Feeling Off-Balance? Consider Vestibular Physical Therapy at Shore Medical Center

Most of us don't think about our balance until something feels wrong. Dizziness, vertigo, or a sense of unsteadiness can quickly disrupt daily life. According to Clare Honick, DPT, Shore Medical Center's outpatient physical therapist who specializes in vestibular therapy, these symptoms often point to an issue within one of the body's most complex and fascinating systems: the vestibular system.

Vestibular disorders generally fall into two categories: peripheral and central. Peripheral vestibular disorders involve the inner ear or the vestibulocochlear nerve, which carries balance information to the brain. Central vestibular disorders affect the areas of the brain that process and respond to that information. Identifying which system is involved is a critical first step in guiding treatment.

"The vestibular system is incredibly powerful," Clare explains. "It works with your eyes, your inner ears, and your muscles and joints to tell your brain where you are in space and how to stay upright. When something is off, even simple movements can feel disorienting."

The Inner Ear: Where Balance Begins
The peripheral vestibular system lives deep inside the inner ear, in a space no larger than a dime. Three semi-circular canals in each inner ear detect angular acceleration and rotational movements of the head, such as nodding, turning, and tilting. The utricle and the saccule detect position sense relative to gravity and linear acceleration, like riding in a car or an elevator.

This information travels through the vestibulocochlear nerve to the brain, which responds by coordinating gaze stabilization, postural stability and balance, functions essential for safe movement and everyday activities.

Symptoms of Vestibular Disorders
When the vestibular system is not functioning properly, symptoms can vary widely. Some patients experience vertigo, described as a spinning, swaying, or floating sensation. Others report dizziness, lightheadedness, wooziness, or a general feeling of being off balance.

Additional symptoms may include instability of vision, ringing in the ears, brain fog, difficulty walking, or a fear of falling, often making routine activities challenging and exhausting.

How Vestibular Physical Therapy Helps
Patients referred to vestibular therapy at Shore may have conditions such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, vestibular labyrinthitis, vestibular migraine, cervicogenic dizziness, persistent postural perceptual dizziness, Meniere's disease, motion sensitivity, concussion, or stroke. Referrals typically come from primary care providers, ENT specialists, neurologists, and other physical therapists.

Each evaluation begins with a detailed conversation. "I ask about what brings symptoms on, how long they last, how intense they are, what triggers them, and whether there are other issues like headaches, hearing changes, or neck pain," Clare says. She also reviews medical and vestibular history.

A comprehensive assessment follows, including posture, joint and neck mobility, balance, strength, gait, vestibular positional testing, and evaluation of visual and vestibular pathways.

Based on these findings, Clare develops an individualized plan of care in collaboration with the patient. Treatment may include balance and posture training, gaze stabilization exercises, coordination exercises, vestibular repositioning maneuvers, habituation exercises, gait training, stretching, strengthening, and education on a home exercise program.

Advanced Assessment with Video Goggles
Certain eye movements can occur with both peripheral and central vestibular disorders. For example, nystagmus (or involuntary eye movement) in a characteristic pattern may present if a patient has benign paroxysmal positional vertigo (BPPV). In turn, that pattern may be indicative of what type of treatment the patient needs.

While some eye movements are visible in normal lighting, others are best detected in darkness using infrared video goggles. Clare may use Vestibular First Infrared Goggles to block out visual distractions and view eye movements on a computer screen in real time to identify and treat vestibular disorders.

"The goggles allow me to see things that might otherwise be missed," she explains. "Sometimes they reveal signs that suggest a different vestibular or neurological condition, which helps determine if a patient needs further medical evaluation. That's important for providing safe, appropriate care."

Restoring Confidence, One Step at a Time
"Some patients feel better in just a few visits," Clare says. "Others need more time. But the goal is always the same: to help people feel more steady, safe, and confident in their movement."

Through specialized training in vestibular physical therapy, careful assessment, and advanced tools like infrared goggles, Clare helps patients at Shore Medical Center regain balance, confidence, and independence, one step at a time.

Clare Honick, DPT, practices at the Shore Center for Outpatient Rehabilitation, located on the first floor at 710 Centre Street in Somers Point, directly across from Shore Medical Center. To schedule an appointment for outpatient vestibular therapy, please call 609-653-3512. Learn more about outpatient rehabilitation services at Shore.