Episode Transcript
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Speaker 1 (00:01):
It's now time for Centered on Health with Baptists Health
on US Radio. Waight fortye WDYJS Now here's doctor Jeff Tubbler.
Speaker 2 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptist Health here on news radio eight
forty whas. I'm your host, doctor Jeff Tulblin, and we're
joined from the studio by mister Jim Fenn. He's awaiting
your calls to talk to our guest this evening. Our
phone number is five oh two, five seven one eight
four eight four five oh two, five seven one eight
(00:33):
four eight four. Twenty three percent of older adults fall
every year. And one of the social media influencers Adam
Frader that I follow for health and wellness, he's a
big proponent of Kylstenex and due to a recent injury,
he posted about it and one of the things he
said that I found really fascinating was he said, movement
is freedom. And for those of us who have experienced
(00:56):
a lack of an ability to have movement, we know
that it doesn't just affit do physically, but it affects
every part of your life. So we're very lucky to
have with us tonight Shelby Schroeder, who is a neurologic
physical therapist who's going to be talking to us tonight
about dizzyness, falling, balance and just so many important issues
when it comes to our overall health. Shelby is a
(01:17):
licensed physical therapist and certified neurologic clinical specialist. She's an
acute care physical therapist with Baptist Health, Floyd and New Albany.
She completed her Doctor of Physical Therapy at Fellerman and
went on to do residency and certification and neurologic clinical specialties.
She has been on our show before. Welcome back to
our show, Shelby.
Speaker 1 (01:39):
Thanks for having me back.
Speaker 3 (01:41):
We are We're thrilled to have you. So.
Speaker 2 (01:43):
I think you heard in the introduction this idea of
how important movement is and actually using the term freedom
with it. What does that say to you in terms
of what you do every day? Is that something that
you feel is out there?
Speaker 1 (02:01):
Definitely? You know, balance is a use it or lose
it skill. So if we're not using it, if we're
not moving, our balance tends to get worse over time,
and if we get in a cycle of a fear
of falling, it ends up leading to doing less and
(02:26):
having less of that movement freedom and leads to increased
risk of falls. So it's important for us to keep
moving to maintain that freedom.
Speaker 2 (02:35):
And well said, And I know that we're going to
kind of talk about different things like dizziness and balance
and things like that kind of all as under this
one big important umbrella. We're going to try and tease
some of those out individually. But is there something that
drew you to this part of physical therapy specifically?
Speaker 4 (02:55):
Yeah.
Speaker 1 (02:56):
I enjoy getting to be creative with treatment strategies, and
I enjoy working with people in general, but I get
to be really creative when working with neurologic disorders and
people who are dizzy and have balance problems and really
get to cater their treatment to the individual.
Speaker 2 (03:17):
So I always like our listeners to know what they
might be able to call in and maybe pick your
brain about or ask you a question about. So as
a neurologic physical therapist, I know we've talked already about
some of the things, but what's the range of things
that you treat?
Speaker 1 (03:33):
So currently, I work in the acute care setting, so
I'm working with people who are admitted to the hospital.
I evaluate a lot of dizzy people in the emergency
department and people who.
Speaker 4 (03:47):
Have been admitted with dizziness.
Speaker 1 (03:49):
But I have a background in working an outpatient and
getting to see a wide variety of neurologic diagnoses.
Speaker 2 (04:00):
Yeah, yeah, so we're going to pick your brain about
some of those things. We're going to start with dizzyness.
So I feel like that, to me, is sort of
a catch all phrase. Dizziness. I think can probably mean
different things to different people. What do you mean when
you talk about dizziness and what kinds of forms of it.
Speaker 3 (04:18):
Do you treat?
Speaker 4 (04:21):
Yeah?
Speaker 1 (04:22):
We when someone tells me they're dizzy, I try to
tease out, Okay, what kind of dizzy? Sometimes we assume
when someone says they're dizzy, that they're experiencing a room
spinning type of dizziness or vertigo, but they don't always
mean that. Sometimes they mean that they're lightheaded, which might
indicate more of a medical cause of dizziness, like a
blood pressure related issue cardiac related issue. They also might
(04:46):
mean that they have that they're off balance, which we
call disequilibrium, which might be related to a variety of things,
but it could be related to lack of sensation on
their feet. We have vertigo, which is just a room
spinning dizziness which is typically related to the inner ear.
Speaker 2 (05:09):
Yeah, I'm going to ask you about that at some
point because I had it once from an inner ear
infection and it is it is not fun.
Speaker 3 (05:16):
I can I can vouch for that.
Speaker 2 (05:19):
How would somebody listening to the show know that they
should see someone like you? What might be going on
where they might say, you know what, I think I
could benefit from seeing a physical therapist for this.
Speaker 1 (05:33):
Yeah, if someone is having positional dizziness that occurs in
only certain positions, such as if they roll over in bed,
they get they get a whirling sensation or they get
a room spinning sensation that lasts about thirty seconds or
two a minute, that's a pretty good indication that you
might have BPPV or benign peroxismal positional vertigo, and you.
Speaker 4 (05:57):
Should see a physical therapist for that.
Speaker 1 (06:00):
It's one of the only things in physical therapy that can.
Speaker 4 (06:03):
Be a pretty quick fix.
Speaker 1 (06:05):
But also people who have balance problems or chronic dizziness
could really benefit from coming.
Speaker 4 (06:12):
To see a physical therapist as well.
Speaker 1 (06:15):
And it's great to get on a balance home exercise
program early on to prevent worsening of in an increased.
Speaker 4 (06:24):
Risk for falls.
Speaker 1 (06:25):
You want to come to physical therapy before you start falling.
Speaker 2 (06:28):
Yeah, I was actually good. I actually had that written
down to ask you about. I feel like maybe it's
just because I'm getting older, so it's sort of the
things that are coming on my algorithms what I'm scrolling.
Speaker 3 (06:38):
But you know, balance is.
Speaker 2 (06:41):
I feel like it's a really important topic that people
are talking about and you started to mention it. But
why is addressing balance early when we're younger and healthier important.
Speaker 1 (06:54):
Well, some of the things that are important to maintain
your functional ability to do, like recovering your balance. Let's
say you lose your balance. We need to be able
to take a big step, a quick, reactive, big step
to be able to recover our balance. If for whatever reason,
some force acts on us, then we need to recover.
(07:17):
We want to keep that muscle power to be able
to do that, and that reactive strategy. We want to
be able to keep the ability to get on and
off the floor. So these are things that we need
to not lose track of when we're younger and keep
doing them and know that they're important. You know, some
(07:38):
people just get into an avoidance phase. They want to
avoid the things that are challenging, and then they lose
the ability to do them, and then it's it almost
gets to a point that it might be a little
bit too late to do it safely.
Speaker 2 (07:53):
And you know, clearly there's an age component to some
of these things that cause it, but dizziness and balance
this is not just an older person's issue. Do you
see patients of all ages, even young patients.
Speaker 1 (08:11):
Yes, people, even in the pediatric realm. You see vestibular disorders.
They're like DPPV, where the crystals and the inner ear
get out of place. Is actually more common in older
adults and specifically women, due to the crystals are made
up of calcium carbonate. So if we have a calcium
(08:31):
or vitamin D deficiency, they're more likely to fragment and
break off and fall out of where they're supposed to
be in the inner ear more frequently. So that happens
more in older adults, they are specifically women, but it
can happen in all ages, especially with.
Speaker 2 (08:51):
Trauma, and so you see patients all ages. So I
hope everybody's listening. We're going to take a quick break.
We're talking with Shelby Schroder tonight about neurologic physical therapy, dizzyness,
balance and all the important things that go along with it.
You are listening to Senate on Health with Baptist Health
here on news radio eight forty whas.
Speaker 3 (09:14):
I'm your host, doctor Jeff Tublin.
Speaker 2 (09:15):
Our phone number five oh two, five seven one, eight
four eighty four. Our producer Jim Ben is on call
to take your calls to ask about any of these issues.
Speaker 3 (09:24):
We'll be right back.
Speaker 2 (09:37):
Welcome back to Senate on Health with Baptist Health here
on news radio eight forty whas. I'm your host, doctor
Jeff Tublin, and we're talking tonight with Shelby Schroder, who
is a neurologic physical therapist with the Baptist System. She's
talking to us tonight about dizzyness and balance and the
importance of maintaining these healthy things as we get older
and throughout our whole life. Our phone number is five
(09:59):
oh two, five seven one, eight four eighty four if
you want to call in and be a part of
this conversation. And Shelby, we did have a caller. I
think we dropped the call, but we did get the question.
So Jim had a question about something that he experiences. Jim,
I hope you're still listening that when he goes to
the grocery store, as an example, and he bends down
(10:21):
to look at something like maybe on the lower shelf
that he he'll get it, and then as he stands
back up, he starts to feel dizzy, and he was
wondering a what could that mean? And is there something
that he should be doing about that.
Speaker 1 (10:38):
That's a great question. I think it's a common thing.
So there's a couple of things that could be going
on and might require a little bit of investigation. So
when we've been down, sometimes we hold our breast, which
can lead to what we call a valves album maneuver
(10:59):
and can increase our blood pressure, and then when we
stand up, it drops our blood pressure all of a sudden.
Then we can get dizzy from that. So I would
encourage you, Jim, to reflect and think, you know, am
I holding my breath when I'm bending down? Am I
kind of groaning and holding my breath? And if so,
try to breathe through that movement and see if that
(11:21):
helps and decreases your dizziness and kind of slow down
how quick you're standing up if that doesn't fix it,
you could be experiencing something related to balance or inner
ear and people do sometimes it's a different scenario, but
get visually sensitive and have what we call supermarket syndrome
(11:43):
where they get really overwhelmed by all the visuals lie
in the supermarket. But it doesn't sound like that's necessarily
what's happening here.
Speaker 3 (11:52):
I mean, that's really the name of a syndrome.
Speaker 4 (11:56):
It really is.
Speaker 1 (11:56):
You have people that get in the overwhelming environment.
Speaker 4 (12:02):
They call it supermarket syndrome.
Speaker 2 (12:04):
Wow, that's a that's that's great. So Jim, I hope,
I hope that helps. And so Shelby, I want to
backtrack to something that you said, and I wanted to
maybe just you know, punch it just a little bit
because it sounded like an important point. You talked a
little bit about a vicious cycle. What did you mean
by that with in terms of avoidance?
Speaker 1 (12:28):
Right, so we all know somebody who has kind of
slowed down because they've gotten fearful of doing certain things.
Maybe maybe they had a fall and then they decided
they were never gonna do anything that could lead to
them falling again. And so that leads to not challenging
(12:51):
your body as much getting weaker. The muscles get weaker,
and you're not challenging your balance systems, and so they're
getting less reactive, less able to prevent you from having
a fall. You're not walking as much, not moving as much,
So the fear leads to avoidance, which then leads to deconditioning,
(13:13):
and then you're more and more likely to fall the
longer this goes on.
Speaker 2 (13:20):
So let's jump into to balance a little bit and
get into a little bit of the details of some
of the causes of it. So, what are the biggest
things in your practice that you see that can affect
somebody's balance.
Speaker 1 (13:34):
Well, Peripheral neuropathy can be really challenging. That one is
pretty common. And so when you lose sensation on the
bottom of your feet and you can't really feel what
your fear doing necessarily without looking at them, that you
might be a little bit more difficult to walk on
(13:54):
uneven surfaces, go up and downstairs, you're going to rely
more heavily on your vision for your balance than you
would if you had good sensation in your feet. So
if you're in a dark environment, a low lit environment,
it's going to be much more difficult to walk, and
in those scenarios, it's really important to get on a
(14:16):
good balance program to protect the balance that you have
and strengthen the systems that you still have, like your
vestibular system, your inner ear, in order to maintain your
balance over time.
Speaker 2 (14:29):
So the periperal neuropathy can be something that's isolated and
also I think is pretty common in patients with diabetes.
Are there other medical conditions that lead to balance issues?
Speaker 1 (14:42):
Certainly so, any history of stroke, Parkinson's disease, multiple sclerosis,
any sort of neurologic disorder can affect your balance over time.
Speaker 2 (14:58):
And then what about you talked a little bit about
the vision can also cause is you what are the
most common things that you see that affect vision that
then affect dizziness and balance.
Speaker 1 (15:12):
So if you have any sort of low vision, that
can affect your balance because you're not able to rely
on your vision system to support you. So we have
three systems that work together to support our balance. Our
vision and then the sensation on the bottom of our feet,
(15:32):
and then our vestibular system. So they all work together
and give feedback to the brain and the body, and
they all work together to keep us balanced. And so
if one of those systems is lacking, then you're relying
more heavily on the other two.
Speaker 2 (15:49):
Do you find that when people are coming to you,
there's already one of those three that is obviously the problem,
or do you find you are the one or your
colleagues are the one sort of figuring out which of
those the three things are causing the problem.
Speaker 1 (16:06):
The people that are falling, it's often a combination problem.
You know, they they have a vestibular problem on top.
Like let's say someone with no other issues, like they
don't have any problem with the sensation on their feet
or their vision, they get an acute.
Speaker 4 (16:25):
Vestibular disorder like you did.
Speaker 1 (16:27):
You said you got vestibular neuritis.
Speaker 3 (16:29):
I did.
Speaker 1 (16:30):
If you don't have any of those other issues, if
you don't have issues with the feeling on the bottom
of your feet, if you don't.
Speaker 4 (16:38):
Have visual issues, you.
Speaker 1 (16:39):
Might be able to somewhat compensate and you might not
be falling. You know, you can navigate it. But let's
say somebody also has a visual deficit or they also
don't have sensation on the bottom of their feet. Those
people end up in the hospital because they're falling.
Speaker 2 (16:56):
And you've used the term vestibular system a couple bull
of times, and I know we talked about that being
the inner ear.
Speaker 3 (17:04):
What's in there?
Speaker 2 (17:05):
What's the vestibular system and how does it lead to dizzyness?
Speaker 1 (17:10):
Yeah, so the vestibular system, it's the inner ear that
it's very tiny. The inner ear itself can fit on
a dime. It's very small, but it does a lot
for our body. It communicates with the brain about where
our head is in space, and so it really helps
with our equilibrium and knowing where we are in space
(17:34):
and being able to react to what our head and
body movements are doing. And so if we don't if
we're not getting that information correctly, if it's not transmitting,
if there's a problem with the inner ear. So the
inner ear, we have one on each side and so
it's what we call like a push pull, so that
(17:58):
one thing is happening on the other side and opposite
thing is happening on the other side. So if we
get a mismatch or something wrong with one inner ear,
that's why all of a sudden we think the room
is spinning, because there's not that push and pull relationship
between the two sides. If we lose input from one side.
Then our brain gets really confused about what's happening.
Speaker 3 (18:21):
Oh, that's really interesting.
Speaker 2 (18:22):
So that's what leads that inconsistency of push and pull
is what leads us act to actually have that sense
of the spinning.
Speaker 3 (18:29):
It's because they're not balancing each other. That's fascinating.
Speaker 2 (18:34):
So I would imagine, you know, one of the things
we talk about this with multiple conditions, but we're all
on so many medications these days, and I would imagine
that medications can cause side effects, which we know that
they do. And do you see that as we get
older and we're on multiple medications, does this problem get worse?
Speaker 4 (18:57):
It does?
Speaker 1 (18:58):
It gets more difficult to kind of parse out what
exactly is happening.
Speaker 4 (19:04):
Too.
Speaker 1 (19:04):
If we're on three different medications that might cause dizziness,
then yeah, there's it becomes more difficult to fix and
to manage.
Speaker 2 (19:17):
Are there any in particular that you see that cause
dizziness a lot? Or is it just that can be
with any medication over the counter prescription everything is spare gain.
Speaker 1 (19:29):
I'd say there's a large mix of drugs that can
cause dizziness. But one thing that we don't always think
about is anybody who's been on certain chemotherapy medications that
can attack the peripheral nerves, and so we can get
chemo induced peripheral neuropathy, which can be a disabling side
(19:53):
effect of chemotherapy and lead to balance issues and people
who have undergone chemotherapy. So that's one that we see
a lot.
Speaker 2 (20:02):
And do you do you find that patients that are
coming to you. Is it are they being brought in
by a family member who's saying, you know what, my
mom or my dad or my relative, they seem to
be falling too much? Or is this something that's sort
of recognized internally by the patient saying this something's wrong.
Speaker 3 (20:21):
I need to go get seen.
Speaker 1 (20:24):
Mm hm. So if we're talking specifically about inner ear
problems like BBBV for example, being the most common, the
benign peroxysmal positional vertigo where the crystals and the inner
ear get out of place, that one can go undiagnosed
and unnoticed for a long time. Some people go years
(20:45):
and they don't get the proper diagnosis because a lot
of times they're given maclasine and like sent home.
Speaker 3 (20:52):
Just for symptom relief. You're saying, just for.
Speaker 1 (20:55):
Symptom relief, and then the issue itself is not addressed
because maybe the provider or that they've they've found, they're
not familiar with the treatment or how effective it is,
or they don't know how to do the test to
identify the problem, or they don't know who to refer
the patient to.
Speaker 4 (21:12):
And so that.
Speaker 1 (21:14):
One well, dizzyness in general, it can take, it can
be expensive, and it can take while a lot of
times people get a lot of unnecessary medical testing when
they have BPPV to rule out things like cardiac issues
or stroke when it was just a simple inner ear problem.
So in that case, people are generally pretty happy by
(21:34):
the time they make it to a physical therapist who
identifies what the problem is. But as far as balance issues,
you know, a lot of times when I'm seeing people
in the hospital, it's because they've had a fall. But
on an outpatient basis, I think people make it to
an outpatient clinic for balance issues a lot of times
(21:56):
I think their primary care provider is advocating that in
that scenario.
Speaker 2 (22:01):
And I'm glad you brought up the cost of all
of the testing, because that is a big deal that
you know, somebody like such as yourself could have identified
maybe a little bit earlier on and even a lot
less expensively. So we're going to talk about what you
do in the office to find those things out when
we come back. So we're going to take another break
right here. I want to remind everybody that you are
(22:21):
listening to senat on Health with Baptist Health here on
news radio eight forty WAHS. I'm your host, doctor Jeff Tubbin.
We're talking to Shelby Schroeder tonight about neurologic physical therapy.
Speaker 3 (22:33):
We'll be right back.
Speaker 2 (22:47):
Welcome back to cenate on Health with Baptist Health here
on news radio eight forty WATS. I'm your host, doctor
Jeff Tubblin. And if you're just joining us or tuning in,
we're talking tonight with Shelby Schroder, who's a neural logic
physical therapist with the Baptist Hospital System and she's been
educating us, doing a great job of us understanding what
(23:08):
these conditions are.
Speaker 3 (23:09):
And now we're going to.
Speaker 2 (23:10):
Talk to her a little bit about what she does
on a day to day basis or her colleagues in
the office. I know she does a lot in the
hospital itself, but Shelby, we're all familiar with the idea
of rehab right we go, we have some kind of injury,
or we have a surgery or a procedure, we need
rehab for it. But rehab is important for this type
(23:31):
of issue too. So talk to us about what rehab
is like for these conditions.
Speaker 1 (23:38):
Okay, So if someone has BBPV where the crystals are
out of place in the inner ear, the rehab involves
doing a series of head positions to get the crystals.
Speaker 4 (23:50):
Back where they go.
Speaker 1 (23:51):
There is about a ninety two percent success rate doing
these maneuvers, so meaning that the crystal go back where
they're supposed to be and the symptoms resolve without any
in a lot of cases, without any additional issues. And
that might take up to up to five maneuvers, usually
(24:17):
anywhere from one to three, but in some.
Speaker 4 (24:19):
Cases up to five. So that can be a really
quick fix.
Speaker 1 (24:24):
Most people don't have balance and dizziness problems after we
get that resolved, but some people do, and then we
would have to stay in therapy and do potentially what
we call either adaptation therapy, which so we have a
(24:45):
connection between the eyes and the inner ear. It's called
the vestibular ocular reflex, and that gets impaired in people
that have vestibular problems sometimes and that makes it hard
to stay the lives of your gaze, meaning to keep
your eyes still while your head moves, and that can
make us really dizzy whenever we're moving, and it can.
Speaker 4 (25:08):
Make us off balanced.
Speaker 1 (25:09):
So we do exercises to help the patient get that
reflex back to keep their eyes stable while they're head moves.
So that's called adaptation. And then we also and people
that need it and people that are just really dizzy,
and we need to habituate their dizziness. We have to
(25:30):
retrain the brain to not get so dizzy when they
do certain things. And unfortunately, the way that we have
to do that is start with things that make people
just a little bit dizzy and do those things over
and over again until they don't make them dizzy anymore.
And then we do something that used to be a
little bit harder, and we do that over and over
again until they're not dizzy anymore. And that's called habituation,
(25:53):
and we really tailor that to the person and what
they're having problems with. So those are a couple of
things that we do and dealer rehab other than balance training.
Speaker 2 (26:02):
Yeah, it sounds like exposure therapy, right, like you you're
kind of training them, and I think you mentioned this,
but what's the success rate of these of these maneuvers
and your programs?
Speaker 1 (26:17):
So for the series of head positions that you do,
it's commonly referred to as the eply maneuver, but there's
a lot of variations of that, depending on which canal
is involved and.
Speaker 4 (26:31):
Where the crystals are. But this success rate is.
Speaker 3 (26:36):
For that in particular, that's great. Oh, that's a that's
a high percentage. That's great.
Speaker 2 (26:42):
So I like for when we're talking about these things,
you know, our listeners sometimes have to decide like, hey,
is this something I should talk to my primary care about?
Or can this wait till Monday? Or you know, is
this something that's kind of a little more urgent. So
when should a pace and be thinking maybe this is
a little bit more serious than just waiting it out.
(27:04):
When should somebody think about going to like an emergency
room or an urgent care if they're having certain types
of dizziness or balance episodes.
Speaker 1 (27:14):
Yeah, this is a great thing to talk about because
we don't want somebody that's dizzy to wait and not
get care. When it was something more serious than an
inner ear problem. So the brain can also cause balance
issues and inner ear issues. So if there's anything that
is potentially resembling a stroke, then we want people to
(27:35):
go to the emergency department as soon as possible because
time is brain, and we don't want to delay going
to the emergency department because you can get care and
more care the quicker.
Speaker 4 (27:46):
You get to the emergency department.
Speaker 1 (27:48):
So if they're starting to fall, if they're experiencing all
of a sudden new onset, balance problems, if the dizziness
is severe and unrelenting, you want a new oncet. If
it's associated with any sort of confusion or weakness, you know,
(28:11):
especially one sided weakness, slurred speech, anything like that, you
want to get or lots of sensation that would not
be an inner ear problem, and you want to get
to the emergency department quickly for those things.
Speaker 4 (28:25):
Also, if it's associated.
Speaker 1 (28:27):
With a high heart rate or your blood pressure is
high or low, you definitely want to go to the
emergency department for that as well.
Speaker 3 (28:35):
That's great advice.
Speaker 2 (28:37):
Kind of on the other end of the spectrum, when
it's not super serious, you know, we're all exposed to
lots of information, right, data overload from commercials and TikTok
and social media about this vitamin or that vitamin or
different things that can help with things are Is there
any role for supplements or vitamins in any of these conditions.
Speaker 1 (29:03):
Yeah, So there's been studies on prevention of the nign
paroxysmal positional vertigo BPPV, So that particular condition. The crystals
in the inner ear, we all have them. They're teeny tiny.
They they're the width of a spider web strand, and
they're usually clumped together in the inner ear and they're
(29:25):
made up of calcium carbonate. So if you have low
calcium or vitamin D, you're more likely for those crystals
to fragment and break off and fall out of the
inner ear where they're supposed to be, which can lead
to recurrent episodes of vertigo, room spinning, dizziness that you
have to keep going back to an E and.
Speaker 4 (29:43):
T or a physical therapist to address.
Speaker 1 (29:46):
So in those cases, there have been studies done to
see does vitamin D and calcium supplementation improve you know,
outcomes in these people and D increase recurrence a BPPV,
And it actually does, but it is recommended that you
only do this under the supervision of your primary care provider.
Speaker 3 (30:09):
Yeah, that's good.
Speaker 2 (30:10):
That's great to know because you know that people would
would like to know these things about what they might
be able to do, because sometimes just not feeling like
you can control anything can be very frustrating. You are
listening to Senate on Health with Baptist Health here on
news Radio eight forty whas. We're going to take a
final break here, and our guest tonight is Shelby Schroeder,
(30:31):
who's talking to us about good health with neurologic, physical therapy,
balance gate and dizzyness. Remember to download the iHeartRadio app
and we will see you after these commercials. I want
(30:58):
to welcome everyone back to Center on Help with Baptists
Help here on news radio eight forty whas. I'm your host,
doctor Jeff Tublin, and we're talking tonight to Shelby Schroeder
about neurologic physical therapy and all the benefits of that.
Remember to download the iHeartRadio app and re listen to
this or any of our previous segments, and also to
have access to all the other features that the app
(31:20):
has to offer. So Shelby, I'm introducing a new segment
of my show tonight that I want to call appropriately hyped,
under hyped, or overhyped.
Speaker 3 (31:30):
And I want to ask your.
Speaker 2 (31:31):
Opinion about taichi, tai chi and yoga is where where
does that fit in that new category? Is it overhyped
to help with this balanced stuff, under hyped or appropriately hyped?
Speaker 1 (31:46):
I would say very appropriately hyped. And how lucky it
me to get to be the first one to comment.
Speaker 2 (31:52):
On a new segment that I just just invented.
Speaker 4 (31:59):
I love it.
Speaker 1 (32:00):
Yeah, I think so yoga and tai te are very
good balance exercises.
Speaker 4 (32:07):
Well, they are.
Speaker 1 (32:08):
Focusing on the core. His core strength is very important
for balance, reactive movements and you know strength in general
being in different positions.
Speaker 4 (32:20):
I think they're.
Speaker 2 (32:21):
Great exercises, fantastic so segment one of that new part
of the show. So one of the things, one of
the things I think about is and you know, for
those of us at a certain age, we probably remember these
commercials of the I've fallen and I can't get up
commercials and life alerts and things like that.
Speaker 3 (32:40):
But it's a serious it's a serious issue.
Speaker 2 (32:43):
For those who might live alone or might not have
a family member. What things are out there, or what
do you recommend while you're working with someone that might
protect them in these situations.
Speaker 4 (32:58):
If they have a.
Speaker 1 (33:01):
Well, I think being able to get up off the floor,
maintaining the ability to independently get onto and off of
the floor is what's going to protect them. The longer
that someone lays on the floor after they fall, the
more likely they are to have a flurry of health
conditions after the fall and end up staying in the
hospital longer.
Speaker 2 (33:22):
And are you assessing that risk when you're seeing them
in your program?
Speaker 1 (33:30):
So, yes, we do a series of balanced tests that
assesses their falls risk and then an outpatient physical therapist
would also be talking about the ability to get on
and off the floor.
Speaker 2 (33:44):
Great, okay, So it's affected a lot of things. COVID
has affected many different conditions. We talk about its effect
on things and lots of episodes of this show. So
is it something that affects what we're talking about tonight?
Did COVID affect people's balance and dizziness and things like that.
Speaker 1 (34:07):
In every sense of the way. Yes, So COVID can.
Because of inflammation that it can cause to the sinuses
and the inner ear. You can have an increased incidence
of BPPV. Of the crystals being out of place, you
can have an increased incidence of neritis. So the nerve
(34:27):
viruses are what causes and triggers vestibular neritis, where the
nerve to the inner ear gets inflamed like you have.
It can also increase medical causes of dizziness like tachycardia
and hypotension. So there are so many ways that COVID
(34:48):
can make people dizzy and hat and I've seen all
of those in the hospital.
Speaker 2 (34:52):
So definitely had an impact on what you're seeing, just
like so many other of us saw things in our specialties.
What about We hear a lot about kids in terms
of concussions, and I've done shows about sports injuries and
things like that, But what about an older adults. Do
you see concussions as a problem and how is that handled?
Speaker 1 (35:19):
I do see it as a problem, and I think
it's under diagnosed and underdiscussed. In the hospital. People come
into the hospital after a fall and we're imaging their
head and we're imaging their hips, and you know, we're
imaging their shoulder wherever they're having pain, and we're saying, okay,
you know you didn't have a hemorrhage and you don't
have a fracture, or you do have a fracture, but
(35:40):
we're not really talking as much about the effects of concussion.
We address the really emergent medical needs, but that one
kind of gets swept under the rug a little bit
or just not even talked about. And so I tried
to be really cognitive that and talk to people about,
you know, did you hit your head when you fall
(36:01):
when you fell, are you experiencing any sort of mental fogginess,
Are you having visual strain or are you having a headache?
Are you noticing any mood or personality changes, are you
having any sleep disturbance? What about your neck? Because your
neck is actually more prone to getting you know, next
(36:22):
strain than you are to getting a concussion. So everybody
that has a concussion also has some sort of next strain,
So we need to talk about the neck as well,
which is another reason to see a physical therapist. So
I think it's important to you know, after we rule
out those really emergent needs, we also need to be
thinking about concussion because it can become prolonged if you're
(36:44):
not getting the proper care and if you push through
it and you don't get it addressed, it's only gonna
laugh longer.
Speaker 2 (36:53):
And what about migrains people, that's a very common condition.
Speaker 3 (36:58):
Also.
Speaker 2 (36:59):
Do you see the relationship between migraines and dizziness that's
treating the migraines make the dizziness go away or is
it you do you still need this kind of rehab
for the dizziness for migraines.
Speaker 1 (37:13):
So there's a subset of migraine called vestibular migraine that
there's some misconception that migraine has to have pain associated
with it, but it doesn't. We can and that's why
these vestibular migraines are tricky because some people don't get
any pain with them. They might have light sensitivity but
not headache, and they can cause vertigo, bouts of vertigo
(37:36):
and room spending, dizziness and difficulty tolerating any sort of
visual stimuli. And so yes, these people need a combination
of conservative care of managing their migraine triggers and vestibular
rehab and medical management.
Speaker 4 (37:54):
It's about fifty to fifty.
Speaker 2 (37:57):
Well, once again, having vertigo is certainly no fun. So
I hope that everybody that is listening to this really
can appreciate the value of what you are doing out
there on the inpatient side and what your colleagues are
doing on.
Speaker 3 (38:10):
The outpatient side.
Speaker 2 (38:11):
Shelby, I want to thank you so much for joining
us again tonight.
Speaker 3 (38:15):
We always learn so much when you come on, and.
Speaker 2 (38:18):
That is going to be for this segment of Centered
on Health with Baptist Health. I'm your host, doctor Jeff Tublin.
I want to thank our guest Jim who called in
with a question, and our producer mister Jim Benn, and
of course the listener and our guests Shelby Schroeder. Listen
and join us every Thursday night for another segment. I
hope everybody has a good, happy, and healthy rest of
the week and weekend. We'll talk to you next week.
Speaker 1 (39:00):
This program is for informational purposes only and should not
be relied upon as medical advice.
Speaker 2 (39:04):
The content of this program is not intended to be
a substitute for professional medical advice, diagnosis, or treatment.
Speaker 1 (39:11):
This show is not designed to replace the physician's medical
assessment and medical judgment. Always seek the advice of your
physician with any questions or concerns you may have related
to your personal health or regarding specific medical conditions. To
find a Baptist health provider, please visit baptistealth dot com
It's now time for Centered on Health with Baptists Health
on US Radio. Waight fortye WDYJS Now here's doctor Jeff Tubbler.
Speaker 2 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptist Health here on news radio eight
forty whas. I'm your host, doctor Jeff Tulblin, and we're
joined from the studio by mister Jim Fenn. He's awaiting
your calls to talk to our guest this evening. Our
phone number is five oh two, five seven one eight
four eight four five oh two, five seven one eight
(00:33):
four eight four. Twenty three percent of older adults fall
every year. And one of the social media influencers Adam
Frader that I follow for health and wellness, he's a
big proponent of Kylstenex and due to a recent injury,
he posted about it and one of the things he
said that I found really fascinating was he said, movement
is freedom. And for those of us who have experienced
(00:56):
a lack of an ability to have movement, we know
that it doesn't just affit do physically, but it affects
every part of your life. So we're very lucky to
have with us tonight Shelby Schroeder, who is a neurologic
physical therapist who's going to be talking to us tonight
about dizzyness, falling, balance and just so many important issues
when it comes to our overall health. Shelby is a
(01:17):
licensed physical therapist and certified neurologic clinical specialist. She's an
acute care physical therapist with Baptist Health, Floyd and New Albany.
She completed her Doctor of Physical Therapy at Fellerman and
went on to do residency and certification and neurologic clinical specialties.
She has been on our show before. Welcome back to
our show, Shelby.
Speaker 1 (01:39):
Thanks for having me back.
Speaker 3 (01:41):
We are We're thrilled to have you. So.
Speaker 2 (01:43):
I think you heard in the introduction this idea of
how important movement is and actually using the term freedom
with it. What does that say to you in terms
of what you do every day? Is that something that
you feel is out there?
Speaker 1 (02:01):
Definitely? You know, balance is a use it or lose
it skill. So if we're not using it, if we're
not moving, our balance tends to get worse over time,
and if we get in a cycle of a fear
of falling, it ends up leading to doing less and
(02:26):
having less of that movement freedom and leads to increased
risk of falls. So it's important for us to keep
moving to maintain that freedom.
Speaker 2 (02:35):
And well said, And I know that we're going to
kind of talk about different things like dizziness and balance
and things like that kind of all as under this
one big important umbrella. We're going to try and tease
some of those out individually. But is there something that
drew you to this part of physical therapy specifically?
Speaker 4 (02:55):
Yeah.
Speaker 1 (02:56):
I enjoy getting to be creative with treatment strategies, and
I enjoy working with people in general, but I get
to be really creative when working with neurologic disorders and
people who are dizzy and have balance problems and really
get to cater their treatment to the individual.
Speaker 2 (03:17):
So I always like our listeners to know what they
might be able to call in and maybe pick your
brain about or ask you a question about. So as
a neurologic physical therapist, I know we've talked already about
some of the things, but what's the range of things
that you treat?
Speaker 1 (03:33):
So currently, I work in the acute care setting, so
I'm working with people who are admitted to the hospital.
I evaluate a lot of dizzy people in the emergency
department and people who.
Speaker 4 (03:47):
Have been admitted with dizziness.
Speaker 1 (03:49):
But I have a background in working an outpatient and
getting to see a wide variety of neurologic diagnoses.
Speaker 2 (04:00):
Yeah, yeah, so we're going to pick your brain about
some of those things. We're going to start with dizzyness.
So I feel like that, to me, is sort of
a catch all phrase. Dizziness. I think can probably mean
different things to different people. What do you mean when
you talk about dizziness and what kinds of forms of it.
Speaker 3 (04:18):
Do you treat?
Speaker 4 (04:21):
Yeah?
Speaker 1 (04:22):
We when someone tells me they're dizzy, I try to
tease out, Okay, what kind of dizzy? Sometimes we assume
when someone says they're dizzy, that they're experiencing a room
spinning type of dizziness or vertigo, but they don't always
mean that. Sometimes they mean that they're lightheaded, which might
indicate more of a medical cause of dizziness, like a
blood pressure related issue cardiac related issue. They also might
(04:46):
mean that they have that they're off balance, which we
call disequilibrium, which might be related to a variety of things,
but it could be related to lack of sensation on
their feet. We have vertigo, which is just a room
spinning dizziness which is typically related to the inner ear.
Speaker 2 (05:09):
Yeah, I'm going to ask you about that at some
point because I had it once from an inner ear
infection and it is it is not fun.
Speaker 3 (05:16):
I can I can vouch for that.
Speaker 2 (05:19):
How would somebody listening to the show know that they
should see someone like you? What might be going on
where they might say, you know what, I think I
could benefit from seeing a physical therapist for this.
Speaker 1 (05:33):
Yeah, if someone is having positional dizziness that occurs in
only certain positions, such as if they roll over in bed,
they get they get a whirling sensation or they get
a room spinning sensation that lasts about thirty seconds or
two a minute, that's a pretty good indication that you
might have BPPV or benign peroxismal positional vertigo, and you.
Speaker 4 (05:57):
Should see a physical therapist for that.
Speaker 1 (06:00):
It's one of the only things in physical therapy that can.
Speaker 4 (06:03):
Be a pretty quick fix.
Speaker 1 (06:05):
But also people who have balance problems or chronic dizziness
could really benefit from coming.
Speaker 4 (06:12):
To see a physical therapist as well.
Speaker 1 (06:15):
And it's great to get on a balance home exercise
program early on to prevent worsening of in an increased.
Speaker 4 (06:24):
Risk for falls.
Speaker 1 (06:25):
You want to come to physical therapy before you start falling.
Speaker 2 (06:28):
Yeah, I was actually good. I actually had that written
down to ask you about. I feel like maybe it's
just because I'm getting older, so it's sort of the
things that are coming on my algorithms what I'm scrolling.
Speaker 3 (06:38):
But you know, balance is.
Speaker 2 (06:41):
I feel like it's a really important topic that people
are talking about and you started to mention it. But
why is addressing balance early when we're younger and healthier important.
Speaker 1 (06:54):
Well, some of the things that are important to maintain
your functional ability to do, like recovering your balance. Let's
say you lose your balance. We need to be able
to take a big step, a quick, reactive, big step
to be able to recover our balance. If for whatever reason,
some force acts on us, then we need to recover.
(07:17):
We want to keep that muscle power to be able
to do that, and that reactive strategy. We want to
be able to keep the ability to get on and
off the floor. So these are things that we need
to not lose track of when we're younger and keep
doing them and know that they're important. You know, some
(07:38):
people just get into an avoidance phase. They want to
avoid the things that are challenging, and then they lose
the ability to do them, and then it's it almost
gets to a point that it might be a little
bit too late to do it safely.
Speaker 2 (07:53):
And you know, clearly there's an age component to some
of these things that cause it, but dizziness and balance
this is not just an older person's issue. Do you
see patients of all ages, even young patients.
Speaker 1 (08:11):
Yes, people, even in the pediatric realm. You see vestibular disorders.
They're like DPPV, where the crystals and the inner ear
get out of place. Is actually more common in older
adults and specifically women, due to the crystals are made
up of calcium carbonate. So if we have a calcium
(08:31):
or vitamin D deficiency, they're more likely to fragment and
break off and fall out of where they're supposed to
be in the inner ear more frequently. So that happens
more in older adults, they are specifically women, but it
can happen in all ages, especially with.
Speaker 2 (08:51):
Trauma, and so you see patients all ages. So I
hope everybody's listening. We're going to take a quick break.
We're talking with Shelby Schroder tonight about neurologic physical therapy, dizzyness,
balance and all the important things that go along with it.
You are listening to Senate on Health with Baptist Health
here on news radio eight forty whas.
Speaker 3 (09:14):
I'm your host, doctor Jeff Tublin.
Speaker 2 (09:15):
Our phone number five oh two, five seven one, eight
four eighty four. Our producer Jim Ben is on call
to take your calls to ask about any of these issues.
Speaker 3 (09:24):
We'll be right back.
Speaker 2 (09:37):
Welcome back to Senate on Health with Baptist Health here
on news radio eight forty whas. I'm your host, doctor
Jeff Tublin, and we're talking tonight with Shelby Schroder, who
is a neurologic physical therapist with the Baptist System. She's
talking to us tonight about dizzyness and balance and the
importance of maintaining these healthy things as we get older
and throughout our whole life. Our phone number is five
(09:59):
oh two, five seven one, eight four eighty four if
you want to call in and be a part of
this conversation. And Shelby, we did have a caller. I
think we dropped the call, but we did get the question.
So Jim had a question about something that he experiences. Jim,
I hope you're still listening that when he goes to
the grocery store, as an example, and he bends down
(10:21):
to look at something like maybe on the lower shelf
that he he'll get it, and then as he stands
back up, he starts to feel dizzy, and he was
wondering a what could that mean? And is there something
that he should be doing about that.
Speaker 1 (10:38):
That's a great question. I think it's a common thing.
So there's a couple of things that could be going
on and might require a little bit of investigation. So
when we've been down, sometimes we hold our breast, which
can lead to what we call a valves album maneuver
(10:59):
and can increase our blood pressure, and then when we
stand up, it drops our blood pressure all of a sudden.
Then we can get dizzy from that. So I would
encourage you, Jim, to reflect and think, you know, am
I holding my breath when I'm bending down? Am I
kind of groaning and holding my breath? And if so,
try to breathe through that movement and see if that
(11:21):
helps and decreases your dizziness and kind of slow down
how quick you're standing up if that doesn't fix it,
you could be experiencing something related to balance or inner
ear and people do sometimes it's a different scenario, but
get visually sensitive and have what we call supermarket syndrome
(11:43):
where they get really overwhelmed by all the visuals lie
in the supermarket. But it doesn't sound like that's necessarily
what's happening here.
Speaker 3 (11:52):
I mean, that's really the name of a syndrome.
Speaker 4 (11:56):
It really is.
Speaker 1 (11:56):
You have people that get in the overwhelming environment.
Speaker 4 (12:02):
They call it supermarket syndrome.
Speaker 2 (12:04):
Wow, that's a that's that's great. So Jim, I hope,
I hope that helps. And so Shelby, I want to
backtrack to something that you said, and I wanted to
maybe just you know, punch it just a little bit
because it sounded like an important point. You talked a
little bit about a vicious cycle. What did you mean
by that with in terms of avoidance?
Speaker 1 (12:28):
Right, so we all know somebody who has kind of
slowed down because they've gotten fearful of doing certain things.
Maybe maybe they had a fall and then they decided
they were never gonna do anything that could lead to
them falling again. And so that leads to not challenging
(12:51):
your body as much getting weaker. The muscles get weaker,
and you're not challenging your balance systems, and so they're
getting less reactive, less able to prevent you from having
a fall. You're not walking as much, not moving as much,
So the fear leads to avoidance, which then leads to deconditioning,
(13:13):
and then you're more and more likely to fall the
longer this goes on.
Speaker 2 (13:20):
So let's jump into to balance a little bit and
get into a little bit of the details of some
of the causes of it. So, what are the biggest
things in your practice that you see that can affect
somebody's balance.
Speaker 1 (13:34):
Well, Peripheral neuropathy can be really challenging. That one is
pretty common. And so when you lose sensation on the
bottom of your feet and you can't really feel what
your fear doing necessarily without looking at them, that you
might be a little bit more difficult to walk on
(13:54):
uneven surfaces, go up and downstairs, you're going to rely
more heavily on your vision for your balance than you
would if you had good sensation in your feet. So
if you're in a dark environment, a low lit environment,
it's going to be much more difficult to walk, and
in those scenarios, it's really important to get on a
(14:16):
good balance program to protect the balance that you have
and strengthen the systems that you still have, like your
vestibular system, your inner ear, in order to maintain your
balance over time.
Speaker 2 (14:29):
So the periperal neuropathy can be something that's isolated and
also I think is pretty common in patients with diabetes.
Are there other medical conditions that lead to balance issues?
Speaker 1 (14:42):
Certainly so, any history of stroke, Parkinson's disease, multiple sclerosis,
any sort of neurologic disorder can affect your balance over time.
Speaker 2 (14:58):
And then what about you talked a little bit about
the vision can also cause is you what are the
most common things that you see that affect vision that
then affect dizziness and balance.
Speaker 1 (15:12):
So if you have any sort of low vision, that
can affect your balance because you're not able to rely
on your vision system to support you. So we have
three systems that work together to support our balance. Our
vision and then the sensation on the bottom of our feet,
(15:32):
and then our vestibular system. So they all work together
and give feedback to the brain and the body, and
they all work together to keep us balanced. And so
if one of those systems is lacking, then you're relying
more heavily on the other two.
Speaker 2 (15:49):
Do you find that when people are coming to you,
there's already one of those three that is obviously the problem,
or do you find you are the one or your
colleagues are the one sort of figuring out which of
those the three things are causing the problem.
Speaker 1 (16:06):
The people that are falling, it's often a combination problem.
You know, they they have a vestibular problem on top.
Like let's say someone with no other issues, like they
don't have any problem with the sensation on their feet
or their vision, they get an acute.
Speaker 4 (16:25):
Vestibular disorder like you did.
Speaker 1 (16:27):
You said you got vestibular neuritis.
Speaker 3 (16:29):
I did.
Speaker 1 (16:30):
If you don't have any of those other issues, if
you don't have issues with the feeling on the bottom
of your feet, if you don't.
Speaker 4 (16:38):
Have visual issues, you.
Speaker 1 (16:39):
Might be able to somewhat compensate and you might not
be falling. You know, you can navigate it. But let's
say somebody also has a visual deficit or they also
don't have sensation on the bottom of their feet. Those
people end up in the hospital because they're falling.
Speaker 2 (16:56):
And you've used the term vestibular system a couple bull
of times, and I know we talked about that being
the inner ear.
Speaker 3 (17:04):
What's in there?
Speaker 2 (17:05):
What's the vestibular system and how does it lead to dizzyness?
Speaker 1 (17:10):
Yeah, so the vestibular system, it's the inner ear that
it's very tiny. The inner ear itself can fit on
a dime. It's very small, but it does a lot
for our body. It communicates with the brain about where
our head is in space, and so it really helps
with our equilibrium and knowing where we are in space
(17:34):
and being able to react to what our head and
body movements are doing. And so if we don't if
we're not getting that information correctly, if it's not transmitting,
if there's a problem with the inner ear. So the
inner ear, we have one on each side and so
it's what we call like a push pull, so that
(17:58):
one thing is happening on the other side and opposite
thing is happening on the other side. So if we
get a mismatch or something wrong with one inner ear,
that's why all of a sudden we think the room
is spinning, because there's not that push and pull relationship
between the two sides. If we lose input from one side.
Then our brain gets really confused about what's happening.
Speaker 3 (18:21):
Oh, that's really interesting.
Speaker 2 (18:22):
So that's what leads that inconsistency of push and pull
is what leads us act to actually have that sense
of the spinning.
Speaker 3 (18:29):
It's because they're not balancing each other. That's fascinating.
Speaker 2 (18:34):
So I would imagine, you know, one of the things
we talk about this with multiple conditions, but we're all
on so many medications these days, and I would imagine
that medications can cause side effects, which we know that
they do. And do you see that as we get
older and we're on multiple medications, does this problem get worse?
Speaker 4 (18:57):
It does?
Speaker 1 (18:58):
It gets more difficult to kind of parse out what
exactly is happening.
Speaker 4 (19:04):
Too.
Speaker 1 (19:04):
If we're on three different medications that might cause dizziness,
then yeah, there's it becomes more difficult to fix and
to manage.
Speaker 2 (19:17):
Are there any in particular that you see that cause
dizziness a lot? Or is it just that can be
with any medication over the counter prescription everything is spare gain.
Speaker 1 (19:29):
I'd say there's a large mix of drugs that can
cause dizziness. But one thing that we don't always think
about is anybody who's been on certain chemotherapy medications that
can attack the peripheral nerves, and so we can get
chemo induced peripheral neuropathy, which can be a disabling side
(19:53):
effect of chemotherapy and lead to balance issues and people
who have undergone chemotherapy. So that's one that we see
a lot.
Speaker 2 (20:02):
And do you do you find that patients that are
coming to you. Is it are they being brought in
by a family member who's saying, you know what, my
mom or my dad or my relative, they seem to
be falling too much? Or is this something that's sort
of recognized internally by the patient saying this something's wrong.
Speaker 3 (20:21):
I need to go get seen.
Speaker 1 (20:24):
Mm hm. So if we're talking specifically about inner ear
problems like BBBV for example, being the most common, the
benign peroxysmal positional vertigo where the crystals and the inner
ear get out of place, that one can go undiagnosed
and unnoticed for a long time. Some people go years
(20:45):
and they don't get the proper diagnosis because a lot
of times they're given maclasine and like sent home.
Speaker 3 (20:52):
Just for symptom relief. You're saying, just for.
Speaker 1 (20:55):
Symptom relief, and then the issue itself is not addressed
because maybe the provider or that they've they've found, they're
not familiar with the treatment or how effective it is,
or they don't know how to do the test to
identify the problem, or they don't know who to refer
the patient to.
Speaker 4 (21:12):
And so that.
Speaker 1 (21:14):
One well, dizzyness in general, it can take, it can
be expensive, and it can take while a lot of
times people get a lot of unnecessary medical testing when
they have BPPV to rule out things like cardiac issues
or stroke when it was just a simple inner ear problem.
So in that case, people are generally pretty happy by
(21:34):
the time they make it to a physical therapist who
identifies what the problem is. But as far as balance issues,
you know, a lot of times when I'm seeing people
in the hospital, it's because they've had a fall. But
on an outpatient basis, I think people make it to
an outpatient clinic for balance issues a lot of times
(21:56):
I think their primary care provider is advocating that in
that scenario.
Speaker 2 (22:01):
And I'm glad you brought up the cost of all
of the testing, because that is a big deal that
you know, somebody like such as yourself could have identified
maybe a little bit earlier on and even a lot
less expensively. So we're going to talk about what you
do in the office to find those things out when
we come back. So we're going to take another break
right here. I want to remind everybody that you are
(22:21):
listening to senat on Health with Baptist Health here on
news radio eight forty WAHS. I'm your host, doctor Jeff Tubbin.
We're talking to Shelby Schroeder tonight about neurologic physical therapy.
Speaker 3 (22:33):
We'll be right back.
Speaker 2 (22:47):
Welcome back to cenate on Health with Baptist Health here
on news radio eight forty WATS. I'm your host, doctor
Jeff Tubblin. And if you're just joining us or tuning in,
we're talking tonight with Shelby Schroder, who's a neural logic
physical therapist with the Baptist Hospital System and she's been
educating us, doing a great job of us understanding what
(23:08):
these conditions are.
Speaker 3 (23:09):
And now we're going to.
Speaker 2 (23:10):
Talk to her a little bit about what she does
on a day to day basis or her colleagues in
the office. I know she does a lot in the
hospital itself, but Shelby, we're all familiar with the idea
of rehab right we go, we have some kind of injury,
or we have a surgery or a procedure, we need
rehab for it. But rehab is important for this type
(23:31):
of issue too. So talk to us about what rehab
is like for these conditions.
Speaker 1 (23:38):
Okay, So if someone has BBPV where the crystals are
out of place in the inner ear, the rehab involves
doing a series of head positions to get the crystals.
Speaker 4 (23:50):
Back where they go.
Speaker 1 (23:51):
There is about a ninety two percent success rate doing
these maneuvers, so meaning that the crystal go back where
they're supposed to be and the symptoms resolve without any
in a lot of cases, without any additional issues. And
that might take up to up to five maneuvers, usually
(24:17):
anywhere from one to three, but in some.
Speaker 4 (24:19):
Cases up to five. So that can be a really
quick fix.
Speaker 1 (24:24):
Most people don't have balance and dizziness problems after we
get that resolved, but some people do, and then we
would have to stay in therapy and do potentially what
we call either adaptation therapy, which so we have a
(24:45):
connection between the eyes and the inner ear. It's called
the vestibular ocular reflex, and that gets impaired in people
that have vestibular problems sometimes and that makes it hard
to stay the lives of your gaze, meaning to keep
your eyes still while your head moves, and that can
make us really dizzy whenever we're moving, and it can.
Speaker 4 (25:08):
Make us off balanced.
Speaker 1 (25:09):
So we do exercises to help the patient get that
reflex back to keep their eyes stable while they're head moves.
So that's called adaptation. And then we also and people
that need it and people that are just really dizzy,
and we need to habituate their dizziness. We have to
(25:30):
retrain the brain to not get so dizzy when they
do certain things. And unfortunately, the way that we have
to do that is start with things that make people
just a little bit dizzy and do those things over
and over again until they don't make them dizzy anymore.
And then we do something that used to be a
little bit harder, and we do that over and over
again until they're not dizzy anymore. And that's called habituation,
(25:53):
and we really tailor that to the person and what
they're having problems with. So those are a couple of
things that we do and dealer rehab other than balance training.
Speaker 2 (26:02):
Yeah, it sounds like exposure therapy, right, like you you're
kind of training them, and I think you mentioned this,
but what's the success rate of these of these maneuvers
and your programs?
Speaker 1 (26:17):
So for the series of head positions that you do,
it's commonly referred to as the eply maneuver, but there's
a lot of variations of that, depending on which canal
is involved and.
Speaker 4 (26:31):
Where the crystals are. But this success rate is.
Speaker 3 (26:36):
For that in particular, that's great. Oh, that's a that's
a high percentage. That's great.
Speaker 2 (26:42):
So I like for when we're talking about these things,
you know, our listeners sometimes have to decide like, hey,
is this something I should talk to my primary care about?
Or can this wait till Monday? Or you know, is
this something that's kind of a little more urgent. So
when should a pace and be thinking maybe this is
a little bit more serious than just waiting it out.
(27:04):
When should somebody think about going to like an emergency
room or an urgent care if they're having certain types
of dizziness or balance episodes.
Speaker 1 (27:14):
Yeah, this is a great thing to talk about because
we don't want somebody that's dizzy to wait and not
get care. When it was something more serious than an
inner ear problem. So the brain can also cause balance
issues and inner ear issues. So if there's anything that
is potentially resembling a stroke, then we want people to
(27:35):
go to the emergency department as soon as possible because
time is brain, and we don't want to delay going
to the emergency department because you can get care and
more care the quicker.
Speaker 4 (27:46):
You get to the emergency department.
Speaker 1 (27:48):
So if they're starting to fall, if they're experiencing all
of a sudden new onset, balance problems, if the dizziness
is severe and unrelenting, you want a new oncet. If
it's associated with any sort of confusion or weakness, you know,
(28:11):
especially one sided weakness, slurred speech, anything like that, you
want to get or lots of sensation that would not
be an inner ear problem, and you want to get
to the emergency department quickly for those things.
Speaker 4 (28:25):
Also, if it's associated.
Speaker 1 (28:27):
With a high heart rate or your blood pressure is
high or low, you definitely want to go to the
emergency department for that as well.
Speaker 3 (28:35):
That's great advice.
Speaker 2 (28:37):
Kind of on the other end of the spectrum, when
it's not super serious, you know, we're all exposed to
lots of information, right, data overload from commercials and TikTok
and social media about this vitamin or that vitamin or
different things that can help with things are Is there
any role for supplements or vitamins in any of these conditions.
Speaker 1 (29:03):
Yeah, So there's been studies on prevention of the nign
paroxysmal positional vertigo BPPV, So that particular condition. The crystals
in the inner ear, we all have them. They're teeny tiny.
They they're the width of a spider web strand, and
they're usually clumped together in the inner ear and they're
(29:25):
made up of calcium carbonate. So if you have low
calcium or vitamin D, you're more likely for those crystals
to fragment and break off and fall out of the
inner ear where they're supposed to be, which can lead
to recurrent episodes of vertigo, room spinning, dizziness that you
have to keep going back to an E and.
Speaker 4 (29:43):
T or a physical therapist to address.
Speaker 1 (29:46):
So in those cases, there have been studies done to
see does vitamin D and calcium supplementation improve you know,
outcomes in these people and D increase recurrence a BPPV,
And it actually does, but it is recommended that you
only do this under the supervision of your primary care provider.
Speaker 3 (30:09):
Yeah, that's good.
Speaker 2 (30:10):
That's great to know because you know that people would
would like to know these things about what they might
be able to do, because sometimes just not feeling like
you can control anything can be very frustrating. You are
listening to Senate on Health with Baptist Health here on
news Radio eight forty whas. We're going to take a
final break here, and our guest tonight is Shelby Schroeder,
(30:31):
who's talking to us about good health with neurologic, physical therapy,
balance gate and dizzyness. Remember to download the iHeartRadio app
and we will see you after these commercials. I want
(30:58):
to welcome everyone back to Center on Help with Baptists
Help here on news radio eight forty whas. I'm your host,
doctor Jeff Tublin, and we're talking tonight to Shelby Schroeder
about neurologic physical therapy and all the benefits of that.
Remember to download the iHeartRadio app and re listen to
this or any of our previous segments, and also to
have access to all the other features that the app
(31:20):
has to offer. So Shelby, I'm introducing a new segment
of my show tonight that I want to call appropriately hyped,
under hyped, or overhyped.
Speaker 3 (31:30):
And I want to ask your.
Speaker 2 (31:31):
Opinion about taichi, tai chi and yoga is where where
does that fit in that new category? Is it overhyped
to help with this balanced stuff, under hyped or appropriately hyped?
Speaker 1 (31:46):
I would say very appropriately hyped. And how lucky it
me to get to be the first one to comment.
Speaker 2 (31:52):
On a new segment that I just just invented.
Speaker 4 (31:59):
I love it.
Speaker 1 (32:00):
Yeah, I think so yoga and tai te are very
good balance exercises.
Speaker 4 (32:07):
Well, they are.
Speaker 1 (32:08):
Focusing on the core. His core strength is very important
for balance, reactive movements and you know strength in general
being in different positions.
Speaker 4 (32:20):
I think they're.
Speaker 2 (32:21):
Great exercises, fantastic so segment one of that new part
of the show. So one of the things, one of
the things I think about is and you know, for
those of us at a certain age, we probably remember these
commercials of the I've fallen and I can't get up
commercials and life alerts and things like that.
Speaker 3 (32:40):
But it's a serious it's a serious issue.
Speaker 2 (32:43):
For those who might live alone or might not have
a family member. What things are out there, or what
do you recommend while you're working with someone that might
protect them in these situations.
Speaker 4 (32:58):
If they have a.
Speaker 1 (33:01):
Well, I think being able to get up off the floor,
maintaining the ability to independently get onto and off of
the floor is what's going to protect them. The longer
that someone lays on the floor after they fall, the
more likely they are to have a flurry of health
conditions after the fall and end up staying in the
hospital longer.
Speaker 2 (33:22):
And are you assessing that risk when you're seeing them
in your program?
Speaker 1 (33:30):
So, yes, we do a series of balanced tests that
assesses their falls risk and then an outpatient physical therapist
would also be talking about the ability to get on
and off the floor.
Speaker 2 (33:44):
Great, okay, So it's affected a lot of things. COVID
has affected many different conditions. We talk about its effect
on things and lots of episodes of this show. So
is it something that affects what we're talking about tonight?
Did COVID affect people's balance and dizziness and things like that.
Speaker 1 (34:07):
In every sense of the way. Yes, So COVID can.
Because of inflammation that it can cause to the sinuses
and the inner ear. You can have an increased incidence
of BPPV. Of the crystals being out of place, you
can have an increased incidence of neritis. So the nerve
(34:27):
viruses are what causes and triggers vestibular neritis, where the
nerve to the inner ear gets inflamed like you have.
It can also increase medical causes of dizziness like tachycardia
and hypotension. So there are so many ways that COVID
(34:48):
can make people dizzy and hat and I've seen all
of those in the hospital.
Speaker 2 (34:52):
So definitely had an impact on what you're seeing, just
like so many other of us saw things in our specialties.
What about We hear a lot about kids in terms
of concussions, and I've done shows about sports injuries and
things like that, But what about an older adults. Do
you see concussions as a problem and how is that handled?
Speaker 1 (35:19):
I do see it as a problem, and I think
it's under diagnosed and underdiscussed. In the hospital. People come
into the hospital after a fall and we're imaging their
head and we're imaging their hips, and you know, we're
imaging their shoulder wherever they're having pain, and we're saying, okay,
you know you didn't have a hemorrhage and you don't
have a fracture, or you do have a fracture, but
(35:40):
we're not really talking as much about the effects of concussion.
We address the really emergent medical needs, but that one
kind of gets swept under the rug a little bit
or just not even talked about. And so I tried
to be really cognitive that and talk to people about,
you know, did you hit your head when you fall
(36:01):
when you fell, are you experiencing any sort of mental fogginess,
Are you having visual strain or are you having a headache?
Are you noticing any mood or personality changes, are you
having any sleep disturbance? What about your neck? Because your
neck is actually more prone to getting you know, next
(36:22):
strain than you are to getting a concussion. So everybody
that has a concussion also has some sort of next strain,
So we need to talk about the neck as well,
which is another reason to see a physical therapist. So
I think it's important to you know, after we rule
out those really emergent needs, we also need to be
thinking about concussion because it can become prolonged if you're
(36:44):
not getting the proper care and if you push through
it and you don't get it addressed, it's only gonna
laugh longer.
Speaker 2 (36:53):
And what about migrains people, that's a very common condition.
Speaker 3 (36:58):
Also.
Speaker 2 (36:59):
Do you see the relationship between migraines and dizziness that's
treating the migraines make the dizziness go away or is
it you do you still need this kind of rehab
for the dizziness for migraines.
Speaker 1 (37:13):
So there's a subset of migraine called vestibular migraine that
there's some misconception that migraine has to have pain associated
with it, but it doesn't. We can and that's why
these vestibular migraines are tricky because some people don't get
any pain with them. They might have light sensitivity but
not headache, and they can cause vertigo, bouts of vertigo
(37:36):
and room spending, dizziness and difficulty tolerating any sort of
visual stimuli. And so yes, these people need a combination
of conservative care of managing their migraine triggers and vestibular
rehab and medical management.
Speaker 4 (37:54):
It's about fifty to fifty.
Speaker 2 (37:57):
Well, once again, having vertigo is certainly no fun. So
I hope that everybody that is listening to this really
can appreciate the value of what you are doing out
there on the inpatient side and what your colleagues are
doing on.
Speaker 3 (38:10):
The outpatient side.
Speaker 2 (38:11):
Shelby, I want to thank you so much for joining
us again tonight.
Speaker 3 (38:15):
We always learn so much when you come on, and.
Speaker 2 (38:18):
That is going to be for this segment of Centered
on Health with Baptist Health. I'm your host, doctor Jeff Tublin.
I want to thank our guest Jim who called in
with a question, and our producer mister Jim Benn, and
of course the listener and our guests Shelby Schroeder. Listen
and join us every Thursday night for another segment. I
hope everybody has a good, happy, and healthy rest of
the week and weekend. We'll talk to you next week.
Speaker 1 (39:00):
This program is for informational purposes only and should not
be relied upon as medical advice.
Speaker 2 (39:04):
The content of this program is not intended to be
a substitute for professional medical advice, diagnosis, or treatment.
Speaker 1 (39:11):
This show is not designed to replace the physician's medical
assessment and medical judgment. Always seek the advice of your
physician with any questions or concerns you may have related
to your personal health or regarding specific medical conditions. To
find a Baptist health provider, please visit baptistealth dot com
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