Connecting you to health information that is relevant
During my Physical Therapy training in Canada we were tasked with a research project where we furthered the current body of knowledge. Our first task was to review the literature. What did we already know? What has already been tested and evaluated? We had to know the research that had been done prior to presenting our idea to a board of PhD’s. If they were not satisfied then we had to go back to the drawing board and dig a little more. (We had to do more digging.)
"Background research – The first step, whether the innovator is within or without the medical community, is to familiarize oneself with existing research. Is the idea plausible, has it been investigated before, are there any similar treatments that can act as a guide to predicting how this new treatment will work?" - Steven Novella MD
Steven Novella does a great job on contrasting the foundation of medicine in the process of developing treatments over time to protect our patients from harm with pseudoscience. I would recommend reading his article in full as it challenges us as practitioners to provide a higher level of care for our patients.
Let’s get back to GyroStim. Where does this approach fall when looking at science versus pseudoscience?
GyroStim: Science or pseudoscience?
In our experience with patients that have undergone GyroStim treatments the first one to two treatments appear to be where the improvements occur.
If the dizziness is related to positional vertigo then the positive effect of GyroStim is the same as the Brandt-Daroff exercise. We already know that GyroStim will not treat vertigo related to BPPV. (See the post – Can Gyrostim treat vertigo related to BPPV?)
How a Brandt-Daroff or GyroStim treatment works to reduce dizziness for positional vertigo is in this way, you continue to create a negative sensation of dizziness and over time the brain attempts to re-route the neural input from the inner ear at the vestibular nuclei. Your brain attempts to ignore the vertigo by blocking the nerve impulses. This does not correct a positional vertigo issue but buries it, until the crystal shifts or moves. Then your spinning sensation returns.
"The Brandt-Daroff exercise is one of several exercises intended to speed up the compensation process and end the symptoms of vertigo. It often is prescribed for people who have benign paroxysmal positional vertigo (BPPV) and sometimes for labyrinthitis. These exercises will not cure these conditions. But over time they can reduce symptoms of vertigo." University of Michigan Medicine
Most positional vertigo problems will get less symptomatic in time. Compensation type exercises speed up this process without correcting the crystal displacement of fixing the underlying problem.
The question is this then, if GyroStim is basically a different form of vestibular rehabilitation how many visits are needed? I have a recent client that has had two 6 week series of GyroStim treatments over the last year (~24 sessions) and her doctor is requesting a third session of 12 visits. 'Third times the charm'? In her case it has not worked to change her symptoms of dizziness in the past. Why would you try a second let alone a third treatment?
Know what dizziness you have!
There are 3 systems that cause dizziness. Your vision or eyes, your inner ear or balance system, and your upper neck. Sometimes dizziness is a product of all of these systems having an issue. When this occurs diagnosis and treatment become very difficult. A combined effort of different professions is needed to help determine the cause of dizziness.
Injuries with GyroStim
There have been injuries with GyroStim where conditions have been made worse. The most common injury is the neck. Imagine if you will, going on a roller coaster, and after you are strapped into your seat you are handed a 10 pound bowling ball to hang onto while you ride. That is essentially what is happening in the GyroStim chair. Your head can weigh around 10 pounds. The forces of swinging it around can sprain or injure the facet joints in your neck.
‘Funny story’, I treated a 9 year old boy with headaches and dizziness following repeated roller coaster rides with his older brothers. When evaluated in our community the recommendation was to try GyroStim. He did not get better but worse. His mother was told that they were treating a positional vertigo problem. I cannot but wonder at the medical decision making that went into this diagnosis and treatment. An evaluation months later at the Mayo Clinic determined that this young man had an underlying condition of a Chiari Malformation. The roller coaster ride injured his neck and indirectly caused eye muscle trigger points and limited binocular vision. This was the cause of his dizziness. His Chiari Malformation had reduced his overall functional margin. Another ‘roller coaster’ was not the answer in this case.
Claims that the GyroStim can help with symptoms other than vertigo and balance, however, are not plausible. Existing evidence suggests that the benefits of these types of interventions do not extend beyond the tasks themselves. There is no global brain-training. Training in a task, for example, improves performance on the task, but not general performance. -SN
Here are my thoughts on GyroStim. Based on the clients I have treated that have undergone GyroStim treatment there are in some cases an immediate reduction in dizziness with improved vision. What the mechanism is I am not sure. This may be related to a vestibular rehabilitation type activity or an otolith crystal being shoved further into the canal thus causing less abnormal stimulation of the cupula or balance sensing organ.
My challenge to the GyroStim community is to research how often and frequent treatments should be. Maybe one or two are enough? If that is the case why are people subjected to 6 weeks of treatment when their symptoms resolved on the first session? Is a home program of exercises as or more effective as GyroStim treatment? Randomized control trials and comparative treatment research needs to be conducted.
The GyroStim is, essentially, automated vestibular therapy. In this regard it is nothing new. The open questions are – is it as or more effective than standard vestibular therapy, and is it cost effective? It’s very expensive, and so the cost-effectiveness question is not trivial. -SN
Does it work and is it better?
Second, improved screening of patients with neck injuries should be part of the pre-treatment decision prior to recommending GyroStim.
Remember our 9 year old young man from earlier? He got better with conservative treatment to restore his ability to move his neck and improve his binocular vision. His symptoms resolved and brain surgery for his Chiari Malformation was avoided.
The GyroStim is nothing more than automated vestibular therapy. Before it is mass produced and incorporated into medical treatment, it needs to be tested to see if it is safe, effective, and cost effective for conditions that are already treated by standard vestibular therapy. -SN
