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Balance

We use 3 main systems to balance: our eyes, inner ears (Vestibular System), and joint sense of position or proprioception.  We can still function if some of them are not working at 100%; however, the more problems with each system we have, the more difficult it will become to balance.  Some patients lose balance due to muscle weakness.  this is more common in the elderly.  As a person begins to move less and less, the muscles begin to get smaller in size and length.  This usually contibutes to a flexed (bent over) posture, which further puts a person at risk for falling.

So, our muscles are important to keep us upright, but also to reduce the chance of a fall.  For example, if we stumble or get bumped, we have to take quick steps to stop ourselves from falling.  If the muscles are ‘de-conditioned’ (not in shape), we may not be able to step quickly enough to stop a fall.  If we are not standing straight, but leaning because of poor posture, gravity will try to pull us over.

Therapy may be the answer to reduce falls!  A Physical or Occupational Therapist evaluates their patient’s balance and tests muscle strength, range of motion, and posture.  They may also evaluate the systems that help us balance, and create a specific excercise plan to work on any body system that isn’t working up to its potential.

Balance Training

Every object has a ‘Center of Gravity’.  This is where the average weight of any object (including people) is located.  When we balance, we have to keep our center of gravity supported.  That is to say, we have to ‘hold up’ our weight!  Whatever is holding up your weight is called your ‘Base of Support’.If you are standing on two feet, then those feet are your base.  If you are standing on one foot, then only that one foot is your base.  If you are sitting, them your bottom is your base.

To stay balanced, we have to keep our center of gravity (our weight) over top of the base of support (whatever is holding us up).

When training patients to balance, one of the first tasks is to get the person to recognize and feel their center of gravity.  Many times, people who have balance problems lose this sense.  This is one reason they fall, as they cannot feel when they are placing their weight outsite of the area that is supporting it!  Sometimes, assistive devices such as canes or walkers help.  But even with a cane or walker, most patients still may benefit from balance training to help reduce the likelihood of a fall.

Dizziness & Vertigo

Dizziness & Vertigo
How is my ear involved with balance and dizziness?

The Ear is a complecated machine that not only helps us hear, but also helps us balance.  It has three parts: The outer ear, middle earm and inner ear. The inner ear contains the Cochlea (for hearing) and the Vestibular System.  

The Vestibular System detects movements of our head.  It has 2 chambers and three semi-circular canals.  These chambers and canals are filled with a fluid (Endolymph), and each has a patch of specialized hair cells that are connected to nerves.  As we turn or move our heads, the fluid shifts.  As the fluid shifts around, the hair cells bend.  As the hairs are connected to nerves, whenever they bend,they send messages along the nerve to the brain.  This tells the brain that we are moving or turning, in which direction, and how fast.

One of the main jobs of the inner ear is to create a reflex called the “Vestibular Ocular Reflex” or VOR for short.  The VOR helps to keep our eyes on a subject while we are moving.  Because we have a Vestibular organ in each ear, they work together as a team.  When one or both of these Vestibular organs fail to work properly, we may experience a spinning dizziness called Vertigo, or have trouble balancing and walking.

Vestibular Rehabilitation Therapy (VRT) helpts to restore gaze stability (i.e., Keep our eyes on whatever it is we are looking at), balance, and helps to decrease symptoms of dizziness, motion sickness, and disequilibrium (feeling off balance).

Evaluation Dizziness

What is included in a dizziness evaluation?

There are many causes for dizziness.  That is why most people who are dizzy are evaluated by many medical and allied health professionals.  During your evaluation, you may have your strength, sensation, eye motion, hearing, walking ability and balance tested.

There are more specialized tests that are designed to check your inner ear (Vestibular) function.  Your inner ear plays an important role in balance and eye motion.  Many people who have inner ear dysfunction may experience: Vertigo (spinning dizziness), become dizzy when watching moving objects, complain of dizziness or lose balance when turning quickly, or complain of difficulty concentrating or reading.

Some specialists use infared goggles that magnify your eye on a TV monitor.  Certain eye motions provide us with information about the function of your inner ear (Vestibular System), that is part of your body’s balance center.  The goggles help the clinician evaluating your eye motion to gain further understanding of your vestibular function.

Balance & Fall Prevention

Our bodies use many sytems working together to maintain our balance.  We use our vestibular system (inner ear), eye sight, and our joint sensations called proprioception (mostly from our ankles, knees and hips).  So, the ankles, eyes and inners ears send messages to the brain.  The brain takes the available information and creates a plan to keep us balanced.  Muscle strength is important, as the muscles carry out the job of keeping us upright as the brain coordinates all of the information from our balance systems.

Many patients who have one or more problems in an of the above systems may have some balance difficulties or even dizziness.  If the problems are bad enough, it may lead to a fall.  Many of our friends and family do not realize they are at risk until they actually fall and injure themselves.  Some signs they may be at risk include: taking short shuffling steps, holding onto furniture or walls when they walk around the house, bent over posture, or a history of falls.

Physical and Occupational Therapists treat patients who have these types of balance problems.  Therapy may not only help to reduce or resolve the dizziness, but also improve balance.  If you are having problems with your balance, let your doctor know, and ask to see a therapist who specializes in balance or dizziness!

Common Conditions

Dizziness- Patients experiencing ‘dizziness’ are many times seen by different types of professionals, including Physicians, Nurses, Audiologists, Physical and Occupational Therapists, and others. This team works together to help determine the cause of your dizziness, and the best way to treat it.

There are many different causes of dizziness, and many ways to describe dizziness. For some, the term ‘dizziness’ means a sensation of motion or spinning (called Vertigo), for others it describes a sensation of being ‘light-headed’ or nauseous. Still others use the word ‘dizzy’ to mean they feel off-balance.  If you experience dizziness, the best course of action is to seek medical attention!

It is important to distinguish between these symptoms, as they each are usually caused by different problems. Vertigo (spinning dizziness) usually points to a problem of the Inner Ear (Vestibular System), the nerve that connects the Inner Ear to the Brain (Vestibulochoclear Nerve), or the Brain itself. Many times, feeling light-headed is caused by sudden drops in blood pressure, abnormal heart rhythm, or blood sugar issues. A feeling of being off-balance (Dysequilibrium) may be caused by any number of issues, and the patient needs a thorough evaluation to determine the cause.

Inflammation- Inflammation of various body structures is sometimes the culprit.  For example, if someone has a cold, their sinuses may be stuffy, putting pressure on the inner ear.  As the inner ear helps us balance, we may become dizzy from this added pressure.  If the nerves that lead from the inner ear to the brain become inflamed, this may also cause dizziness, and sometimes tinnitus (ringing or noise in the ears).

Vestibular Neuritis- This condition is an inflammation of the Vestibular Nerve, and is the second most common peripheral vestibular disorder. It is thought to usually be the result of a viral infection. Symptoms include vertigo, nausea, vomiting, oscillopsia, and falling or veering to one side. Symptoms are aggravated with head motion. This condition begins with an acute onset; with symptoms improve over days to weeks.

BPPV “Loose Crystals”-Of the various problems that may cause vertigo, a condition called Benign Paroxysmal Positional Vertigo (BPPV) is by far the most common. Many people refer to this condition as “Loose Crystals”. To understand BPPV, one must first understand the anatomy of the inner ear. The Vestibular System (inner ear) has 2 chambers and 3 semi-circular canals. There are specialized hair cells in each chamber, and at the end of each canal. The entire system is filled with a fluid (Endolymph). As we turn, bend and move or heads, the fluid shifts and the hairs bend. When the hairs bend, and signal is sent to the brain, and depending on how far and fast they bend, the brain interprets the signals to determine which way we are moving. The hair cells in the chambers have crystals (Otoconia) glued on top of them, making them susceptible to the pull of gravity. If these crystals break free and begin to float around in the canals (where they don’t belong) it causes the hairs in the canals to bend. The brain thinks you are spinning, and wants you to see, so begins to move your eyes (Nystagmus). A person with this condition usually sees and feels the room spin whenever they pitch their head back as when looking up, sitting up or lying down, or when rolling in bed. The actual sensation of spinning usually lasts less than 1 minute after position change, although nausea may last longer. Medical professionals trained in treating BPPV usually resolve the issue in the first week of treatment. It is believed viral infections or head traumas are the most likely causes of BPPV.

Orthostatic Hypotension-Patients who have Orthostatic Hypotension will complain of feeling light headed or “woozy” during changes of position, such as lying to sitting, or sitting to standing. They typically do not get dizzy when moving in the other direction (standing to sitting, or sitting to lying). Examination includes checking the blood pressure in 3 different positions. More accurately, the examiner is looking at the change in pressure after moving into each position. (lying to sitting to standing). Drops in Systolic Blood Pressure of 20 mmHg or Diastolic drops of 10 mmHg or more within three minutes of getting up may indicate ‘Orthostatic Hypotension’.  Normally when we change positions, we have a reflex of the blood vessels to keep blood in the head. If this reflex does not happen quickly enough, we lose blood pressure in the head (brain), and begin to feel dizzy (light-headed). This sensation will usually pass. Sometimes it requires treatment of Physical Therapy, or an adjustment of medications by the Physician.

Other Conditions-There are many other conditions that may also cause ‘dizziness’.   Here is a list of other conditions that may cause dizziness: Acoustic Neuroma (tumors), Brainstem and Cerebellar Lesions, Cardiac Arrhythmia, Central Positional, Vertigo, Cerebellar Toxicity, Cervicogenic, Drug or Medication-Induced Dizziness, Hypoglycemia, Hypertension, Labyrinthine Infarction, Labyrinthitis, Menière’s Disease, MS, Perilymph Fistula, Psychogenic Dizziness, Ototoxicity, Vertebrobasilar Transient Ischemic Attacks (TIA’s), Vestibular Migraine.

As you can see, there are many things that may make someone feel “dizzy”.  Seeking medical advice is always the best course of action.

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