BALANCE Disorders + symptoms + causes +Types + treatments + Training Exercise !

( Useful post for physical therapists (and OTs) )

A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking.

It may be accompanied by feelings of giddiness or wooziness, or having a sensation of movement, spinning, or floating.

Balance is the result of several body systems working together: the visual system (eyes), vestibular system (ears) and proprioception (the body’s sense of where it is in space).

Degeneration or loss of function in any of these systems can lead to balance deficits.

**symptoms of a balance disorder?

If balance is impaired, you may feel as if the room is spinning.
You may stagger when you try to walk or
teeter or fall when you try to stand up.

Some of the symptoms you might experience are:

• Dizziness or vertigo (a spinning sensation)
• Falling or feeling as if you are going to fall
• Lightheadedness, faintness, or a floating sensation
• Blurred vision
• Confusion or disorientation
Other symptoms are nausea and vomiting,diarrhea, changes in heart rate and blood pressure, and fear, anxiety, or panic.
Some people also feel tired, depressed, or unable to concentrate.
Symptoms may come and go over short time periods or last for longer periods of time.

**causes a balance disorder?

_ viral or bacterial infections in the ear,
_ head injury,
_ blood circulation disorders that affect the inner ear or brain.
_ also many people experience problems with their sense of balance as they get older.
_ Balance problems and dizziness also can result from taking certain medications.
_Vestibular disorders can also result from or be worsened by genetic or environmental conditions, or occur for unknown reasons.

**some types of balance disorders?

Some of the most common are:

*Benign paroxysmal positional vertigo (BPPV) or positional vertigo is a brief, intense episode of vertigo that occurs because of a specific change in the position of the head.

If you have BPPV, you might feel as if you’re spinning when you look for an object on a high or low shelf or turn your head to look over your shoulder (such as when you back up your car). You also may experience BPPV when you roll over in bed.

BPPV is caused when otoconia tumble from the utricle into one of the semicircular canals and weigh on the cupula. The cupula can’t tilt properly and sends conflicting messages to the brain about the position of the head, causing vertigo.

BPPV sometimes may result from a head injury or just from getting older.

*Labyrinthitis is an infection or inflammation of the inner ear that causes dizziness and loss of balance. It frequently is associated with an upper respiratory infection such as the flu.

*Ménière’s disease is associated with a change in fluid volume within parts of the labyrinth. Ménière’s diseasecauses episodes of vertigo, irregular hearing loss, tinnitus (a ringing or buzzing in the ear), and a feeling of fullness in the ear. The cause of this disease is unknown.

*Vestibular neuronitis is an inflammation of the vestibular nerve and may be caused by a virus. Its primary symptom is vertigo.

*Perilymph fistula is a leakage of inner ear fluid into the middle ear. It can occur after a head injury, drastic changes in atmospheric pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections.

Its most notable symptom, besides dizziness and nausea, is unsteadiness when walking or standing that increases with activity and decreases with rest.

Some babies may be born with perilymph fistula, usually in association with hearing loss that is present at birth.

*Mal de debarquement syndrome (MdDS) is a balance disorder in which you feel as if you’re continuously rocking or bobbing.
It generally happens after an ocean cruise or other sea travel. Usually, the symptoms will go away in a matter of hours or days after you reach land. However, severe cases can last months or even years.

** How is a balance disorder treated?

The first thing a doctor will do to treat a balance disorder is determine if your dizziness is caused by a medical condition or medication. If it is, your doctor will treat the condition or suggest a different medication.

Some people with a balance disorder may not be able to fully relieve their dizziness and will have to develop ways to cope with it on a daily basis.

A vestibular rehabilitation therapist can help by developing an individualizedtreatment plan that combines head, body, and eye exercises to decrease dizziness and nausea.

To reduce your risk of injury from dizziness, avoid walking in the dark.
You also should wear low-heeled shoes or walking shoes outdoors and use a cane or walker if necessary.
If you have handrails in the home, inspect them periodically to make sure they are safe and secure.
Modifications to bathroom fixtures can make them safer.
Conditions at work may need to be modified or restricted, at least temporarily.

driving a car may be especially hazardous. Ask your doctor’s opinion about whether it’s safe for you to drive.

***Some of Important balance training exercises : ***

Many balance problems may improve with a rehabilitation program. Often, balance
training exercises are critical in improving balance function.


Cawthrone’s exercises should be carried out for 4 minutes, 10 times per day. You can
expect dizziness when beginning these exercises and you will find this lessen over time
with repetition. Be seated while doing these exercises.

_Eye exercises: Look up, then down—at first slowly, then quickly 20 times. Look from
one side to the other—at first slowly, then quickly 20 times. Try to focus on an object at
the end of each head turn.
_Head exercises: With eyes open, bend head forward, then backwards—at first slowly,
then quickly 20 times. Turn head from one side to the other—at first slowly, then quickly
20 times. As dizziness lessens, these head exercises should be done with eyes closed.
Sitting/Bending: While sitting, shrug your shoulders 20 times. Turn shoulders to the
right, then to the left 20 times. Bend forward and pick up objects from the ground and sit
up 20 times.
_ Standing: Change from a sitting to standing position, and back again, 20 times. Do this
initially with eyes open. As balance improves, do this with eyes closed (but only if you have a partner to help you). Throw a rubber ball (or similar objects) from hand to hand
above eye level.


1. Begin in a sitting position. Choose an object on the wall, such as a clock or picture.
Keep your eyes focused on the object from about 5 feet away. Turn you head to the
right and left about 30 degrees, making the head motion like saying “no”. Move the
head like a grandfather clock or metronome. You should be turning right to left and
then left to right about one time per second. Repeat this head turning 20 times/session.
2. Focus again on an object on the wall. This time move your head up and down, thus
making the head motion like nodding “yes”. Again, perform one nod per second, and
repeat 20 times.


These exercises should be repeated 10 times a day as tolerated. Ensure that someone
is with you and prepared to catch you should you start to fall!

1. Stand on a soft (compressible) surface with your eyes open for one minute. Keep
shifting your weight from your left leg to your right leg.

2. Stand on a flat (firm) surface with your eyes open for one half minute. Rock back
and forth about the ankle without bending at the hip.

3. Stand on a flat (firm) surface in a corner with your back against a wall. Keep your
eyes closed for one minute.

4. In the corner, practice standing on your heels and then your toes with your eyes
open for one half minute.

5. Walk across the room (with your partner) with eyes open, then again with them
closed. Walk up and down a slope with eyes open, then closed. Perform these 10
times a day.

6. Try swinging carefully with a partner, performing frequent turns. Any activity
involving stooping or turning is generally good.

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