Keeping Your Balance in Life (Literally)

Little kids twirl and turn in dizzying circles for fun, arms outstretched, until they fall to the grass and watch the sky appear to spin. Older kids — and many adults — enjoy a similar thrill from gravity-defying roller-coasters.

But imagine if you couldn’t choose to take the ride — if you felt unsteady and dizzy when you tried to walk or even just sat still. Suddenly, the sensation is both sickening and dangerous.

Balance problems and dizziness are a common complaint among millions of Americans. It’s also one of the top reasons that people over age 75 see their doctor. Falls due to balance and gait dysfunction are among the leading causes of injury and death in the elderly, according to the National Institutes of Health (NIH), which addresses balance on its SeniorHealth website. These falls often lead to bone fractures, hospital stays and a loss of independence that may never be recovered.

‘Balance is an Acquired Skill’

But there is good news, too. Balance can be regained and improved through physical therapy and exercise. Physical therapist Flavio Leite, who specializes in balance disorders, works with patients in the Vestibular Rehabilitation Program at Baptist Outpatient Rehabilitation Center, located on the Baptist Hospital campus.

“Balance is an acquired skill,” Leite explains, which relies on three body systems working together:

• Visual. Try standing on one foot with your eyes open, and then again with your eyes closed, and you will experience the importance of vision in balance. Likewise, age-related vision decline affects balance. “We use vision to judge distance when we’re walking,” Leite says.
• Somatosensory. Think about how your body’s muscles and joints move and shift to accommodate the surface you’re walking on, be in concrete, grass or a slippery, wet floor.
• Vestibular. Based in the inner ear, this system detects head movement and helps your body adjust to outward motion. Think about sitting on a boat or standing in an elevator or driving a car up a circular entrance ramp to a parking garage.

When one system falters, the body can learn to compensate, Leite says. There are many types and causes of balance dysfunction and dizziness. Vertigo gives sufferers the perception of motion, often spinning, even when they aren’t moving at all. Dizziness also is described as feeling disoriented, unsteady, off balance or light-headed.

Situations in the environment or medical conditions that affect any of the three balance-related body systems can result in a loss of steadiness. Such conditions include cardiovascular disease, inner ear or vision problems, head injuries, central nervous system diseases such as Parkinson’s, weakness or pain, and peripheral nerve problems (often caused by diabetes) that can deaden sensation in the feet. Loss of balance is also a common side effect of many medications. In fact, some medications prescribed for dizziness may actually complicate the problem.

“Studies support the effectiveness of the exercise approach to treat patients with vestibular dysfunction and balance problems,” Leite said.

Baptist Hospital is about to begin a clinical study to test a specific balance-retraining program for elderly patients who are hospitalized after a fall. One group of patients in the study will receive the OTAGO exercise program before they are discharged from the hospital and the other will not. Leite will assess patients in the study. “I won’t know which ones received the retraining,” he said. The results of the two groups will be compared.

After a physician refers a patient for vestibular rehabilitation, the first step toward better balance is a complete evaluation. Leite starts by interviewing the patient, then having the patient perform functional tests, such as walking with shoes on and off. Leite will carry out positional tests to examine the patient’s ability to move from a sitting to standing position, for example. He also will assess the patient’s three balance systems before customizing a rehabilitation program.

Outpatient Rehab Includes Visual Exercises, Balance Training

The outpatient rehab program typically includes balance activities, visual exercises, endurance training, strength and flexibility exercises and a home exercise routine. Patients will practice walking on tip-toes, on their heels, in slow motion, along a straight line. They will stand with their feet in various positions, with their eyes open and with their eyes closed.

Some patients are diagnosed with benign paroxysmal positional vertigo (BPPV), a common inner ear disorder that creates an occasional but intense spinning sensation following any movement of the head. BPPV happens when tiny particles in the inner ear, called otoconia, are disrupted and move into the inner ear canals.

“I see a lot of people with BPPV after a car accident, a fall, an infection, allergies or even out of the blue,” Leite said. BPPV can be relieved in most people by performing the so-called “canalith repositioning procedure.” The patient’s head is repositioned at various gentle angles to move the otoconia out of the inner ear canals.

Leite also teaches patients and their families how to create a safe home environment to reduce the “extrinsic” risk factors for a fall, such as loose rugs, slippery floors and cluttered walkways.

For more information about balance and related issues, visit the Centers for Disease Control & Prevention’s STEADI website — Stopping Elderly Accidents, Deaths and Injuries. The site includes checklists for home safety, chair exercises, a video on assessing balance and more.

Image: Physical therapist Flavio Leite uses Frenzel goggles to magnify the patient’s eye movements and determine which inner ear canals are causing her benign paroxysmal positional vertigo (BPPV), a common cause of vertigo. He then repositions her head through various gentle maneuvers to move particles causing the vertigo out of the canal.