Introduction to Balance Disorders (Kelli M. Watts, AuD)

What is balance

to keep or put (something) in a steady position so it doesn't fall

How do we control our balance?

-Vision (Vestibular Occulur Reflex)
-Proprioception
-Vestibular (inner ear) (Vestibular Spinal Reflex)

Balance Disorder

any condition that makes you feel unstable/dizzy

Balance Disorder Causes

-Aging
-Disease
~Cardiovascular
~Neurological
~Diabetes
-Medications
-Injury (trauma)
-Genetics (syndromes)
-Inner Ear Disorders
~Infection
~Autoimmune

Balance Disorders Symptoms

-Vertigo and Dizziness
-Imbalance and Falls
-Visual Disturbances
-Hearing/Ear Changes
-Cognitive and Psychological Changes

Vertigo

-true spinning sensation
-usually caused by damage to inner ear

Dizziness

-variety of sensations, including light headedness, floating, rocking

Imbalance

-stumbling, difficulty walking straight or turning corner
-clumsiness or difficulty with coordination
-difficulty maintaining straight posture
-tendency to look down to confirm the location of ground (walk w/ wide based gape)
-head may be held low and in tilted position
-tendency to touch/hold onto something when standing
-sensitivity to changes in walking surfaces or footwear
-difficulty finding stability in crowds or in large open spaces

Falls commonality

-common in:
~people over 65
~in home
-->on stairs/uneven flooring
-->in bathroom
~dim light
~unintentionally

Vision Disturbances

-jerking motion of eyes
-trouble focusing on tracking objects w/eyes
-objects or words on page seem to move
-discomfort w/busy visual environments (traffic, crowds, patterns)
-sensitivity to light, glare and moving/flickering lights; computers
-increased night blindness; difficulty walking in the dark
-poor depth perception

Nystagmus

jerking motion of eyes

Hearing/Ear Changes

-Hearing Loss
~permanent
~temporary
-Ear Fullness
-Tinnitus (ringing, roaring, buzzing, whooshing or other noises in ear)
-Sensitivity to loud noises or environments
~sudden loud sounds may increase symptoms of vertigo, dizziness, and imbalance

Cognitive Symptoms of Balance Disorders

-difficult concentration and paying attention
-forgetfulness and short term memory lapses
-confusion, disorientation, difficulty comprehending direction
-difficulty following speakers in convos, meetings (especially with background noise)
-mental and/or physical fatigue out of proportion to activity

Psychological Symptoms of Balance Disorders

-fear of falls
-anxiety
-panic attacks
-social isolation
-depression

Additional Symptoms of Balance Disorders

-nausea/vomiting
-motion sickness
-headaches
-slurred speech
-sensitivity to pressure and temp. changes
~may cause vertigo, dizziness, or imbalance

What is a Vestibular Disorder?

conditions that diminish function of vestibular system in inner ear

What is the vestibular system?

-processes sensory info involved w/ controlling balance and eye movements
-peripheral vestibular system includes:
~inner ear
-->saccule (up and down, pressure on it like in elevator)
-->utricle
-->semicircular canals (3) (head tilt)
~8th cranial nerve (12 in all)
-central vestibular system:
~vestibular nucleus (brain stem)
~cerebellum

How Vestibular Disorders assessed?

-VNG (videonystagnography)
-VEMPS (Vestibular Evoked Myogenic Potentials)
-vHIT (Video Head Impulse Test)
-Posturography
-Bedside Tests

Additional Vestibular Disorder Tests

Hearing, Vision, BP

Who works with Balance Disorder patients?

-audiologists (testing; refer to those below)
-PTs (therapy)
-Physicians
~otologists (ear surgeon)
~neurologists (progressive disorders)
~cardiologists (like BP)

How to treat Balance Disorders? Who does it?

-Physician
~surgery
~meds
-Audiologists
~amplification
~Tinnitus therapy
~Vestibular Rehab
~Full prevention Education
-PTs
~Vestibular Rehab
~Strengthening Exercises
~Full Prevention Education

VNG

(videonystagnography) battery test looking for nystagmus; camera on each eye

VEMPs

(Vestibular Evoked Myogenic Potentials) loud sound through headphones measuring electrical stimulation

vHIT

(Video Head Impulse Test) testing of 6 semicircular canals; quick movement of head (eye movement optimized)

Posturography

present visual and moving stimuli to see reactions of muscles

Bedside tests? What are the three types?

-use little to no equipment; looks @ balance
~may also include:
-->timed get up and go (TUG)
-->Romberg/Tandem Romberg
-->Stepping Fakuda

TUG

(timed get up and go) looking for speed

Romberg/Tandem Romberg

stability standing still (ROM)..put dominate foot behind like tightrope

Stepping Fakuda

marching with eyes closed