Balance Management

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Balance dysfunction can have a significant impact on daily life. Dizziness was 2nd only to back pain, as the most identified “illness” that required a doctor visit in the last few years. In fact, 75% of ER visits of patients over 75 are fall related injuries. 33-50% of the population over 65 years old experience falls and half of the patients that experience falls, do so repeatedly. There are approximately 500,000 falls reported annually and the cost to treat these injuries is over 20 billion dollars a year. This section will discuss some common balance system disorders and the patient populations that are at the greatest risk of fall related injuries.

Elderly Fallers

The elderly seek treatment for balance more than hearing loss, yet there are fewer clinicians to deal with them. They go to multiple physicians, multiple times looking for solutions but few receive the outcomes they desire. Falls are the leading cause of accidental death over the age of 95. This psychological trauma and fear of falling can produce a downward spiral of self imposed activity reduction leading to loss of strength, flexibility and mobility, thereby increasing the risk of future falls. Falling is not a normal part of the aging process and elderly fallers usually have an underlying condition different than their healthy, age matched peers.

Osteoporosis

Osteoporosis has an estimated 52 million sufferers over the age of 50 and that number will increase to approximately 61 million in 2020. Women especially develop a significant risk of falling and incurring a bone fracture. Research has shown that early identification combined with early intervention, could lead to reduction of the number of fall related fractures in this at risk population.

Sports Injuries/Orthopedic Patients

This population can range in age from young to old. High school athletes are constantly pushing themselves to return to the field of play too early and risking re-injury. Balance deficits in orthopedic patients exist, are often persistent, and impede the return to normal function. Research confirms the presence of proprioceptive deficits and musculoskeletal impairments in orthopedic patients and that balance problems exist in these populations.

Head Injury/Concussion

Whether a violent collision on a football field or in a car, post-concussion syndromes will often demonstrate balance deficits. Athletes with mild head injuries exhibit postural control instability for several days post injury. Research also shows that players who sustained one concussion were three times more likely to suffer a second concussion when compared to non-injured players.

Neurological Disorders

Disorders of the Central Nervous System can impact the perception of balance and how the environment can play a role with risks to fall. Parkinson’s Disease is a deficit in the Substantia Nigra portion of the brain that affects movement and coordination of specific motions. This population will have a high risk for falling backwards and need a lot of education to compensate for the neurological deficits. Multiple Sclerosis is another neurological disorder that does not allow signals to travel on the nerves from the brain to extremities. This population requires energy conservation and education to respond appropriately to the demands of daily tasks without fatigue. Peripheral Neuropathy is a condition that causes numbness and tingling in the lower extremities. Impaired sensation is another high risk factor for falls.

Stroke

Approximately 700,000 Americans suffer a stroke each year. It is still the number one cause of adult disability and the third leading cause of death in the United States. Depending on location of lesion and degree of severity, many stroke victims suffer balance deficits secondary to direct damage of the brain or from the impaired strength, range of motion, and/or sensation loss of hemiparesis.

Chemical Toxicity

Ototoxicity is a rare occurrence in 5% of the population that is treated for life threatening infections with Aminoglycoside antibiotics (gentamicin, streptomycin). The hair cells in the inner ear that are responsible for relaying balance information to the brain are damaged. These effects are irreversible and require timely intervention for assessing sensory system functional use for balance. Some chemotherapy drugs have been linked with balance disorders, and several prescribed medications have side effects that include dizziness. It is important to research new medications for possible drug interactions when taken in combination with current drug regimen.

Amputees

Whether upper or lower extremity, the loss of a limb can have a profound affect on Balance. A below the knee amputation will receive less sensation/ somatosensory information from a prosthesis. Even an upper extremity amputation can affect balance by altering the gait of normal arm swing patterns during walking.

Vestibular Disorders

The vestibular system is responsible for sorting out all the sensory information that we perceive and relaying it to the brain to take appropriate postural actions. Damage to this system will often result in vertigo or the sensation of spinning/dizziness when turning or tilting the head. This population is extremely complex and can require extensive testing to localize the area of lesion for appropriate treatment options. These patients respond well to Vestibular Rehabilitation and suffer from a wide range of pathologies including BPPV, Meniere’s disease, and labyrinthitis.

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