The Consultation
Dizziness is very common. It is accepted that up to one third of all adults may become dizzy at some time, and this figure increases as we become older. In the over-75's age group, dizziness is the most common reason to see your GP. It is often extremely distressing and greatly affects your quality of life. An early identification of the balance problem is key to successful and efficient balance rehabilitation.
Our sophisticated consultation structure is patient-friendly and customised to every individual. We use the latest state-of-the-art equipment that enables us to collect accurate information about the function of the balance system, and produce real-time comprehensive reports.
The consultation takes just 30 minutes, and the cost ranges between £250 to £450 per test.
Case History
This is a crucial part of our consultation. We use a sophisticated dizziness and medical history questionnaire which enables us to collect and analyse information about the dizziness symptoms, and their effect on patient’s quality of life. Because dizziness can be a symptom of a variety of health disorders, the questionnaire allows us to understand the underlying cause.
The most common causes of dizziness are peripheral disorders – those that affect the vestibular structures of the inner ear.
Learn more about the symptoms and causes.
Dizziness can also be caused by disorders of the central nervous system (CNS) and the brain, which can result from disease or trauma. It can also be caused by cardio-vascular problems, exposure to toxic drugs and chemicals or even allergies.
We collect specific information about the onset and duration of symptoms, their characteristics (vertigo, nausea), frequency of attacks and other associated symptoms (hearing, neurological). The more accurate patients are in describing their symptoms, the easier it is to identify the underlying cause.
Eye movement Examination
The movement of the eyes is very important in the balance mechanism. The nerves going to the eye muscles are activated by structures known as the eye nerve nuclei within the brain stem. These nuclei are very closely opposed to the balance mechanism nuclei within the brain stem. There are a lot of connections and pathways between the eye muscle nuclei and the balance mechanism.
A close examination of the eye movements allows us to identify or exclude any pathological traces in the eye movements such as nystagmus or saccades, which could indicate a problem with the balance system.
It is a short and patient-friendly exam - a set of light goggles with in-built cameras are placed on patient’s head. Patient is asked to follow a series of visual targets in different positions with their eyes. The eye movements are recorded by the in-built cameras and later analysed for abnormal traces.
Dynamic Positioning Tests
These tests include a series of exercises that involve a change in body and head positions. They are very effective in identifying the most common cause of dizziness – the Benign Paroxymal Positional Vertigo (BPPV). The aim of these tests is to identify which semi-circular canal has the dislodged “calcium crystals” in it.
Firstly, patients are asked sit up-right on the examination couch. They are then asked to lie down, while turning their head to one side. After 45-60 seconds, patients are asked to sit-up and maintain position for another 10 seconds. The whole procedure is repeated again while turning the head to the opposite side.
Patients will usually experience symptoms (vertigo, dizziness) when moved in the position relevant to the affected semi-circular canal. An accurate identification of BPPV is crucial to the successful vestibular rehabilitation therapy (VRT).
Head Impulse Test
The movement of the eyes is very important in the balance mechanism. The brain constantly receives signals from the whole of the vestibular system, including the semi-circular canals in the inner ear, and the eyes. If one, or more of these canals get affected, there will be a mismatch between its signals to the brain and the consequent eye movements – vestibulo-ocular reflex. Learn more about why we get dizzy.
Head Impulse Test provides an easy, patient-friendly method to detect a deficiency of the VOR and identify the individual semi-circular canals that have been affected by a disease or disorder.
A set of light goggles with in-built cameras are placed on patient’s head. The goggles are calibrated to achieve maximum accuracy of the test results. The patient is asked to relax – no action is required from them. The examiner then holds patient’s head and performs a series of brief, rapid head movements. The eye-movements resulting from the change in head position are recorded in 3-D format and analysed by a computer, to identify the affected canal. There is absolutely no discomfort during or after the test, even if patients have arthritis, neck or shoulder pain.
The whole test takes no longer than 10 minutes, and can be performed at many stages to monitor the effects of rehabilitation. The state-of-the-art equipment enables us to produce a comprehensive, easy-to-understand report in real-time.
Balance Platform
Almost all balance disorders will cause symptoms of unsteadiness and postural instability, which may lead to problems with gait (walking) and an increased prevalence of falls. This is especially important in elderly population, where the likelihood of falls due to dizziness and disequilibrium is greatest. It is one of the most reported complaints to GPs, and poses a real danger to the elderly person.
The balance platform evaluates person’s postural stability. It is used to identify and confirm abnormalities in posture caused by disorders of the vestibular system. It can pick up the smallest degree of abnormal sway, instability and likelihood of falls. It is also used as a rehabilitation tool, able to monitor the progress of the vestibular rehabilitation therapy.
Patients are asked to stand on the platform with their feet. Sophisticated software generates a series of visual stimuli on the screen, and begins to interact with the patient. All patient movements are collected and analysed by the software, allowing the examiner to determine the amount of postural sway (if any).
The balance platform is not limited to the diagnosis and rehabilitation of people with balance problems. It is also useful for people wanting to improve their general balance, increase confidence and quality of life. This may be very important to established athletes and those thinking of choosing a career in sports or dance.
Report
Following the tests, we will explain the results and findings in a clear and patient-friendly manner. We will also discuss an option of vestibular rehabilitation therapy (VRT), and will make an appointment to see our Specialist Balance Physiotherapist. A full written report will also be sent to patient’s GP, informing them of the findings and thus enabling continuity and integrity of care.