NDBC: Getting Patients with Neurotologic Conditions Back on Their Feet

Tuesday, May 1, 2018

National Dizzy and Balance Center (NDBC) specializes in diagnosis and rehabilitative treatments and an individualized, multidisciplinary approach to addressing dizziness, vertigo and balance disorders.

Neurotologic conditions, such as dizziness, vertigo and balance problems, can have a variety of causes, including traumatic brain injuries such as concussions, neurological disease, vestibular disorder or a combination of these issues. At NDBC, providers are well-equipped to assist patients in overcoming these challenges.

“We see a wide spectrum of patients,” says Kenneth Ginkel, Co-founder and Manager at NDBC. “They may have vertigo related to an ear infection or trouble staying on their feet due to peripheral neuropathy caused by diabetes. In each case, we’re ready to identify the cause and help patients find relief.”

Due to the varied nature of the disorders their patients face, NDBC providers utilize a detailed evaluation process and advanced diagnostic equipment, much of which is typically seen only in academic centers or university hospitals, to help them make accurate and complete diagnoses.

“We have specialized equipment at every one of our locations,” Ginkel says. “Patients can be tested and treated at a single outpatient clinic for added convenience and continuity of care.”

Partnering with Workers’ Comp

National Dizzy and Balance Center’s (NDBC) healthcare model focuses on lowering costs, offering seamless patient experiences and improving outcomes. To achieve these goals, the center follows patients’ progress closely to make sure they’re undergoing appropriate treatment. Small adjustments can be made as patients move through a rehabilitation program to ensure they are benefiting as much as possible from the process.

Because treatment options recommended by NDBC are based on objective data gathered from thorough, cost-effective diagnostic tests, many insurers prefer the outpatient clinic system for managing workers’ compensation cases. Area providers, for example, often refer their patients to NDBC for audiology tests that can help determine if patients have a condition that warrants an MRI.

“Workers’ compensation programs try to reduce the amount of time people spend out of work, which reduces costs not only for employers but for patients as well,” says Kenneth Ginkel, Co-founder and Manager at NDBC. “All the money that’s spent here at NDBC actually goes toward helping the patient get better as opposed to money that might otherwise be spent on unnecessary scans or workups elsewhere.

“About 75 percent of patients referred to us are good candidates for the services we provide,” he adds. “Those who aren’t are quickly referred elsewhere. Appropriate patient assessment and management saves money and resources.”

The Right Tools

To craft an accurate care plan, the NDBC team conducts a thorough patient evaluation that determines whether the patient needs and is capable of physical or occupational therapy for a neurotologic condition. Physicians lead this initial workup, coordinating with a team that includes doctors of audiology and physical and occupational therapists.

One of the key pieces of diagnostic equipment at NDBC is the SMART EquiTest system, which is used to perform computerized dynamic posturography (CDP). This test measures the functionality of patients’ visual, sensory and vestibular systems to determine which are impaired and to what degree.

“CDP was developed by NASA 20 years ago to examine astronauts’ vestibular systems in weightless environments,” Ginkel says. “Now, we use this test for initial evaluations of patients to assess whether they’re appropriate candidates for rehabilitation and also to check their progress during treatment.”

The CDP test can also be used in combination with videonystagmography (VNG) to diagnose the cause of a patient’s condition. VNG tests patients’ inner-ear and central motor functions to determine if they have a vestibular disease and pinpoints whether the condition is present in one or both ears by stimulating patients’ inner ears with warm and cold air through a process called caloric testing.

To obtain a complete understanding of the patient’s condition, rotational chair testing is typically ordered alongside VNG to help determine whether the balance disorder originates in the vestibular or neurological system and to confirm diagnosis.

“Rotational chair testing is the gold standard for diagnosing bilateral vestibular disorders,” Ginkel says. “We use this testing to evaluate how well a patient’s brain has already compensated for a vestibular disorder. If the brain hasn’t compensated enough, we pursue compensative rehabilitation for the patient that helps the brain do so properly and effectively. Otherwise, we can pursue adaptive rehabilitation for the patient to help him or her acclimate.”

Dedicated to Education

To help ensure a high level of standardized care, providers at National Dizzy and Balance Center (NDBC) undergo additional, specialized training when they join the NDBC team.

“Vestibular rehabilitation and neurotologic balance lab testing are highly specific fields, and there aren’t many programs that offer training on what we do,” says Kenneth Ginkel, Co-founder and Manager at NDBC. “That’s why almost all of our providers, especially our therapists and full-time team members, receive certification from Susan Herdman.”

Susan Herdman, PT, PhD, FAPTA, Director of the Doctor of Physical Therapy Program at Emory University School of Medicine, offers a vestibular rehabilitation course in Atlanta every spring. New full-time staff members at NDBC attend this course and also undergo an internal certification process with the clinic.

“If there were a pyramid in our field, Herdman would be at the top of it,” Ginkel says. “There is no comparison to the training she offers.”

New providers also spend the first 60 days at NDBC working in tandem with their more experienced colleagues before seeing patients on their own, ensuring that patients are always seen by staff members who are knowledgeable about the NDBC process.

The Importance of Early Intervention

Once a diagnosis is confirmed, audiologists and physical therapists conduct further testing, which is used to develop a final, individualized treatment plan.

“Some patients who come to us are already taking medication, but it’s important to note that some medications can inhibit the vestibular system from compensating for neurotologic conditions,” Ginkel says. “This can cause a permanent vestibular deficit for patients, so we take steps to wean them off potentially harmful medications as early as possible.”

Treatment typically includes a combination of physical or occupational therapies to recalibrate patients’ vestibulo-ocular reflex. Once physicians and audiologists have determined which sensory input is not working correctly, therapists focus on isolating that input, leading patients through exercises that stimulate it.

When the optimal therapy is administered in a timely manner, patients typically experience rapid improvement.

“If patients come to one of our clinics within 30 days of symptom onset, they can often make 70 percent of their total gains within the first 30 days of therapy,” Ginkel says. “It’s important to refer patients into the clinic early rather than have them wait because they can miss the window for a better outcome.”


To learn more about the services offered at NDBC, visit nationaldizzyandbalancecenter.com.