Intro
Hello and welcome! My name is Bettina, I am a third-year part-time Occupational Therapy (OT) student currently on placement with Jo. I invite you to read on how a vestibular neuritis turned my life upside down. I emerged as my own (sometimes unwilling) OT. And I’m getting plenty of lived experience in pacing, planning, and prioritising. Also, how small moments of joy – “glimmers” – can provide light wherever you are in uncertain times.
My Story – OT training
The OT training requires all students to complete placements to allow us to gain experience in a variety of settings. I had a good and hectic time in year one on a ward for older people. Followed by a placement in a large children’s hospital in year two. I greatly enjoyed that after huge anxieties beforehand (but this is a very different story). This year a community placement was suggested with a neuro-rehab team an hour and a bit commute from our house.
My Story continued – things start going wrong
In January this year I commenced placement. After hectically finishing my beloved part time job at a local charity for older people. I was equal parts scared and excited for the upcoming experience. From the start I could feel something wrong with my right ear. A GP diagnosed this as a middle ear infection and treated it with antibiotics. Strange symptoms continued: tingling of part of my face, pressure on my ear, extreme tiredness and occasional dizziness. I also had head and neckache. Over two weeks more GP visits and more antibiotics issued. Until one morning I woke up to find the world spinning around me. Getting out of bed wasn’t an option anymore.
Getting to know Cranial Nerve VIII- “On occasion our trusted truck acts funny, very good vehicle anyhow!”
The next 24 hours are a hazy memory:
I booked an emergency appointment with the GP which I couldn’t get to as I simply couldn’t walk anymore. My partner half-carrying me to the loo. I called 111 with intense nausea, ear and headache, vomiting. They suggested this is neither stroke nor an allergic reaction to antibiotics. I considering going to A & E but didn’t manage. The following morning another GP phone appointment in which it was suggested that this could be a condition called vestibular neuritis. A problem with the vestibular nerve.
Like the mnemonic of the cranial nerves above, I definitely felt that the “trusted truck” (my body) “acted funny” indeed and I was just hoping it would remain a “very good vehicle anyhow”.
What we use the vestibular system for and how issues with it affect us
The vestibular system contains structures in the inner ear that pick-up movement of the head, tilting, turning from side to side etc. (motion, equilibrium, spatial awareness). This information is then passed on to the brain via the vestibular nerve. The brain uses this information together with signals from our eyes, bones, muscles and joints to help us balance while we get on with our lives. Managing the household, caring for pets or brushing our teeth while standing up (read more about the vestibular-visual systems connect vision and balance. There are various theories about how problems with the vestibular nerve come about:
– Dormant virus that’s been reactivated by stress
– Inflammation from a viral infection that causes small blood clots in blood vessels surrounding the vestibular system, in turn damaging the nerve
– An imbalance of the immune system that attacks the vestibular nerve
– Fatty deposits in blood vessels that deliver blood to the brain
With one nerve unable to transmit, information challenges with balance and severe nausea occur in the acute phase. This acute phase lasts several days, in my case two. With weeks and sometimes months of the nerve healing following, all while the brain starts to compensate for the loss of information. According to NICE, symptoms may resolve within six weeks. After that, further treatment is recommended for remaining symptoms. I saw ENT which I then followed up with specialist vestibular physiotherapy.
Link to Occupational Therapy
In this blog I am utilising the Kawa Model (Iwama, 2006). That uses the imagery of a river to capture a person’s life. In this model the river symbolises the flow of life, the banks of the river represent the environment of the person – for instance social as well as physical. The rocks represent the issues that we are dealing with, and the driftwood are the person’s assets, characteristics, beliefs or principals. OT practitioners come in with the aim of shifting rocks to let life flow, or the river run smoothly. As you can see the biggest rock is my health post-vestibular neuritis.
Canadian Model of Occupational Performance and Engagement (CMOP-E)
Additionally, the CMOP-E (Townsend and Polatajko, 2007) is used as it also includes thinking and feeling, our driving forces. Utilising this model has allowed me to highlight those of my occupations that are currently not balanced. In my case this is the leisure side of things, as my energy mostly lasts for “must do things” such as work and only very occasionally meeting others. Click here to view how I completed the model.
Occupational disruption: temporary loss of function, loss of roles, loss of identity
Occupational disruption, being unable to carry out roles and activities that until this point had provided the structure of my life, happened overnight. Movement and balance are everywhere. Balancing our head, balancing our bodies in space, getting out of bed, dressing. Basically most personal activities of daily living (PADLs) are affected. Click here for a side story.
Gronski and Neville (2017) find that Occupational Therapy is ideally placed to support people with vestibular impairment with the whole toolkit of remediation, modification and adaptation of roles, routines and occupations. They elaborate that vestibular impairment affects not only the individual but also has an impact on the wider environment. Family, colleagues or friends as often avoidance of situations and tasks that aggravate symptoms occurs.
Going out of the house felt like stepping from a boat onto dry shore. So even a walk in the garden that’s five metres from the kitchen felt like an impossible, wobbly adventure. Of course, continuing my university placement was not an option either, nor was returning to my regular workplace. Emptying the dishwasher in one go was out of the question as bending down repetitively caused dizziness. And just forget about socialising due to extreme fatigue caused by my brain playing catch up and compensating for the loss of one side of the vestibular system.
This is how OT could have helped on my journey – and me being an OT fledgling did help
Pace, Plan, Prioritise (RCOT, 2026).
Pacing is the art of breaking activities into smaller chunks that consume our energy before we go bust. It is taught at university and utilised widely by OTs and other health professionals to support people living with a vast range of conditions that cause pain and fatigue. I anticipate that the lived experience of learning how to pace myself will come in handy when we support our clients in future. Learning pacing strategies helped me over the initial weeks to get to grips with the demands of everyday home life. Pacing, like all learning takes some time to embed and I am far from perfect at it. Jo offers a Pacing Masterclass to teach this important skillset. Witnessing these classes has reinforced how crucial these skills are to live our lives in the best way possible according to our pain and energy levels.
Remediation
I take sessions with a physiotherapist who is trained in vestibular rehabilitation and who gave me a set of exercises called Cawthorne-Cooksey exercises. However, an Occupational Therapist could also be well placed according to Cohen and Gronski (2025) with regaining function to engage in occupations. For instance, in my case the occupation of keeping the house in order involves emptying the dishwasher. This requires bending over to empty the bottom shelf which was inducing slight dizziness. The exercises gently challenge and habituate the brain again to movements involving the turning of the head. Emptying the dishwasher matches one exercise already. So far better to tidy than picking up random objects from the floor. More on vestibular rehabilitation.
Adaptations
Such as a beanbag at work, earplugs to help with noise sensitivity or a permanent chopping station in the kitchen could have been suggested by an OT. In terms of work, a phased return could have been collaboratively established with the help of an Occupational Therapist. I connected with my manager at work to keep me in the loop with how my project was going. Then worked from home for three hours before eventually going into work for short periods of time. I still have a bean bag at my disposal for rest. Reconnecting with the role of worker was a crucial element in the healing process. I strongly identify with being the breadwinner for my family. A lot of self-advocacy was required in this process. Take a look here for placement student Emilia’s Blog on self- advocacy in healthcare.
Support with Mental Health and Wellbeing (RCOT, 2026).
All the roles we fill shape our identity (Kielhofner, 2008), give meaning and structure to our days. With three major roles Worker – Student – Mother severely disrupted so too was my mental wellbeing. It was my luck (or misfortune some would say) that my boys were sitting their GCSE and A-levels this year. And therefore even though cooking initially was hard and consisted often of throwing a pizza in the oven, my presence in the house for cheering on and moral support was much appreciated (as much as teenagers show that). I learned to re-focus on my role as mother, feeling I was able to fulfil a role to my satisfaction. Occupational Therapy could have supported with reframing and highlighting capabilities through a strength-based approach according to Dunn (2017). And supported with strategies to regulate the nervous system. One strategy proved very important: collecting “glimmers.”
Glimmer moments
Glimmer moments are tiny moments of joy that give you a sense of wellbeing. The term was coined by Deb Dana, a clinician working with people who have experienced trauma. She utilises Polyvagal Theory, developed by Stephen Porges. Centring around our autonomic nervous system’s responses in our everyday lives – from flight-fight to rest and digest and our successful ability to shift from one state to the next. Remaining in one state is detrimental to our health and wellbeing. There are various ways to help us move between states. More on understanding pain through Polyvagal Theory in student Mariana’s Blog.
Glimmers can be found anywhere: it could be a smile that a passer-by gives you, the purring of a cat that sits on your lap, a beautiful flower, a phone call with a friend, etc. They are accessible in many different situations: you could be in bed like I was on-and-off for four weeks, on your way to work or sat in a park. It’s about seeing and recognising what you have witnessed that helps your nervous system regulate and thus achieve a moment of wellbeing.
Like grains of sand (or pebbles in the UK) create a beach, so there is the idea that many tiny moments of joy can bring about an increase in wellbeing. Our brains become more attuned to collecting the positive information that is literally all around us. This helps regulate our nervous system into a calm state.
My top glimmers during the early days of being very unwell were:
- Feeling the warm water of the shower run over my skin
- Tasting soup after not being able to eat for two days
- Seeing a tulip come up in the garden that I had planted in the previous year
Another very recent glimmer:
• Watching wildlife sat in a peaceful spot in Nunhead cemetery with my partner
This approach is something that we can share with our clients and, of course, those close to us. It is not about viewing life through rose-tinted glasses. Rather establishing one strategy amongst others to manage difficult and ongoing situations. Creating an awareness that it’s ok to feel moments of joy.
In conclusion
My struggle with fatigue but also pain of ear, neck and headache is ongoing as the nerve slowly heals and my brain continues to compensate. On this journey I have learned so much about my boundaries. What it means not to trust my body anymore and having to rely on those close to me. Advocating for myself at work, university and with healthcare professionals. It has allowed me to utilise OT theory, models and frames of reference and put them into practice on myself. Not as smooth and confident as a fully-fledged OT would have done, but it was definitely something.
This lived experience will enable me to work in a different way with future clients who are facing rocks in their lives. OT’s practice therapeutic use of self -bringing our authentic selves into building a collaboration with our clients. This will allow me to use my lived experience of a chronic condition as a strength. And that for sure feels like a moment of “glimmer”.
We would love to hear more about your “glimmer” moments. By sharing them not only will you reconnect with this moment of joy but you’ll also let it spread and bring joy to others. Thank you for reading 🙂
References:
Iwama, M.K. (2006) The Kawa Model. London: Churchill Livingstone Elsevier.
Kielhofner, G. (2008) Model of Human Occupation: Theory and Application. 4th ed. Baltimore: Lippincott, Williams and Wilkin.
Townsend, E.A. and Polatajko, H.J. (2007) Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation, Ottawa: CAOT Publications ACE
