February 19, 2001
New center puts
on even keel
By Janet Christenberry
Dizziness and imbalance can be more than simple inconveniences. They
can severely restrict movement, affect day-to-day functioning and cause
falls, which can have severely debilitating consequences. The new Center
for Balance and Dizziness (CDB), based in the Center for Rehabilitation
Medicine, offers state-of-the-art technology and treatment for these problems.
Neurologist Ronald Tusa, director of the Emory center, has worked in
the field for more than 20 years. With proper diagnosis, according to
Tusa, almost all patients can experience relief. Dizziness is a
very broad area and is due to a lot of common diseases, Tusa said.
We advocate that, no matter what the cause is, it can be treated.
Tusa holds joint appointments in neurology, ophthalmology and otolaryngology,
and is the founder and former director of the University of Miamis
Dizziness and Eye Movement Center. Earlier, he spent 13 years at Johns
Hopkins University, where he began his research in vision and eye movement.
He is the author of two books and numerous chapters and articles for professional
journals concerning movement disorders and disorders of the eyes and ears.
Dizziness can affect any age group from babies to the elderly, Tusa explained.
It may come from a variety of causes such as eye movement disorders, diseases
of the inner ear and migraines. Accurate diagnosis of the root cause of
the dizziness is key to effective treatment.
Treatment varies according to the diagnosis. For example, one of the
most common diagnoses of the condition called vertigo, or spinning,
is benign paroxysmal positional vertigo (BPPV). The condition occurs when
crystals that form in the inner ear break free over time or due to head
trauma. As they float, certain head movements will then induce vertigo.
If a patient has been diagnosed with BPPV, he or she can be treated in
the office, often with immediate results. Other causes of vertigo include
disruptions of the balance center in the inner ear due to
a variety of causes, including Menieres Disease, viral infections
or side effects of certain antibiotics.
Dizziness and balance problems are often misdiagnosed or overlooked entirely
by doctors, Tusa said. Patients are sometimes told they must simply live
with the condition or are prescribed medications which may not be effective.
Rather than be put on medication, CDB patients are more often treated
with a customized program of physical therapy and, if needed, diet and
lifestyle modifications. The program has three physical therapists on
staff who work only with patients with dizziness and imbalance. One of
these therapists, Susan Herdman, is the author of the nations most
utilized textbook on vestibular rehabilitation. Physical therapy plays
a key role in treatment.
In the case of balance disorders, which often affect the elderly, the
cause may turn out to be disuse or disequilibrium, Tusa said.
As we get older, muscles atrophy; we develop arthritis; our range
of motion diminishes, he said. People often develop a fear
of falling. They then become more sedentary. Its a vicious cycle.
With an exam, testing and then physical therapy, we can usually turn this
around in about a month, primarily with a home therapy program.
The new center is focusing on a three-pronged program: patient care; research devoted toward improving the ability to diagnose and treat patients; and education of physicians and the general public about the causes and effective treatments for problems with dizziness and balance.