Losing one’s balance and falling due to dizziness is one of the primary reasons why older adults are admitted to the hospital. To maintain balance, the brain coordinates information from the eye, inner ear, and body position sensors. It then sends signals to the muscular system to react.
Three primary systems contribute to our sense of balance. The first is the visual system. The second is the inner ear. There are a series of canals that contain tiny hair cells, fluid, and crystals. This system is primarily involved with linear motion (moving forward) and angular acceleration (turning our head or body). The third system is the body position sensors. These are located everywhere but are increased in our palms, soles of our feet, and the base of the skull.
If there is a deficit in one or more of the systems, the others can compensate to some degree. However, the risk of losing one's balance increases. Numerous medical conditions can decrease the efficiency of this interconnected system. Persons who have sustained a stroke, particularly in the cerebellar portion of the brain have a decreased sense of balance. Many classes of prescription medication can specifically affect balance; however, there is a higher correlation with the absolute number of drugs taken. Any optical condition that decreases visual acuity can also affect balance.
Dizziness and balance issues can also be caused by other conditions like BPPV or Vertigo where you feel like the room is spinning and you can't get sure-footing underneath you.
Peripheral neuropathy, due to poor circulation, diabetes, or the side effects of chemotherapeutic drugs, affects the body-position sensors. Urinary tract infections negatively affect balance. Motor vehicle accidents, or trauma to the head, such as whiplash or concussion decrease balance. Orthostatic hypotension, which is a drop in blood pressure when standing up from a chair, can lead to transient dizziness and a decrease in balance.
Loss of balance can occur with transitional changes, such as standing up from a chair or bending over to pick something off the floor. The person may be aware that they are falling, or have no prior clue. The individual may notice that they shuffles when they walk or is stumbling over objects on the floor.
Common physician diagnoses include benign positional paroxysmal vertigo, unsteadiness of gait, vertigo, dizziness.
Physical therapy treatment of balance and dizziness issues begins with a thorough subjective history and objective assessment to determine which of the three systems mentioned above is involved (there may be more than one), as well as ruling out any non-musculoskeletal cause. Balance is examined in static positions (standing on one leg, tandem stance, etc), as well as dynamic (walk with head turns).
Strength and gait are assessed. The motion that provokes the loss of balance is also examined. A comprehensive treatment program and plan of care will focus on the deficits identified in the evaluation. If the impairment cannot be reversed (such as neuropathy or poor vision), treatment will focus on compensatory strategies to reduce the risk of falling.
As we age, our balance system naturally degenerates. We become more dependent on our visual system. Therefore, low-light situations are more problematic. Keeping rooms well lit, and using night lights in the hallway/bathroom for nocturnal trips to the restroom are recommended. Throw rugs and area rugs should be firmly attached to the floor to prevent sliding or getting one’s toes under it. Minimize clutter on the floor and maintain clear pathways in hallways and rooms. Handrails on stairways and grab bars in the shower/bathroom will provide stable surfaces to hold onto. Maintain physical activity, a sedentary lifestyle is a significant risk factor for falls and decreased balance.
How Can Physical Therapy Soothe BPPV and Vertigo?