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

What is balance

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