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AANLCP JOURNAL OF NURSE LIFE CARE PLANNING ISSN 1942-4469 40
SPRING 2017 PEER-REVIEWED EXCELLENCE IN LIFE CARE PLANNING SINCE 2006 VOL. XVII NO. 1
Abstract
Vestibular disorders such as vertigo,
impact approximately 69 million people
in the United States (Agrawal, Carey,
Della Santina, Schubert, & Minor
(2009). The symptoms of vertigo have
a significant impact on many workers’
ability to remain employed in the
occupations before the onset of their
vertigo and in the performance of
many activities of daily living. When
developing a Life Care Plan, it is
important to consider the vocational
aspects and the activities of daily
living of the person’s life. This article
reviews the impact of vertigo on a
person’s ability to perform activities
of daily living and a worker’s ability to
perform her/his occupation or other
occupations. Many worker trait factors
and temperaments may be impacted
by the symptoms of vertigo and may
impede a worker’s ability to safely
return to work. These worker trait
factors also provide good data-points
to assess areas of activities of daily
living that may also be impacted by
vertigo. The appropriate employment
of medical care, case management, and
vocational rehabilitation will have the
most effective employment and re-
employment outcomes for individuals
with vertigo.
Keywords:
Vertigo, Occupations and Vertigo,
Vertigo and Work, Vestibular Disorders
Activity, Vestibular Rehabilitation
Therapy, Employment; Vocational
Rehabilitation, Balance, Equilibrium,
Life Care Planning
Introduction
Vertigo impacts many workers’ ability
to continue to perform their occupation
upon its onset. The same abilities and
limitations of occupational activities
can also be attributed to many of the
activities of daily living of a person.
Vertigo is more frequent in woman up
to the age of seventy (Bisdorf, Bosser,
The Impact of Vertigo on
Employment and Activities
of Daily Living
DAVID SAN FILLIPPO, PHD
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Gueguen, & Perrin, 2013). Vertigo can
initially be caused by a blow to the
head, an inner ear infection, or can
spontaneously occur without a specific
cause. Vertigo impacts the individual’s
ability to maintain equilibrium or
orientation in space. This orientation
is maintained by a person’s visual,
kinesthetic, and vestibular abilities
(American Medical Association [AMA},
2007). Vertigo is a sense of movement
that is either subjective or objective.
The subjective sense is a result of the
movement of an individual, such as
moving the head or eyes up or down
or from side to side. The objective
sense is a result of the movement of the
environment, such as an amusement
ride or the rocking of a boat on the
water. There may be a sense of a
whirling motion or a sense of rotation.
Vertigo is not the same as dizziness.
Vertigo and dizziness are often terms
used interchangeably but they are
two separate types of equilibrium
impairments with different sources of
onset and exacerbation. Dizziness
is described as a feeling of light-
headedness and perhaps a weakness.
A person suffering from vertigo may
feel a sense of spinning, pulsation,
or a tilting of the visual environment
with a change in position of the head
or eyes. A person with vertigo has a
sense of dizziness along with the false
interpretation that the environment
is moving, sometimes described as a
sense that the floor and/or walls are
moving or the surrounding environment
is moving. Meniere’s disease and some
central nervous system impairments
have similar symptoms as vertigo
(Vestibular Disorders Association.
(n.d.-c).
This article will provide an overview
of vertigo and focus on the impact
that the symptoms of vertigo have on
activities of daily living and a worker’s
ability to perform her/his occupation
or other occupations. Discussion
will include the worker trait factors
and temperaments that may be
impacted by the symptoms of vertigo
and may impede a worker’s ability to
safely return to work and may also
impact activities of daily living. The
rehabilitation of the vertigo client
should consider these activities of
daily living and work activities. The
awareness of the impact of vertigo on
a person’s activities of daily living and
work activities, as measured according
to the ability to perform specific
worker trait factors and temperaments,
may benefit Life Care Planners when
evaluating clients with vertigo.
Overview of Vertigo
Vertigo can result from a variety of
incidents within the central neurological
and inner ear. Vertigo can be caused
by head trauma, inner ear trauma, brain
tumors, central neurological disorders
or viral infections, and diseases that
impact the inner ear. There are three
basic types of vertigo: spontaneous
vertigo, recurrent-chronic vertigo, and
positional vertigo.
Spontaneous vertigo occurs when
a client has an intense sensation of
rotation that is aggravated by head
motion and change of position. It
is difficult to stand and to walk, and
there is a tendency to veer toward the
affected side (Vestibular Disorders
Association, n.d.). The recurring vertigo
symptoms can last from minutes to
several hours. Recurrent vertigo can be
caused by Meniere’s disease, vestibular
migraines, vertebrobasilar transient
ischemic attacks, vestibular paroxysmia,
orthostatic hypotension, panic attacks
(Brownfield, 2002). Positional vertigo
is caused by movement of the head
and/or eyes. It is the most common
type of vertigo. The most common
form of positional vertigo is benign
paroxysmal positional vertigo (BPPV). It
is often caused by a blow to the head
that impact the inner ear by impeding
the motion of small crystals in the inner
ear that promote balance (Woodhouse,
n.d.).
Vertigo may include some or all of the
following symptoms:
A sensation of motion either of the
person or the environment
A sensation of disorientation or
motion
Nausea or vomiting
Sweating
Abnormal eye movement
Hearing loss & tinnitus
Visual disturbances
Weakness
Difficulty speaking
Decreased level of consciousness
Difficulty walking
These symptoms can be chronic or can
be exacerbated with the eye, head,
and body motions or elements of the
external environment such as lighting,
noise, colors, and/or ground and wall
contours and patterns (Vestibular
Disorders Association, n.d.-b).
Impact of Vertigo on
Activities of Daily Living
and Vocational Activities
Vertigo can impact a person’s activities
of daily living and vocationally from a
cognitive, physical, and mental health
perspective. Cognitive impairments
can impact thinking, processing, and
retention of information. The physical
impact of vertigo is directly related
to maintaining equilibrium, balance,
and strength. Additionally, visual
perception may be impacted. The
mental health impact of vertigo may
result in a deficiency in one’s ability to
maintain concentration, persistence,
and pace along with elements of
depression and anxiety due to the
equilibrium limitations.
A person’s ability to perform activities
of daily living and activities associated
Risk for trauma (Domain 11,
Safety/Protection, Class 2, Physical
Injury)
Ineffective coping (Domain 9,
Coping/Stress Tolerance Class 2,
Coping Responses)
Risk for falls (Domain 11, Safety/
Protection, Class 2, Physical Injury)
Risk for injury Domain 11, Safety/
Protection, Class 2, Physical Injury)
Nursing Diagnoses
to Consider
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with work may be impacted by the
symptoms of vertigo. The limitations
caused by vertigo may also have
a negative impact on many of the
worker trait factors and temperaments
associated with occupations. Worker
trait factors and temperaments also
provide measures to assess one’s ability
to perform activities of daily living.
When developing a Life Care Plan,
consideration to a person’s equilibrium
impairments, as a result of vertigo,
should be taken into consideration as
its impact on the person’s activities of
daily living. The Life Care Plan “should
include reasonable and appropriate
recommendations to improve the
status of [an] individual” (Deutsch,
Kendall, Daninhirsch, Cimino-Ferguson,
& McCollom, 2006, p. 313). Many
activities of daily living are replicated
in the work force so the use of worker
trait factors and abilities are good data-
points to reflect aspects of a person’s
life that may be addressed in a Life
Care Plan.
Worker abilities are defined as the skill
level that a worker may perform. A
skilled worker has developed a specific
set of skills as a result of education,
training, and work performance. Skilled
work often requires the worker to make
decisions and judgments. A semi-
skilled worker has less training and/
or education than a skilled worker and
has performed the work long enough
to perform the semi-skilled work
sufficiently. This type of work does
not require complex work or decision-
making. An unskilled work involves
simple, repetitive type tasks which
requires little judgment or decision-
making (Field, 1992).
Occupational abilities are defined as
“enduring attributes of the individual
that influence performance” (National
Center for ONET Development,
n.d.). These abilities are the aptitudes
an individual has to perform tasks
either in a worker or personal setting.
According to National Center for
ONET Development (n.d.), the O*Net
database has divided the abilities
category of occupational data into
cognitive, physical, psychomotor,
and sensory abilities. The cognitive
domain is described as the “abilities
that influence the acquisition
and application of knowledge in
problem-solving” (National Center
for O*NET Development, n.d.). The
physical domain is described as the
“abilities that influence strength,
endurance, flexibility, balance and
coordination” (National Center for
O*NET Development, n.d.). The
psychomotor domain is described
as the “abilities that influence the
capacity to manipulate and control
objects” (National Center for O*NET
Development, n.d.). The sensory
domain is described as the “abilities
that influence the visual, auditory, and
speech perception” (National Center
for O*NET Development, n.d.).
Worker trait factors are defined as
an individual’s
1. interest in an occupation’s content,
2. general educational development
in preparation for the occupation,
3. phy sical demands for the
occupations,
4. temperaments for the occupation,
5. aptitude for the occupation,
6. environmental conditions
associated with the occupation,
and the
7. occupation’s relationship to data,
people, and things.
The aptitudes defined as worker
trait factors are
1. general learning ability,
2. verbal, numerical,
3. spatial,
4. form perception,
5. clerical perception,
6. motor coordination,
7. finger dexterity,
8. manual dexterity,
9. eye-hand-foot coordination, and
10. color discrimination
(U.S. Dept. of Labor. Bureau of
Statistics (1991).
Vertigo does not directly impact the
worker trait factors of interest, except
when a person loses interest in an activity
due to the symptoms of vertigo and
general educational development of the
person. However, some of the aptitudes
associated with occupations and activities
of daily living may be affected by vertigo.
Workers with symptoms of vertigo are
employed throughout the workforce in
occupations ranging from very unskilled
work to highly skilled work. Celebrities
who have or have had vertigo include
(Ranker, n.d.) :
• Janet Jackson
• Nicolas Cage
• LeBron James
• Alan Shepherd
• Vincent van Gogh
• Peggy Lee
• Philip K. Dick
• Emily Dickinson
• Kristin Chenoweth
• George Clinton
• David Duval
• Nick Esasky
• Katie Leclerc
• Richard Lugar
This list of celebrities represents
a diverse range of occupational
abilities and worker trait factors
in the performance of their work.
These individuals have learned to
accommodate their work performance
and/or setting to be successful at their
job and with activities of daily living.
This demonstrates that with proper care
and rehabilitation many persons with
vertigo can return to work either at their
occupation or another occupation and
improve their activities of daily living.
Rehabilitation of
Individuals with Vertigo
The rehabilitation of individuals with
symptoms of vertigo requires a multi-
disciplined approach of medical care,
physical rehabilitation, mental health
support, and vocational rehabilitation.
Medical Care & Physical
Rehabilitation
Proper diagnosis and treatment of
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vertigo symptoms are essential to
rehabilitate persons with vertigo.
The underlying causes of vertigo
symptoms will help determine the most
effective treatment plan for vertigo
clients (Djalilian, 2009). In some cases
of vertigo, medication is helpful in
alleviating some of the symptoms.
Prescribed medications include those
that address motion sickness, anti-
anxiety medications, and medications
associated with the treatment of
Meniere’s disease. Many of these
medications are over-the-counter
medications. A physician consultation
is advised before taking any type of
medication for the effects of vertigo
(Cunha, 2016).
The primary physical rehabilitation that
is required to overcome or live with
vertigo involves the steps to recalibrate
the client’s equilibrium through
vestibular rehabilitation therapy (VRT)
or other equilibrium treatment (Farrell,
n.d.-a). Vestibular rehabilitation (VR),
“is a specialized form of therapy
intended to alleviate both the primary
and secondary problems caused by
vestibular disorders. It is an exercise-
based program primarily designed
to reduce vertigo and dizziness, gaze
instability, and/or imbalance and
falls” (Farrell, n.d. “What is Vestibular
Rehabilitation,” para. 1). The intent
of the therapy is to allow the client
to learn how to compensate for
the equilibrium deficits. Vestibular
rehabilitation therapy focuses on three
primary exercise forms to rehabilitate
the vertigo client: a) habituation, b)
gaze stabilization exercises, and c)
balance training. The purpose of
habituation therapy is to help the
client to become familiar with and
adapt to the symptoms of vertigo. The
brain learns new ways to interpret and
overcome the symptoms of vertigo
by repeated exposure to movements
and/or visual stimulation. T
Gaze stabilization exercises are used
to stabilize the vision of clients with
visual problems that causes the field of
vision to move about when attempting
to read or look around. There are
several eye and head exercises that are
employed to help bring stability to the
client’s visual field.
Balance training is used to support
the independence of the person with
vertigo. It prepares those with vertigo
to adapt themselves, by retraining
their central neurological system
to compensate the symptoms of
vertigo (Farrell, n.d.-a). Some of these
exercises are:
Visual and/or somatosensory cues
Stationary positions and dynamic
movements
Coordinated movement strategies
- movements from ankles, hips, or a
combination of both
Dual tasks - performing a task while
balancing
According to Farell (n.d. -a), these
rehabilitation approaches are counter-
indicated for clients with Benign
Proximal Positional Vertigo (BPPV). This
type of vertigo is caused by movement
of the head and/or eyes and is caused
by an inner ear crystal disturbance.
Appropriate rehabilitation for this type
of vertigo is particle repositioning
head exercises such as the Epley or
Semont exercises (Poinier, 2015a). To
improve the brain’s compensation
process the Brandt-Daroff exercise
can be employed. Improving the
compensation process shortens the
time for the brain to ignore abnormal
motion messages associated with BPPV
(Poinier, 2015b).
Mental Health Support
People who deal with vertigo on a
chronic basis may develop some
mental health and/or emotional issues
associated with the symptoms of
vertigo. Many report being frustrated
by their inability to do many of the
things they used to do either at home,
recreation, or work. Those who used to
be good multi-taskers find it frustrating
that the symptoms of vertigo impair
their reaction time and ability to multi-
task. Because of the ongoing effects
of vertigo, some people prefer to limit
their activities and sometimes become
reclusive.
The combination of the chronic
effects of vertigo and the associated
impairment to personal and work
activities can lead some vertigo clients
to become anxious and/or depressed.
Mental health services should
focus on encouraging individuals
to consistently do their vestibular
rehabilitation exercises and to learn
adaptive approaches to compensate
for the limitations of equilibrium
impairments. Vertigo clients should
be encouraged to remain engaged
in their life within the limitations
of the vertigo symptoms to not
become isolated from others. In
some cases, cognitive behavioral
therapy has been found to be
helpful for persons dealing with the
dizziness, anxiety, and other effects
of vertigo (Obermann, Bock, Sabev,
Lehmann & Diener, 2015; Whalley &
Cane, 2016).
Vocational Rehabilitation
Although this section focuses
specifically on workers, occupational
impairments can be similar to activities
of daily living for the worker and
unemployed. Many workers with
vertigo will require some vocational
rehabilitation services to assist in either
maintaining employment or seeking
re-employment. Although workers
may have a transferable skill set, many
workers will find that they are unable
to perform their occupation and many
other occupations as a result of their
equilibrium impairments. Individuals
with chronic vertigo may need to
have ongoing work restrictions or
accommodations to be able to possibly
return to work. When considering
employment or re-employment
opportunities for workers with vertigo,
consideration should focus on the
limitations imposed by the symptoms
on the physical, mental health, and
environmental aspects of the effects of
vertigo.
According to the Job Accommodation
Network (JAN) (2011) accommodations
for individuals with vertigo may be in
the areas of:
• Accessibility and Transportation
• Attendance
• Lighting
• Computer Use
• Medical Treatment Allowance
• Stress
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Activities and temperaments that
may be impacted by equilibrium
impairments may fall in the following
vocational categories:
Dynamic Flexibility
Extent Flexibility
Gross Body Equilibrium.
Depth Perception
Field of Vision
Glare Sensitivity
Peripheral Vision
Reaction Time
Response Orientation
Performing Varied Duties
Dealing with Stress
Work environments also impacts
individuals with vertigo. The instability
that is caused by vertigo can make the
following work environments dangerous
for individuals with equilibrium issues:
Vibrations
Exposure to Noise
Proximity to Moving Machinery
Exposure to High Places
Exposure to Electrical Shock
Exposure to Radiation
Working with Explosives
Exposure to Toxic & Caustic Agents
Limitations in these vocational activities,
temperaments, and environments
affect many unskilled, semi-skilled, and
skilled occupations and activities of
daily living. In some cases, when job
accommodation and/or transferable
skills cannot provide a return to
the workers own occupation or any
occupation, then retraining to a new
occupation should be considered.
Some occupations provide for
reasonable accommodations that
can provide for a safe and productive
work for vertigo clients. Key areas
to consider with work site and job
accommodation is to minimize eye-
head movement, accommodate for
the false interpretation that one’s
environment is moving, the visual
impairments caused by vertigo, and the
impact on the worker’s balance. Some
simple accommodations can be made
to the work site by properly leveling
the height of the work surface and
sufficient lighting to minimize eye-head
motions and provide illumination to the
work surface. These accommodations
also can be employed in a personal
environment and activities. More
specific accommodations should be
recommended by certified vocational
rehabilitation consultants, medical
rehabilitation consultants, Life Care
Planners, and physicians.
Conclusion
Symptoms and impairments associated
with balance and equilibrium are
prominent in the United States with
more than a third of the population
having encounters with balance
dysfunction (Agrawal, Carey, Della
Santina, Schubert, & Minor, 2009). The
symptoms associated with vertigo
have impacted many people’s ability to
perform activities of daily living and for
workers to remain in occupations that
they had been employed before the
onset of vertigo.
The rehabilitation of individuals with
symptoms of vertigo require a multi-
disciplined approach of medical
care, physical rehabilitation, mental
health support, and vocational
rehabilitation. Life Care Plans for living
with equilibrium impairments should
take into consideration adequate
medical care and rehabilitation
services. The use of vocational and
medical rehabilitation services and the
development of a specific Life Care
Plan focused on compensating for the
effects of vertigo symptoms, can assist
individuals to return to personal and
vocational productivity by learning to
live with their symptoms and making
accommodations for the effects of the
symptoms.
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DAVID SAN FILIPPO, PHD
Dr. San Filippo is the Chair of the Health Studies Programs in the College of Professional Studies
and Advancement (CPSA) at National Louis University (NLU) in Chicago, Illinois. He is the Faculty
Advisor for the NLU Student Veterans of America chapter and the Quality Matter Coordinator
for NLU's learning management platform. Dr. San Filippo is also a former Faculty Senate
Chair for National Louis University. He also teaches online courses in critical thinking, strategic
management, leadership, and ethics. Additionally, he teaches online courses in consciousness
studies, death, dying, and near-death experiences. Dr. San Filippo serves as a vocational expert
involving workers' compensation, personal injury, automobile, and social disability matters. He
also represents disabled individuals before the Social Security Administration. Dr. San Filippo is
a licensed mental health counselor, certified disability management specialist, a Florida qualified
rehabilitation provider, and Quality Matters Peer Reviewer. Dr. San Filippo has started five
companies related to medical cost containment, vocational rehabilitation services, and software
and systems development. He has consulted for organizations in Colombia, South America
regarding medical cost containment, human resources development, bereavement, and cost
containment software. Dr. San Filippo offers seminars nationally on the topics of international
business, online education, death and dying, near-death experiences, and marriage.
