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VESTIBULAR DISORDERS: description of outcomes and coping issue
experience without being changed by it. As an
individual living with the experiences a
vestibular disorder presents, I am indeed a
changed person.
First, I will take liberty tor explain that the
vestibular system is the part of the inner ear
concerned with balance and body orientation
(a sense of knowing where one's body is in
relation to the vertical and horizontal planes).
When this inner ear portion is damaged by
disease or by injury, a vestibular disorder can
result. Since the vestibular system interacts with other parts of the nervous system, symptoms of a vestibular disorder are experienced as problems elsewhere in the body and brain (i.e. symptoms are not limited to balance and body orientation). The ramificationa of the wide range of physical and cognitive (basic mental function) disturbances associated with many vestibular disorders are extensive and life-changing. orientation). The ramifications of the widerange of physical and cognitive (basic mental function) disturbances associated with many vestibular disorders are extensive and life-changing.
The most commonly diagnosed vestibular disorders include positional vertigo (also called Benign Paroxysmal Positional Vertigo (BPPV) or (BPV); Meniere's Disease; infections of the inner ear (called labyrinthitis or vestibular neuronitis); injury caused by trauma to the head (called inner ear concussion syndrome); endolympathic hydrops; and perilymph fistula. Other, and more rare disorders, include acoustic neuromas (tumors on the vestibular nerve) and a variety of other conditions associated with auto-immune disorders.
Symptoms of vestibular disoders mimic other disorders such as multiple sclerosis and clinical depression because imbalance and vertigo (sensation of spinning) can affect not only the ability to stand and walk, but vision, hearing, and mental function.
Traumatic head injury and whiplash are the most frequent causes of vestibular disorders in people under age 50 . Chronic bacterial ear infections, exposure to toxic chemicals and high doses or long term use of certain antibiotics are also causative factours. Additonally, if the flow of blood to the inner ear or the brain is reduced or blocked (as in the case of a stroke), damage to the vestibular system can result.
Physical limitatons of a vestibular system disorder can include some of or all of the following:
- changes in vision, visual perception and visual control;
- changes in hearing, reduced hearing ability, distortion of sound;
- reduced proprioception (reduced sensation in muscle and other tissues)
- imbalance or loss of equilibrium (in advanced cases this results in an inability to maintain body
postures;
- vertigo, a violent spinning sensation;
- dizziness, nausea, vomiting intolerance to motion and movement;
- coordination difficulties, clumsiness, alteration in gait; and
- hypersensitivity to hot and cold temperatures; and general fatigue
To date little is known about the cognitive (basic mental functions) aspects of vestibular disorders, however, studies recognize a number of associated cognitive difficulties. Researchers conclude that the reason cognitive problems are experienced by "vestibular persons" is because the brainstem is involved. The brain stem is a stalk-like structure connfected to the spinal cord. There are nuculei located in the brain system and to other reslated structures; they are also highly important for keeping one's cortex or think areas alert, aroused and attentive. Some of the cognitive disturbances include, but not restricted to, the following:
- attention and memory deficits; difficulty and concentration;
- diminished sequencing ability;
- lack of confeptual validation (a sense of internal certainty, seeing the big picture)
- trouble in perceiving accurate spatial relationships;
- visual, auditory and/or time agnosia (an inability to recognize familiar objects, sounds and/or the
loss of comphrhension of succession and durantion of events);
- difficulty in comprehending or expressing language (including tracking, conversation, word-finding,
etc);
- diminished menta stamina.
- a tendency of "facial blindness" and XXXXX
- an inability to judge speed - for brain injury suvivors in particular, the sense of "speed" is not
recognized or determined.
What do these disturbances translate to in one's everyday living? To begin with, these disturbances wreak havoc with one's ability to function in any setting in the home, at work, in the community, in social interactions and in the family envirnment. The contrast with one's ability to perform any task before the onset of a vestibular disorder to that after the onset is a picture of confusion
What do these disturbances translate to in one's everyday living? To begin with, these disturbances wreak havoc with one's ability to function in any setting in the home, at work, in the community, in social interations and in the family environment. The contrast with one's ability to perform any task before the onset of a vestibular disorder to that after the onset is a picture of near total confusion.
Certainly, the various physical symptoms and cognitive distrubances that accompany the vesitular disorder affect all aspects of one's daily living.
With respect to imposed physical difficulties, balance problems pose a very difficutl but manangeable challenge. Cognitive struggles, howevr, hav dictated fthe need to find a balance t life itself. The task of rebuilding a world is an enduring exercise of self-examination, personal development and acceptance.
How does a "vestibular person" cope with what would seem to be an imposition of overwhelming change? For the average person, this process evolves over a number of years and provides extraordinary personal growth opporutnities. Don't allow my messsge to lead you to belive this process being that of a picnic as the road will be bumpy. In the course of managing acute episodes, always reflect back to the blessing of what you have achieved to this point is worthy of the biggest hug you have every experiencied. Validition and acceptance follows in its natural course.
With respect to imposed physical difficulties, balance problems pose a very difficult but manageable challenge. Cognitive struggles, however, have dicated the need to find a balance to life itself.
Many believe this one missing link of the immediate path blocks validation. It is the outocme of a lack of internal certainity or the inability to get the big picture that becomes the osbacle. At the conslusion of each day it is important for the vestibular compromized individual to acknowledge that she has done the best she can and be very satisfied -- enough for her to herself a hug and a pat on the back. Trying to recapature a day becomes an impossibility as there is always that sense of fragmentation and uncertainity present. There is never a true feeling of completion and closure. No amount of note-taking, detailed journal entries or graphic displays have been recognized to alleviate this haunting delimma.
An inability to understand and have a sense of time is another rather unque limitation. Some "vestibular persons" consider this a great disturbance while others prefer to remain "ageless".
I am also fourtunate to be one of a long line of optimists in my family. When I have been at my absolutel worse, that optimism has provided me with the spirit needed to regroup and carry on.
The key to my ability to manage the more difficult physical symptoms is my use of self-hypnosis and meditation. Before becoming skilled in this activities, the effects of motion sickness left me confied to home and in bed much of the time. Now, through the benefits of these skills my world has become much larger, full and satisfying.
Partipating in a therapeutic program of an equestrian focus, provided great advantages and gain. I now translate the sense of motion on a bumpy sidewalk to the motion I once enjoyed as a skier and equestrian enthusiast.
When encountering a difficult path, I transfer the unpleasant effect of motion as a pleasant expereince and expectation to what which I enjoyed while riding. After becoming disabled, and with many limitations, I returned to the horse stable and through riding challenged vestibular function.
What advice do I have for other "vestibular persons"? This is a question that is not easily answered. First, it is essential to find coping strategies to address memory deficits, mobility issues and fatigue. The services of a physical medicine specialist, neuropsychologist, physiotherapy, occupational therapist and a speech pathologist can be of great assistance with respecct to these matters.
When considering the mammoth alterations that take place on one's basic thought processes, it would be only reeasonable to conclude that anxiety and depression, as well as self-doubt, could become part of the picture.
I would also encourage "vestibular persons" to continue to seek out alternative medicines until they find options that work for them. I would caution that there is no "quick fix" approach to most of the symptoms of a vestibular disorder and that the support of loving family and friends is imperative.
Some additional words of wisdom that I ewill pass on are:
- accept change but don't surrender to it,
- keep personal goals realistic,
- be passionate abgourt achieving goals,
- be good to yourself,
- celebrate even the smallest gain, and
- ABOVE ALL - keep a sense of humor.
Networking with persons who also experience similar problems can be of help as they are most often willing to share coping strategies.
Nightingale - July 2012
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