I'd love to attend the senior fitness class," Betty confided to her friend Martha, "but my dizzy spells have gotten worse, and my doctor says there's nothing else he else can do about my vertigo."

With 25 percent to 30 percent of community-dwelling seniors experiencing frequent dizziness, and more than half of the accidental deaths in the elderly related to balance-related falls, Betty is not alone in her concerns.

Every year, more than a quarter of a million American seniors experience hip fractures after a fall; 25 percent of these seniors die within the year, and more than half are unable to return to their former independent lifestyle. Betty doesn't want to be another one of these statistics, so she limits her outings to the senior luncheon, bridge games and other sedentary pursuits.

Betty's lifestyle has been severely hampered by vertigo, a form of motion-provoked dizziness common in elderly patients. Even though she probably could safely perform most of the basic exercises in the senior fitness class, Betty's fear of falling, combined with her uncertainty about the motion-provoked dizziness, is enough to keep sitting on the sidelines. It's going to take a motivated therapist to define Betty's limitations and help her overcome the vertigo.

Motion Sensitivity Test

The motion sensitivity test (MST) is an excellent instrument for defining the parameters that cause motion-provoked dizziness in the elderly. Faith W. Akin, PhD, and Mary Jo Davenport, MS, PT, used the MST to take a closer look at motion-provoked dizziness among community-dwelling men and women in Tennessee.

The MST measures motion-provoked dizziness that occurs in response to a series of 16 quick changes to either head or body position (see sidebar on next page). The test records the severity and duration of dizziness for each of the 16 positions, and includes an algorithm to calculate the MST quotient. The algorithm includes a calculation of three parameters:

• the number of positions in which symptoms occurred,
• the duration of motion-provoked dizziness in each of these positions, and
• the intensity of the dizziness in each of the positions.¹

Using control and test subjects, Akin and Davenport determined that the MST is a valid and reliable instrument for measuring and monitoring motion-provoked dizziness. In addition, the researchers concluded, the MST is simple to administer and score and requires only minimal test equipment.¹

Vestibular Rehabilitation Therapy

Vestibular rehabilitation therapy (VRT) is an innovative treatment for patients with motion-provoked dizziness and/or balance disorders. In normally functioning individuals, motion-provoked dizziness caused by vestibular imbalance resolves when there is enough central compensation to correct the body's response to the vestibular dysfunction.

Patients with ongoing vertigo, like Betty, continue to experience chronic dizziness in response to head or body movements because their brains fail to develop this compensatory mechanism.

Vestibular rehabilitation therapy stimulates and enhances the body's normal compensatory mechanisms by guiding the patient through repetitions of the specific eye, head or body movements that provoke the dizziness. VRT includes habituation and adaptation exercises, along with gait and balance exercises. For patients with motion-provoked dizziness, habituation exercises are designed to produce a long-term improvement in the pathological response (dizziness) to perticular stimuli (head and body position changes).

Let's say that Betty has a motion sensitivity test done, and the therapist finds that she becomes dizzy after four of the 16 head and body movements included in the test. By designing a supervised exercise program that repetitively produces these four movements, the therapist provides Betty with a habituation exercise program as a part of overall vestibular rehabilitation therapy. As Betty performs these habituation exercises, in conjunction with the adaptation, gait and balance exercises from the VRT, she experiences a decrease in motion-provoked dizziness.

In the beginning, the therapist will instruct Betty to carry out the habituation exercises in the therapy gym under close supervision. As Betty becomes more comfortable with the activity program, the therapist may recommend specific home exercises that are safe and effective. If the baseline MST showed that Betty experienced dizziness when she changed her position from sitting to supine, supine to right side, supine to left side, and supine to sitting (movements 1-4 on the MST, see sidebar), the therapist would demonstrate these particular maneuvers on the therapy table. After observing Betty during return demonstrations of these activities in the therapy gym, the therapist would then write out a set of home exercises that involve a prescribed number of repetitions of each of these movements several times a day, with Betty safely positioned in her own bed.

In general, patients experience habituation responses that are unique in both timing and magnitude. If Betty conscientiously carries out her home activity program of customized daily exercises, she can expect to see improvement in exercise-provoked dizziness in as early as two weeks, or as late as six months. As a general rule, most seniors can expect dramatic improvement in their vertigo within four to six weeks after starting daily habituation exercises.¹

Time For Senior Fitness

After a month of conscientious home exercises, Betty calls her therapist to report a significant decline in motion-provoked dizziness. When the therapist administers the motion sensitivity test once more, Betty has only a few mild spells of dizziness following three particular movements, and her MST quotient is dramatically improved.

The therapist discharges Betty from vestibular rehabilitation therapy and sends a closing report to the referring physician. When Betty consults once more with the doctor, she is delighted to hear him recommend a regular senior fitness program.

Reference

1. Akin, F., & Davenport, M. (2003). Validity and reliability of the motion sensitivity test. Journal of Rehabilitation Research and Development, 40 (5): 415-422.

Sandy Keefe is a nurse consultant for RNS Healthcare Consultants Inc., Sacramento, CA.