Council of America in the Cecchetti method of ballet which gives her an intimate knowledge of the physical demands, injuries and pressures of performing artists. While continuing to blend passions for the physical therapy and dance professions, she is certified in Active Release Technique for the lower extremities and head of Strive's Performing Arts Significant Interest group. She is thrilled to be a part of team Strive and hopes to further clinical knowledge in McKenzie and manual therapy courses.

Contact Stasia Bahring, PT, DPT

7 Tips to Better Understanding your Health Insurance

What is your Health Insurance trying to tell you?

Copays, deductibles, co-insurances, and monthly premiums. How does one comprehend what they are actually going to spend when they come in for a physical therapy visit? While the answer may not be as cut and dry as you would prefer, it is still obtainable. Here are some questions you can ask your insurance company:

    1. Is there a visit limit on your coverage? Some companies will put a visit limit on physical therapy visits based on the calendar year. Some insurances will only cover services for “consecutive days”. For example, if your insurance provider says they will cover a case for your knee for 60 consecutive days, and you began therapy on the first of March, your coverage would expire on April 30th.
    2. Is the insurance coverage based on a benefit year or calendar year? Knowing the answer to this question will ensure that you know when your coverage is terminated or when your deductible will reset.
    3. The big one. How much is your copay? While this seems obvious, it is always good to double-check. Some companies tailor their policies to have their copay change in the middle of a patient’s care. For example, some plans will charge a $10 copay for visits 1-20, but visits 20-40 will be $20.
    4. Does your insurance policy carry an Out of Pocket Maximum? Your insurance may carry a $2,000 deductible and a $40 dollar copay. But your Out of Pocket Maximum may only be $4,000. This means if your total out of pocket expense hits that $4,000 mark, your services are covered at 100% for the remainder of your benefit year.
    5. Always check with your employer’s benefit coordinator about possible upcoming changes to your health plan.
    6. By law, when services are rendered through your health insurance, the company will supply you with an EOB (Explanation of Benefits) that will explain that the medical professional charged, what the insurance is going to cover, and what you will ultimately be responsible for.
    7. Ask questions! If you do not understand something about your plan, statement, or explanation of benefits do not hesitate to ask!

At Strive, your plan will always be verified prior to your first visit. Our billing specialists will reach out to your insurance company to confirm that your coverage is active, furthermore to see what your out of pocket responsibility looks like.

For more information, click here: https://www.strivephysicaltherapy.com/patcenter/


Drew Kelly, Inbound Marketing Strategist

Drew Kelly

CTE and Physical Therapy

Most people are familiar with concussions. After a head impact or whiplash-like injury, experiencing any of the below symptoms for any period of time indicates that a concussion has occurred.

Symptoms from Concussions

  • Blurred/Double Vision
  • Sensitivity to Light/Noise
  • Headache
  • Dizziness/Balance Problems
  • Nausea
  • Fatigue
  • Depression
  • Memory Deficits

CTE (chronic traumatic encephalopathy) is a progressive degenerative disease that is thought to originate from repetitive trauma to the brain. This trauma may or may not have resulted in symptoms of a concussion. Physical Therapy, an effective rehabilitative treatment for concussions, has gained significant attention in CTE research and prevention. Your skilled Physical Therapist aims to prevent CTE degenerative changes by ensuring previous head injuries are fully healed prior to returning to sports/contact activities. The rehabilitative process includes visual, vestibular and exertional rehabilitation after head injuries.

Symptoms from CTE

  • Memory Loss
  • Confusion
  • Impaired Judgment
  • Impulse Control problems
  • Aggression
  • Depression
  • Anxiety
  • Suicidality
  • Parkinsonism
  • Dimension

The most recent research indicates that work activity (e.g., military personnel) and athletes (e.g. hockey, boxers, football, soccer, lacrosse) that are subject to repetitive head trauma may be more likely to present with CTE (although genetics may play a substantial role in the likelihood of presentation). CTE symptoms may not occur for years after the last recorded head injury. Diagnosis of CTE currently occurs postmortem with the identification of a substantial increase in the protein Tau in the brain matter.

Strive Physical Therapy and Sports Rehabilitation is the market leader for all skilled care after concussion. Our Strive Physical Therapists maintain constant and direct communication with your Physician ensuring that our patients are fully recovered after their injury. Highly trained and experienced Physical Therapists enable safer return to play after concussion and decreased likelihood of more degenerative conditions like CTE.

John Walker

John Walker, DPT, MBA, CERT. MDT, CSSBB
Clinical Director

John received his Doctorate in Physical Therapy in 2003 from Widener University and is currently a licensed Physical Therapist in New Jersey and Pennsylvania. John brings 11 years of spine, orthopedics, and sports medicine clinical experience to the Strive team which he joined in 2014. John is a Certified Mckenzie MDT (Mechanical Diagnosis and Therapy) Practitioner and has two noted publications including chapters on thoracic spine dysfunction and post-operative proximal femur fractures. During his time at Widener University, John was awarded Academic All-America District II for lacrosse and was 2-year assistant men’s lacrosse coach. John has his MBA from Temple University’s Fox School of Business with an emphasis on healthcare/ health system efficiency. Originally from Northeast Philadelphia, John lives with his wife in the Cinnaminson area of New Jersey.

Contact John Walker, DPT, MBS, CERT. MDT, CSSBB

Posture Tips for Pain Free Travel

Ergonomics on the Road: Between 2 Points

Spring is here and summertime is around the corner - a time for hammocks, a time for leisure and, especially, a time for travel. Unfortunately, for some, it may also be a time of injury. Though postural monitoring and body mechanics are typically thought of workplace practices, these elements can help in our much needed travels away from the workplace. So, let's take a moment to see how we can apply these concepts about posture, and hopefully keep these times as healthy and enjoyable as possible.

POINT 1: POSTURE – Ears, Shoulders, Hips

By vertically aligning these three landmarks (ears, shoulders, hips), we are able to maintain the natural curves of our spine. From sitting in your beach chair to standing at your barbecue to backpacking on the trail - try not to let your posture go with your inhibitions.

Additional Considerations:

  • Choose your footwear carefully – what is most fashionable is not always the most functional. Keep the minimally supportive shoes (i.e. sandals) for the short walks from the hotel to the beach and make sure that you wear well supportive shoes (i.e. sneakers) if the day's activities call for lots of walking and/or exploring.
  • Fit your backpack appropriately – beware the overloaded bag, and shun the low hanging straps. Try to keep the amount of weight in your bag to a reasonable limit – do you need to be carrying around your solar powered tomato slicer at all times? Also, wear both straps securely around both shoulders. Gone are the days of the one shoulder carry and allowing the bag weight to swing down to your bottom.

POINT 2: BODY MECHANICS – Bending, Twisting, Reaching

A tale from baggage claim:

We have all been there before - excitedly rushing to baggage claim to get our luggage and begin our vacation, or cantankerously trying to outrun the other passengers to get our bags and get home. Sometimes it's best to pause, take a breath, and realize that everyone else is trying to do the same thing; and that there are most likely 37 other passengers with the same black, rolling suitcase (That's why there is a big ‘Hello Kitty' sticker on mine…I mean…uh…Eagles sticker). Also try to keep some of these other tenants of body mechanics and posture in mind as you try to push through the masses. Such as:

  • Be careful with how much you are bending – If your suitcase is resting high up on the slow, perpetual belt, it is most likely caught on top of someone else's slow moving possessions. Additionally, it is most likely that this other bag weighs as much, if not more than your own. Try not to bend over and simultaneously move the lower level bag and lift your own. It is best to separate the bags on the first run and the appropriately lift (i.e., squat) your bag on the next pass.
  • Be careful with how much you are twisting – Once the slow boat of the luggage carousel has brought your bag back around, please do not try to lift and throw your bag down over the side without moving your feet. Remember to keep your "nose and toes" in the same direction. Especially if you forgot that your bag is now carrying an extra 10-15 lbs. of towels & shampoos that "came" with your room and 17, newly purchased puka shell necklaces.
  • Be careful with how much you are reaching – It can be quite admirable to be the family Bag Whisperer that bravely volunteers to swim through the Tour De France-like crowds that swarm the sides of the luggage belt; however, be careful not to overplay, or more specifically to overreach your hand. As you subsequently remove each travel companion's suitcase, from Aunt Bethany's to Cousin Eddy's, ensure that you are not stacking them immediately in front of your feet. As that pile gets bigger and bigger you will have to reach farther and farther for the next bag and the harder and harder it will become to lift each suitcase (especially those containing the aforementioned puka shell necklace weight).

So remember to pack your posture and body mechanics along with your temperature-controlled buckwheat airplane pillow so that your travel can go as healthy as possible. Being that a major aspect of traveling is proper body movement, you may find yourself having a question about these key elements to healthy travel. Contact your Strive Therapist to ensure that you are taking the right preventative measures. If you do sustain an injury while trotting the globe, contact your local Strive clinic to determine if you are in need of an evaluation to address your injury.

Bon Voyage! -JM


Jason Melnyk

Occupational Therapist

Jason has been a licensed Occupational Therapist since graduating with a Bachelor’s (2001) and Master’s Degree (2002) in Occupational Therapy from Thomas Jefferson University.

Jason is a Certified Ergonomics Assessment Specialist – Level II, having received these credentials from The Back School of Atlanta, and is trained in administering Pre-Placement Post-Offer Assessments, Job Demand Analysis, and Functional Capacity Evaluations. His areas of clinical expertise are derived from multiple years in an academic health center, acute care, and outpatient service delivery. Jason is licensed in both New Jersey and Pennsylvania and is currently a faculty member for the Thomas Jefferson University Occupational Therapy Program.

Jason and his wife Sara are the proud parents of Madeline and Evelyn. In his free time, Jason enjoys reading, music and spending family time at the beach.

Concussions and Physical Therapy

What is a concussion?
It is a mild traumatic brain injury, from a sudden acceleration or deceleration of the head. Two examples are a blow to the head during a sporting event or motor vehicle accident. Individuals may have a temporary loss of consciousness, with temporary memory loss, but loss of consciousness is not required for diagnosis of concussion. Symptoms and signs may include some of the following: headaches, dizziness, nausea/vomiting, loss of concentration, delayed response to questions, loss of balance and difficulty with vision. These symptoms can make it difficult to read, focus in school, drive, use the computer at work and exercise.

What can physical therapy do for me if I have a concussion?
At the first visit, a comprehensive evaluation with a physical therapist will take place to get a baseline of your symptoms, balance, eye movements, gait (walking) and focus. You may be advised to limit sports, TV, computer use/texting at first in order to avoid aggravating your symptoms. We will work with your physician to determine appropriate treatment, which may start with aerobic conditioning exercises. These include bike, treadmill and elliptical exercise, monitoring your heart rate and symptoms closely. In addition, we work on static and dynamic balance, concentration, neck mobility, and gaze during physical therapy sessions. The goal with therapy is to reduce symptoms and improve function, to return to your normal activities as soon as possible.


Jen Carapetyan

Jennifer Carapetyan, PT, DPT

Jen graduated with her Doctorate in Physical Therapy from Temple University in 2008. She has worked in the outpatient setting for over 5 years in both Delaware and New Jersey. Jen has achieved a Graston Technique certification and has taken extensive coursework in the McKenzie method. Her passion for the field has enabled her to balance high volume of patients with individualized exercise programs. In addition to the variety of diagnoses treated including post-concussion, pre- and post- op, workers' compensation, and wound care; she plans on taking coursework in vestibular rehab in the future. Jen loves to spend her free time with husband Tim and children, Aaron and Ava.

Contact Jennifer Carapetyan, PT DPT

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