Balance Problems In Physical Therapy

Physical Therapy is used to help with many problems someone may face. Walking, talking, and writing are very important in everyday life. However, one that is hardly talked about is balance problems. Balance problems affect many people yet they do not know they have it or how to treat it. Balance problems are conditions that make you feel dizzy, lightheaded, or nauseous. Balance problems are commonly caused by health conditions, muscle weakness, joint stiffness, heart conditions, or problems in the inner ear or brain. Balance can also be caused by stroke, Parkinson’s Disease, or a brain injury. Balance is mainly controlled by the Labyrinth in your inner ear. The parts that make up the inner ear is called the vestibular system (Disorders,
2017; Problems, 2015). A patient with balance problems might experience tripping, swaying, stumbling, dizziness, vertigo, and falling. Although most patients are easily able to perform “static” movements, it is the “dynamic” movements that seem to be more difficult such as walking while turning their head to talk to someone. Balance problems often make people scared to perform everyday tasks because they are fearful they are going to fall. A side effect of balance problems is anxiety and depression because most patients feel like they can not do activities they enjoy on a daily basis. As a result of this the majority of patients end up with a decrease of muscle strength, flexibility, stamina, and an increase in joint stiffness (Problems, 2015; Vestibular, 2017). Diagnosing a balance disorder can be very difficult.
There are multiple causes but the main reasons are medical conditions and medications. To help measure a balance problem, doctors will recommend seeing a otolaryngologist--someone who specializes in the ear, nose and throat. They may take tests to decipher the causes of the problems. Otolaryngologist might want to take tests such as hearing exams, blood tests, electronystagmogram--measurement of eye movement and muscles--, imaging studies of your head and brain, or posturography. Posturography is a test that tests your body’s responses to a patterned screen. (Disorders,
2017). The most effective form of rehabilitation is vestibular rehabilitation therapy (VRT).
The reason why is because most patients who have balance problems the source comes from the vestibular system. Vestibular rehabilitation is a form of therapy that can reduce the primary and secondary causes of the vestibular system. VRT is an exercise based therapy that helps reduce vertigo, dizziness, gaze instability, and/or imbalance and falls. For the majority of patients with a vestibular disorder the amount of restoration of function to the vestibular system is very small. However, that is not the case with patients who have vestibular system damage. Patients who have vestibular system damage will end up feeling better and be able function after a couple of sessions. The reason why this happens is because the brain learns how to use the other senses (vision and somatosensory) to replace the insufficient vestibular system. The health of some major parts of the nervous system (brain stem, cerebellum, visual, and somatosensory sensations) are very important in deciding the amount of recovery that can be gained through therapy. For many, balance will increase over time. Those whose balance does not increase and continue to have difficulty returning to everyday life will find improvements while using VRT. Most patients who do use VRT take from six to eight weeks of therapy about one to two times a week (Vestibular, 2017; Rehabilitation,
2017). The goal of VRT is to use a problem-oriented approach. This is done by specifying specific exercises to the patient’s needs. So, before any type of therapy can be done, therapists have to perform a comprehensive clinical examination which identifies the problems related to the vestibular system. Three different methods can be prescribed depending on the vestibular-related problems: Habituation, Gaze Stabilization, or Balance Training (Vestibular, 2017).
Habituation
Habituation is exercises that are used to treat dizziness caused by self-motion and visual stimuli. Habituation exercises are needed when patients report an increase of dizziness when they move around. This especially happens when they make quick movements such as bending over or looking up to reach over their heads. The exercises are suppose to mildly, or at the most moderately, scare the patients’ symptoms of dizziness. These symptoms should only be temporary, and the patient should only move onto the next exercise if their symptoms return to the normal level. After a while with patience and perseverance, the patient’s dizziness should start to diminish as the brain learns to ignore the unusual signals from the inner ear (Vestibular, 2017).
Gaze Stabilization Gaze stabilization exercises are more commonly known for improving the control of eye movements so the patient's vision is not fuzzy during movement. These exercises are for people who commonly start moving around and their vision gets blurry while doing so. Another time the vision would go haywire is while reading or trying to identify objects. There are two forms of exercises to improve gaze stability. The type of exercise you have to use depends on the type and extent of vestibular disorder. One exercise includes keeping your eyes locked on an object while moving your head up, down, left, and right repeatedly for a couple minutes. The other exercise is suppose to use vision and somatosensation (body sense) as substitutes for the vestibular system. Gaze shifting and memory exercises use sensory substitutes to help with gaze stabilization (Vestibular, 2017).
Balance Training Balance training exercises are used to improve balance so that patients can do everyday activities such as self-care, work, and leisure successfully. The exercises used should be designed to the patient’s specific problem. The exercises need to be somewhat challenging but not difficult enough so that the patient will fall while doing them. Some balance exercises include visual and somatosensory cues, stationary positions and dynamic movements, coordinated movement strategies, and dual tasks (Vestibular, 2017). There are some factors that can affect the overall progression of VRT. Some factors include: a sedentary lifestyle, pain, and presence of other medical conditions (Vestibular, 2017).
Sedentary Lifestyle When you are inactive, it can lead to lower levels of health and fitness, which might cause problems. Being inactive can also decrease the tolerance to movement. When this happens patients are less likely to be active. Training the body to increase tolerance to movement and increase physical health is one of the main goals of VRT (Vestibular, 2017)
Pain
Pain is one of the reasons there is an increase of falls in older adults. Most patients restrict their mobility when they experience pain so in turn, leads them to have a more sedentary lifestyle. To avoid the pain the patients will not be able to do the exercises they are told to do, which restricts the VRT and the effectiveness of VRT too. Pain should be managed with the Physical Therapist to find out what the problem is and how to prevent it (Vestibular, 2017).
Presence of Other Medical Conditions When multiple medical conditions come up it is much harder to focus on just one. Anything that will interfere with the exercises will lower the chances of having a high success rate. Just like pain is a factor of falling so are other medical conditions (cardiovascular, arthritis, foot problems, vision problems, neurological diseases, cognitive impairments (Vestibular, 2017). Balance exercises are originally designed to help reduce environmental barriers and falls. Balance training should help a patient with walking outside or walking in the dark. Ultimately, balance training exercises are used to help improve standing, bending, reaching, turning, walking, and running so that patients can return to their everyday lives (Vestibular, 2017).