Maintaining Balance with Vestibular Therapy

When Aspen Valley Hospital hired vestibular therapist Kelsey Sanders, PT, DPT in 2022, it filled a missing piece of the puzzle for the Rehabilitation Services department.

Kelsey’s skills were put to use right away in the Traumatic Brain Injury (TBI) program, working with other therapists to support brain injury patients in their recovery. As she has settled into her role as the Hospital’s full-time vestibular therapist, Kelsey has made all the difference in the world for patients with TBI and other vestibular conditions, including dizziness, vertigo, nausea, gaze instability, imbalance and other related symptoms.

“There is a huge need for vestibular therapy in the valley, and my schedule is quite full,” she says. “Nevertheless, I make it a priority to see people experiencing vertigo for the first time as quickly as possible, which is usually possible within a few days.”

The Vestibular System — It’s Complicated

“Good balance is a vital function in our wellbeing that is often taken for granted until it’s not working well,” Kelsey says. “Our vestibular system provides sensory information to detect head position, motion, equilibrium and spatial orientation via the vestibular apparatus located in the inner ear.”

The human balance system — the vestibular system — allows people to respond appropriately to constant environmental challenges to their balance and stability. It relies on a coordinated and complex set of sensorimotor-control systems that includes the inner ear, vision and input from muscles and joints that generate information which is integrated through our brain stem. This coordinated integration is vital to everyday activities like walking down the street and more athletic endeavors like skiing.

If the system is damaged, balance, control of eye movements when the head is moving, and sense of orientation in space are all adversely affected.

A vestibular therapist is a physical therapist whose specialty is the inner ear apparatus, which is at the heart of the vestibular system. Vestibular therapy uses customized, comprehensive exercise-based programs to alleviate conditions such as vertigo and dizziness, and visual motion sensitivities and imbalance, which can lead people to fall and injure themselves further. 

Vestibular impairments sometimes have obvious presentations or can be more difficult to recognize. They can develop quickly, or over a longer period of time. The most common causes are viruses, head injuries, aging, other illnesses, environmental factors and genetics.

“Vestibular therapy requires a lot of curiosity and then the knowledge to fit the puzzle pieces together for each patient,” Kelsey says.

Solving the Puzzle — A Patient’s Description

In the 20 months Kelsey has been working at AVH, vestibular therapy has been fully integrated into the Rehabilitation Services department and at the Hospital. She regularly receives referrals from providers — primary care physicians, ENT specialists and other therapists — who have identified vestibular challenges with their patients.

No doubt some of Kelsey’s patients have learned about the vestibular therapy program through word of mouth recommendations from other patients.

Katherine, a patient of Kelsey’s, experienced dizziness that was misdiagnosed for years before she scheduled an appointment with Kelsey. Katherine was particularly struck by Kelsey’s quest to fully understand what she was experiencing and what was triggering her episodes.

“In our first session Kelsey asked the right questions, did the proper maneuvers and determined I had BPPV (Benign Paroxysmal Positional Vertigo) in several canals,” Katherine wrote in an email. “As my vestibular specialist, she educates me about the many contributing factors of dizziness, and understands and is supportive of any psychological issues. The physical therapy exercises have improved my balance, and as ‘flares’ come up, I have confidence she will know what to do.”

A Personal Approach

For cases like Katherine’s vertigo, Kelsey begins by asking her patients to describe their symptoms and the events and circumstances that typically trigger those symptoms. That information informs her follow-up questions, which, along with the use of Frenzel lenses to gauge and record eye movements, helps Kelsey make the proper diagnosis and develop a treatment plan.

“We’ve definitely evolved our treatment for vertigo in recent years, along with our understanding that the causes and extent of BPPV can be way more complex than previously believed,” Kelsey says. “It usually takes more than one treatment session and more than one maneuver to resolve the symptoms.”

First sessions with Kelsey involve a lot of education so patients can understand their condition and what they can do about it. This helps them overcome the fear and anxiety that can result from vestibular disorders and more fully engage in their treatment.

Kelsey’s patients go home with an individualized home exercise program to specifically improve sensory integration based on their diagnosis and symptoms.

Seeing Kelsey

Kelsey sees patients in both Aspen and Basalt and splits her time between these locations each week. She can take appointments without a referral, but urges patients to comply with the referral policy of their health insurance provider.

Learn more about Rehabilitation Services and vestibular therapy. To schedule an appointment, please call 970.544.1177.