♪ Bob and Brad ♪ ♪ The two most famous ♪ ♪ Physical therapist on the internet. ♪ - Hello folks, I'm Brad
Heineck, physical therapist. - And I'm Shari Berry, physical therapist. - And I'm exactly 1/2 of the
bottom Bob and Brad team. However, Bob is not here today, but we're very fortunate
enough to have someone much better looking than Bob.
(Shari laughing) 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 a specialist. I think she's an expert. But anyways, we're gonna talk
about the vertigo, dizziness, and this is the person you wanna hear and get proper information for. So, Shari, do you wanna
do a little introduction about your background?
- Sure. 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." (Brad laughing)
I've always been a little dizzy, (laughing) but I became an official
dizzy 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, and we are better at
identifying it and treating it. So we've made-
- Yes, excellent. - great gains that way. - And she's being very modest because she actually teaches
classes to therapists like me. I took a vestibular classroom 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 in "Star Trek" that's got the big ears. - Yes, yes! (laughing) - All right, Shari, here we are, we've got the vestibular
system, vertigo, dizziness, all these things, and we're gonna talk
about actual treatment and what you can expect if you go in and some things maybe you can do. And Shari, you're still
directly treating patients. And we're gonna have a volunteer, Mike's gonna come in. This is exciting. This is gonna be very
helpful for everyone. And I'm just gonna kind
of stand off and watch. Maybe I'll ask a question. - Absolutely, you're welcome to. I am still treating-
- Carry on. - not as much as I'd like to. I teach full time. And so when people... I've trained a lot of people
to do what I do in the clinic, but sometimes, the schedule's full, and they'll call me and
say, "Can you see someone?" and I say, "Absolutely." - And she's got children in hockey, so you know what that means. (laughing) - It means I'm going all
over the world, so exactly. So yeah, I think we talked a
little bit in our last segment about some anatomy. I just wanna highlight a couple things before we get into what can
you expect when you go in? So just a reminder that your vestibular
system is very complex. - So it's in the ears. - Well, part of it is in your ears. And then part of it is your
eyes and part of is your body. So your eyes, your ears, and your body are telling your brain where you are at all times. And then your brain is making an appropriate response to that. And when things go poorly,
if there is a conflict, if your eyes are saying one thing, and your ears and your body
are saying a different thing, your brain's responses
to hit the puke button, and you feel sick. - So abnormal information
is going in there and then we throw up. - Exactly. Or you might, if
you're lucky, just feel dizzy. And so that's typically what
brings people to the point where they think,
"Something's wrong with me. I should go get checked out." - Yes. - And so what we wanna talk about is what are the things you
might be able to do at home? And then what can you
expect if you were to go in and see a physical therapist or see a provider who
might take a look at you? So I think it's also important for us to talk about just a little bit about how those inner ears are working. - So if someone's getting these
symptoms, and they throw up, they darn well better
go in to see someone? - Correct. I think dizziness and being
sick can have other causes other than the vestibular problem, and you wanna make sure
you rule those out. You can have a stroke, you
can have a heart attack, you can have some big bad stuff, and you wanna make sure you don't have any big bad ugly stuff going on before you start working on this. - Okay. 'Cause once again,
these are not real, though- - You feel bad, but they're
probably not gonna kill you. (Shari laughing)
- No, but I mean it can be treatable without a lot of special stuff.
- Correct. - But just knowing what
we're gonna talk about. - Right. So we think in the case
like you just said, if you have a unilateral hypofunction or one ear goes on vacation,
you feel terribly sick. You are very, very dizzy. You are very, very ill. You probably feel like
you're having a stroke or a heart attack, and you end up gonna the doctor or the ER. - And this is a constant feeling? - A constant feeling of dizziness. You might wake up with
it, and it is there. And it is there all the time. As you're sitting still you're dizzy. - For like all day long? - All day long. And it can last a few days, actually. Usually, the first day is the worst. Then your brain tries to
start figuring it out, and by day three, you're feeling a little bit better. If you don't go in... Some people think they just
have a bad case of the flu, they don't go in. Usually, four to six weeks later, they're feeling pretty normal again. But it takes a while for
your brain to figure it out. - Right. - So there's things you can do to make your brain adjust faster. And so I think that's one of the things that I'd really like
to highlight today is, what's one of the exercises if one of your ears took a vacation, and you had a loss of one
of the vestibular apparatus or the input from one side;
you're gonna feel horrible; and then what can you do
to feel better faster? - Sure. - So, as I mentioned, do you remember I told
you that this system, you can have an
intentional motor response, or you can have a
reflexive motor response, and automatic response that
you don't have to worry about? - Right. - One of the automatic
responses is your eye movement, and it's called a
vestibular ocular reflex. - Ooh! I don't wanna have one of those. - It sounds complicated,
but it's not so bad. - Okay. - So here's how to explain it. If you look at your palm, find a place on you palm where
you have creases that cross. - Okay. - Okay? If you move your palm to
the left and to the right, and you just track it with your eyeballs without moving your head,
go as fast as you can, but don't let that section blur or jump. You can only go so fast. It gets blurry, right?
- Sure. - Now find that same spot. - Yep. - Instead of moving your hand, you're gonna move your
head to the left and right, just a quick little
rotation, fast as you can, keeping that spot in focus, and you'll see that you can move your head a whole lot faster. - Right. - The reason you can do that is the vestibular ocular reflex. As your head moves, one way, your eyeballs could stay
pinned on that another way. - And that's normal? - That's normal. You are normal. - Good. (Shari laughing) - We have that on video. - Not many people say that. (Shari laughing) - When you have a vestibular problem where one ear takes a vacation,
that becomes a problem. - So you can do this, but if you do- - Both will make you yucky. - Oh, both will.
- Both will make you yucky. - You mean, like ugh?
- Blah, feel a little puckey. - Throw up kind of thing. - Yep, and very dizzy. So your brain has to remap
the messages it's getting. And it does that when you move your head. So Mike, if I can call
you in as a sample here. I'm gonna have you sit on the table, and we're gonna give you a business card. So if I have a person
who has a unilateral loss or you experienced this, or you
have been diagnosed with it, you're gonna hold a business
card at arms length away. Find a letter and keep it in focus. You don't want it to jump.
You don't want it to skip. You don't want it to blur. And you're gonna turn your head to the right and to the
left, starting very slowly. If Mike were acutely involved or just had this happen to him, he would probably be moving this slow because this would be enough movement to make him feel a little yucky. You're gonna do that for two minutes, three or four times a day. - [Brad] You should time it. - Time it.
- Don't just guess. - Try to get for two minutes. You may not make it two minutes. You might only make it a minute when you're first involved in all of this. - [Brad] What happens then?
You just start feeling- - You start feeling really terrible. So let's say you make it
two minutes, you stop, and you think to yourself,
"I feel a little yucky." The yucky should go away
in 15 to 20 minutes. If it lasts longer, you've gone too fast. You have to slow down
the next time you do it. So within probably two weeks, Mike will be doing this activity, looking at that letter and being able to shake
his head pretty rapidly. The brain adapts that quickly. And so then he can do that for two- (Shari laughing) Maybe, Mike should practice. (all laugh) That looked like that bothered
you for just a little bit. - Nah, it's all right. (Brad and Shari laugh) So you wanna do that
for about two minutes, three or four times a day. It retrains your brain to accept
the messages from your ears and make sense of it. And you can get better faster.
- So it's (faintly speaking) - And that's with BVVP or-
- Very simple. - No, this is with a
unilateral hypofunction. - That's where it's always- - One ear (indistinct) - Okay, you have that constant blah.
- Constant yucky, yup. - All right. - Positional vertigo is
a little bit different. Now we talked about positional vertigo, and we talked about the fact that deep in your inner ear you have semicircular canals
that are fluid-filled. Mike, if you rotate
your head to the right, there's fluid that moves to the left. If you rotate your head to the left, there's fluid that moves the other way. In a fluid-filled
system, the fluid moving, it gives information to your brain about where your head is in space, okay? You have also a part in the middle ear where these canals are attached that give you information
about linear acceleration; if you're moving forward or backward, or if you're moving up and
down like in an elevator. - Kind of movement in space.
- Yep. In that section of your ear, you have little crystals that
are attached to hair cells, and they are called
calcium carbonate crystals. We like to say, you
have rocks in your head. You really have rocks in your ears, okay? (Brad and Shari laughing) So one of those little
rocks pops off that area, drops into the fluid-filled canal, and it's like dropping
a pebble into a pond. It creates a ripple. So Mike, if you turn
your head to the right, the fluid moves, and then the crystal drops
down through that canal, creates a ripple in the fluid because the crystal is
affected by gravity, and it drops to the bottom. And while that's happening, Mike has a sensation of being dizzy. - Is this the actually spinning dizzy? - More often than not,
people will tell you, "I feel like I'm spinning,"
or "The room is spinning." And that is very classic
symptoms of positional vertigo. The other classic element
of positional vertigo is it only lasts seconds to minutes. - Okay. - Okay? So Mike says, "I keep
getting this spinning thing. Every time I roll over in bed, I should maybe get this checked." So what can Mike expect when he walks through the door of physical therapy? The most common test for this
is called a Hallpike-Dix test. So Mike, I'm gonna take you
through that test here a minute. - Oh! - If you will turn so
your feet are on the mat out in front of you, and you're
in a long sitting position. Perfect. Then I'm gonna turn
your head to the right, and then we're gonna tip you down, so your head just falls
off of the mat here into that position. And that's a whole Hallpike-Dix test. Typically, I would have
special goggles on his face, which would magnify his eyeball. His eyes, if he had
positional vertigo would do this funky twisting thing. - [Brad] So you're watching, Shari- - And I'm watching the video
if I have video goggles, or if I don't, I'm watching
his eyes like this, because I'll even be able to see that eye movement without goggles. It's a little harder to see, but you can. - [Brad] Will the patient know that their eyes are twitching? - No. - [Brad] But you could see it.
- They'll feel dizzy. - [Brad] Yep, okay. - They'll feel like they're spinning. And when you have goggles on, you can start to see their eye move, and you'll say to the patient,
"All right, it's starting." And then you'll see their
eyes stop moving, you'll say, "Okay, you should be feeling better." And the patient will say,
"How'd, you know that?" - [Brad] Ah!
(Shari laughing) - "Because we could see
it in your eyeballs." Then when Mike sits back up, keeping your head to the
right, it'll all happen again, 'cause we're moving that fluid,
the little crystal drops, and we create that again. - Now sometimes, does a
therapist do that more quickly? - We would typically do it quickly. If a person's not too sick or not too sensitive in the
stomach, we can move it quickly. We wanna move that fluid
quickly, bring them up quickly. It's easier for us to see
what's happening that way. All right, so Mike, you can sit back to the front there again. A physician or a doctor
might even do that test in the clinic also. It's the test that we use to
predict positional vertigo. - Because if it's positional, then there's another treat? - There is treatment
for positional vertigo, and it's pretty easy to do. We just have to roll
you around a little bit and put the crystal back where it belongs. (Brad laughing) The treatment depends on
which canal is involved, but here's the good news, 85 to 95% of the time,
it's the posterior canal. And so I'm gonna show you an exercise you can try at home that actually addresses
the posterior canal and 85 to 95% of the time, it works. - So when she says posterior canal, it's in the vestibular system. You don't have to really understand that. - No, you really don't.
- As a therapist, you really technically do, but, you know. So we're gonna show the treatment. - You got three canals in this ear, three canals in this ear, 85% of the time, it's in
one of those three canals, and the position to fix it is
what I'm about to show you. - And this is a maneuver that... What's it called? - It's the Brandt-Daroff maneuver. It's how we used to
treat everyone with this before we had goggles. - What about the Epley, isn't
that kind of high-end of- - The Epley- - 'Cause we do have a video on Epley, and that's what I've used. - Oh, yes, so the Epley as a therapist, if you've identified
which canal is involved, the Epley targets that canal. And then you're specifically moving the fluid in that canal quickly to send that crystal home.
(hands smack) The Brandt-Daroff is similar to that. We're just targeting the posterior canal. - Okay. - Playing the odds, 85 to 95% of the time, that's the one-
- It's pretty good. - that's involved. Pretty good. - Yeah. - So if it's not, you've tried it at home, then you can go see a
specialist, pay the extra money, whatever you need to do. But if you're not too sick, this is a great thing to try at home. - Oh, so, you got symptoms
where you turn your head, you roll over, but it's not too bad-
- You could try this. - go ahead? - Yep. - So listen carefully because I think there's
some little things in here. - There are some really important things to doing this correctly. So Mike, first, when you are at home, you're gonna wanna sit somewhere where your feet are in
contact with the floor. This is a little high,
(Brad giggles) so we're breaking the rules already. So you're gonna sit with your feet in contact on the floor, either on the side of your bed or the side of a couch works great. So what you're gonna first do is you're gonna turn your head to the left and then very quickly, you're gonna lay down
on the right shoulder. Now the key to this is
you don't wanna turn and look where you're going. You wanna go as quick as you can, but you wanna keep your head to the left-
- To the left. - as you throw your body to the right. So as quickly as you can, you're gonna go down to the right. - Whoa! - Yes, just like that! That was perfect! - And keep looking up? - And you keep looking up,
your nose is to the ceiling. Here's the other piece
where things go poorly. You don't wanna roll back into the couch. You wanna stay directly on your side, your nose to the ceiling. You flip yourself down, and you wait for the dizziness to come. You wait for the dizziness to
go away, and you count to 20. - After it goes away? - After it goes away. - And typically, if
this is the right thing, it'll go away within 30 seconds or so? - 30 seconds to a minute at most, exactly. Once the dizziness has gone,
and you've counted to 20, then you sit right back up to the middle, and you're probably gonna get dizzy again. And so you wait, when the
dizzy is gone, you count to 20, then you turn your head to the right, and you're gonna flip yourself
down to your left shoulder. Again, don't look where you're going. Trust where you are. Flip yourself to the left fast
as you can. Don't roll back. Nose stays to the ceiling. You wait for dizziness to
go away and count to 20. - Just one, two, three or one, two, three, four,
five, six, seven, eight. - One, two three. - Oh, like 20 seconds.
- You can do Mississippi's if you'd like. - There you go. - Then you can come back up again, Mike. And this is considered one repetition. You have to go down and up,
down and up to equal one. - So that could take three minutes or so? - Yep. You're gonna do five of them. - Right in a row? - In a row.
- Okay. - By the fifth one, so with positional vertigo, your brain gets used to the
input that it's getting, and you get less and less dizzy; very common that by the fifth one, you're not really that dizzy anymore. So if you lay down, and
you don't have dizziness, you just count to 20, and then you sit back up.
- Oh, nice. - You lay down the other
way and count to 20. If you can do this two
to three times a day, more often than not, you can either self-correct
by sending that crystal home, or there's a theory of the Kool-Aid method that you're shaking it up enough to kind of dissolve that crystal. That maybe isn't as sound as
sending that crystal home. - One way or another. And this is something,
typically, in your experience, by the fifth one- - Feeling better.
- Feeling better. - Yup, Yup.
- Okay. - And again, two to three
times a day is great. Most people, after a week or so, don't need to do it anymore. They're feeling better. - Yup. - So this is a real easy
home treatment to try. Now where things go wrong
is when people go down, and they're really, really dizzy, and they just can't handle it. Go and see someone. They
can fix it a little faster. So if this is too much at home, there are other things that we as physical therapists
can do for you very easily in the clinic. - Yeah, like if you go down, and you just feel like
you're gonna throw up or you do. (laughing) - Or you do. (laughing) - Get some help. - That'd be a good
indication to go get someone to give you a hand. - All right, well, that's excellent. At home, you can do it yourself. Pay attention, look at... I always tell people when they comment, look at the video again,
the details are in there. So you did an excellent
job at teaching this. - Excellent job of being my patient, so. Good job. - Actually, people don't know this, but Mike was Shari's student
(Shari laughing) 10 years ago or so.
- Years ago! Yes, yes, yep. - So there's a lot of
history going on here. - That's right.
- And Mike's doing behind our scenes, doing all kinds
of stuff with the computers, and filming, and- - Making the magic happen. - What are you doing? Some filming, you're putting
some little shirt things out. Yeah, the motivational ones-
- Very nice. - but yeah, that's right, you're not doing the
other media that we do. I'm thinking what Matt does.
- Podcast. - What Matt does. What does he do? Instagram? You don't do any of that. (Shari laughing) I don't know what the hell's going on. Anyways, we gotta go.
Have a Merry Christmas! (Brad and Shari laughing) - Thanks. (bright chime)
