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Health & Exercise Forum

TREATMENT FOR LOSS OF BALANCE: 2nd of 3 Columns on Balance Disorders and Falls Prevention

Mar 8, 2009

Dr. Mackarey's Health & Exercise ForumGuest Columnist: Janet M. Caputo, PT, OCS
Contributors: Dr. Louis DeGennaro & Dr. Mark Frattali, Dr. Seth Jones

Last week we discussed the causes of balance loss. Today, we will discuss treatment for this problem. Two primary treatments are medication and vestibular rehabilitation.

Medication requires a visit to your family doctor. In a more involved case, your family physician may refer you to a specialist such as an ear, nose and throat physician or neurologist. There are many medications available for loss of balance. While this can be complicated, the specialist will determine the most appropriate one for your balance disorder.

Vestibular rehabilitation is a great adjunct to medication to manage your balance disorder. It is a comprehensive program that addresses a wide range of problems that may cause imbalance such as: addressing the inability to tolerate motion, visual changes, providing balance rehabilitation, instruction in repositioning techniques for BPPV (benign paroxysmal positional vertigo), correcting postural dysfunctions and muscle weakness/joint stiffness, offering education for prevention, maintenance and self care after discharge. Through experience and motion, vestibular rehabilitation allows: formation of internal models (one learns what to expect from ones actions), learning of limits (learning what is safe and what is not) and sensory weighting (one sense, either vision, vestibular or somatosensory is selected in favor over another in maintaining balance).

In some minor cases, vestibular rehabilitation may be performed at home. However, more serious cases may require an evaluation by a physician specializing in the dizzy patient such as an ear, nose and throat physician or neurologist. These specialists will determine the nature of your problem and may enroll you in a more structured program under the direction of a physical therapist. Some examples of vestibular rehabilitation exercises are:

  • Cawthorne-Cooksey Exercises are indicated if moving your head quickly causes dizziness, which is a sign of an inner ear imbalance resulting from a virus, wear and tear, etc. They give your balance system more practice with movements that cause dizziness.  Dizziness disappears because the brain learned to cope with new signals from your balance system. These exercises are head/body movements that progress from simple to complex to be done slowly/gently at first and then more quickly as the dizziness diminishes.
  • Recreational Activities/Eye Exercise involves using eyes while head and body is in motion: dancing, golfing, tennis, walking while looking from side to side.
  • Alternative Balance Activities (Yoga, Tai Chi, Pilates) incorporate slow gentle movements to improve strength, balance and posture and relaxation techniques for anxiety accompanying dizziness/off-balance.
  • Epley Maneuvers are indicated for vertigo caused by BPPV. In BPPV, particles in the inner ear become displaced and get lodged in an area that produces vertigo. Vertigo is experienced with tilting head, looking up/down and rolling over in bed. The causes include: infection, head trauma and degeneration. During the Epley maneuver the patient is guided through positional changes which clear these particles from the symptomatic part of the ear.
  • Gaze Stabilization Exercise involves staring with eyes fixated on a stationary object held at eye level. The head is rotated from left to right while gaze is maintained. Once mastered, this exercise is progressed to a more challenging one.
  • Somatosensory Dependence Exercises are helpful if proprioception from the legs is unreliable.  These exercises encourage reliance on vestibular or visual input. The exercises are performed on tilt boards, balance beams, foam and in sand to perform a variety of tasks from simple standing to more complex arm and leg movements.
  • Otolithic Recalibration Exercises: the ocular reflex (keeps eyes in visual field) and the righting reflex (keeps head upright). Unfortunately, both diminish with age. To stimulate these reflexes, bouncing on Swiss balls or minitramps are advocated.
  • Ocular Tracking Exercises are helpful in Meniere’s disease. They encourage use of visual tracking and vestibular stabilization in tandem. In other words, the eyes track objects that are moving in phase or in counterphase to their heads.
  • Posturography Training involves a moving platform coupled to a computer monitor. The goal is to maintain the center of pressure within a box on the screen or track a visual target by shifting body weight on the platform. This helps the individual learn what to expect from ones actions.
  • Virtual Reality Training is useful with inappropriate visual dependence and may assist in increasing an abnormally low vestibular ocular reflex

One fall increases your risk of another fall. It is imperative to determine what caused your fall and take action! Ask your physician to assess your fall risk.