BLOG: Patients with equilibrium problems benefit when practitioners work together
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I recently saw a 40-year-old woman who had undergone decompression with a C1 laminectomy for an emergent chiari malformation that was causing short-term memory problems, visual depletion, and speech and swallowing difficulties.
After the procedure, she had a left eye esotropia and continued to have balance issues, especially when tired. Thanks to prism lenses prescribed by a neuro-optometrist, she was able to function again but was still struggling with fatigue and other symptoms.
We assessed her eye movements, balance and memory and created a series of six brain rehabilitation exercises based on those findings. After just 1 month of doing these exercises daily at home, her vertical prism was able to be reduced by 1.5 D and horizontal prism by 0.25 D.
This case is a great example of how patients benefit when practitioners work together. Without the specialized glasses, her functioning was so poor that she probably would not have been able to make it in the door of my office. Once the prisms had stabilized her eyes, we could be much more effective in rehabilitating her brain.
As a chiropractor, I know the eyes are the window to the nervous system and I have to take them into account. My hope is that more eye care providers also will realize how integrated the vision and vestibular systems are — and how easily they both can be knocked off balance.
We all rely on sensory inputs from our ears and eyes, which are then integrated in the brain. These sensory inputs contribute to three interconnected balancing reflexes: the vestibulo-ocular reflex, which maintains stable vision during head motion; the vestibulospinal reflex, which stabilizes the body; and the vestibulocollic reflex, which acts on the neck muscles to keep the head stabilized.
Their interconnectedness means that an imbalance in the right ear can also cause changes in head, neck and eye function. Addressing the eye problem on its own may partially relieve symptoms, but it doesn’t fully rehabilitate the vestibular system.
Unfortunately, vestibular therapy tends to be generic when it should specifically be targeted to individual needs and deficits. I often use a cross-crawl temporal tap as part of therapy to activate the corpus callosum, the large bundle of nerve fibers that connect and allow communication between the right and left hemispheres of the brain. This indirectly affects the cerebellum and vestibular system. But every patient has a preprogrammed speed and timing for the tapping that works best for them.
We also use video nystagmography to evaluate eye movements and a computerized balance board to objectively test vestibular function. Brain exercises can then be customized based on individualized findings. This process can quickly help change and balance the vestibular system, facilitating the other types of treatments the patient may be undergoing at the same time so they can get better — faster.
Post-concussion and other patients with equilibrium problems are truly suffering. They need all of our expertise to get better.
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John Hatch, DC, DACNB, FABBIR, is a board-certified functional neurologist and chiropractic physician. He is co-founder of the Brain Rehab Clinic, a full-service functional neurology center in Orem, Utah, and founder of Cognuro, a brain functionality assessment equipment company. He will be teaching a course on the vestibular system and brain rehabilitation at the 2023 NORA conference on brain-based rehabilitation. For more information and to register, visit https://noravisionrehab.org/about-nora/annual-conferences/2023-annual-conference.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.
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