Balance therapy is a generalized category of physical therapy exercises to help an individual improve their balance. The ultimate goals of balance therapy are to prevent falls and increase a person’s functional abilities and independence, both at home and in the community.
These goals are driven by the following 4 main factors:
1. Lifestyle. Is the person sedentary with hobbies such as reading, playing bridge, or watching TV? Is the person active with hobbies such as golf, tennis, boating, or gardening?
2. Location. Where does the person live, and what are the obstacles they encounter in their home or community? For instance, my balance therapy practice is located in Sarasota, Florida. In order for my patients to function safely in the community, they need to be able to walk on uneven parking lots or sidewalks, and walk up and down the periodic ramp or curb. Most of the homes in Sarasota are condos or single story homes with only one step to enter the building. The only reason a person might walk on the grass would be if they are a golfer, enjoy gardening, or enjoy walking on uneven surfaces at the beach or local parks. However, if they are a snowbird and only come to Florida in the winter, when they return to their home up north they may live in a 2-story home with 5 steps to enter. The bedroom and bathroom may be upstairs, and the washing machine down in the basement, and they may have a cobblestone driveway. I think you get the idea…
3. Personal choice. What does the person want to achieve or be able to do that they cannot currently do because of poor balance? This is different for every person. Some people just want to be able to walk around their home without falling, and to go to the grocery story or doctor’s office on their own. Some people want to improve their balance so that they do not need to use a cane or walker. Some people have given up a sport they used to love because of their poor balance, and their goal is to return to playing golf or tennis again with their friends.
4. Health Status. A person’s underlying health status plays a factor in setting reasonable goals. For instance, if the person has terrible arthritis in their knees, a reasonable goal is probably not that they would be able to run a marathon or climb Kilimanjaro. However, it may be reasonable that they should be able to climb a flight of stairs safely, or be able to walk their dog each morning with good balance.
I want to encourage you to think about your personal goals and discuss these things with your balance therapist. Having good goals with motivate you to do your home exercise program, and allow you to chart your progress.
Included image: Balance, a painting by Norval Morrisseau
A former patient recently came back to see me due to an article he received from the Harvard Health Letter. I thought it was a good article, and wanted to share it with you. Maybe you, or your parent, or loved one, need to think about how using a rolling walker could improve safety and independence. An evaluation by a physical therapist would help in determining if you could benefit from balance therapy, and if using a rolling walker is a good idea. In the case of my patient, he was so happy with the walker because now he is able to walk without assistance of another person, and he can walk for much longer distances than he ever could with his cane alone.
Click here to read the article.
This week, we are celebrating Balance Awareness Week at my physical therapy practice in Sarasota, Florida. In honor of this recognition, I am happy to share with you a new infographic from the Vestibular Disorders Association. Infographics are pictures boards that help to communicate a concept or idea. I hope this infographic helps you better understand what causes dizziness, and what to do about it!
Old woman seen from behind, sketch and study in pencil by Van Gogh, 1882
Most people with balance problems want to avoid walking with a cane or rolling walker unless absolutely necessary. Even when necessary, many people refuse to use a cane because they are too proud or embarrassed for others to see them walking with one. The thing is, if a person is at risk for falling, a fall can cause serious injuries, and even death.
The Center for Disease Control estimates that one out of three adults age 65 and older falls each year, but less than half talk to their healthcare providers about it. And among older adults (those 65 or older), falls are the leading cause of injury death! This is a serious issue...
So I tell my clients, “You need, what you need, when you need it”. The purpose of the balance exercises is for the person to improve to the point where they don’t need the cane or walker. But until that time comes, the last thing a person needs is to add to their problems by falling and getting hurt... When my balance patients in Sarasota understand that the cane or walker isn’t meant to be a “forever thing”, they are usually willing to use it temporarily until their condition improves.
If you or someone you love falls into this category, I encourage you to use a cane or walker, and to seek out a physical therapist who specializes in balance disorders, so that you can address your balance problem and regain your safe and independent lifestyle again.
Balance Awareness Week is September 15th-21st, 2014!
Are you having a balance problem? The goal of balance awareness week is to help people recognize if they are having a problem, and to urge them to seek help. Falling is not a normal part of aging. We know that falls can lead to serious injuries and even death. If you have had one fall with serious injury in the last 12 months, or 2 falls without injury, I encourage you to seek out a professional vestibular balance specialist. Something can be done to help your problem!
Generally speaking, balance therapy is a type of physical therapy that is performed to help a person with a balance problem. Different therapists may approach treating a balance problem based on their own background and expertise. For example, a therapist who comes from an orthopedic background and loves treating mainly people with joint and muscle problems, will tend to do what makes their other orthopedic patients better. That is, put the patient on a bike, and give them leg exercises. If the patient’s balance problem is caused by muscle weakness, they will improve.
However, if the problem is not weakness, they will not improve. It is not unusual for me to get a patient for balance therapy in my Sarasota office, and for the patient to say straight out that they don’t think I will be able to help them, because they have had a lot of physical therapy and did not get any better. The next question I ask is, “Well, tell me what you were doing?”, and 9 times out of 10 they will say sitting on a stationary bike and using machines to strengthen their legs. I usually tell that person, well, good, I am glad to hear that the exercises I have in mind you haven’t done before, so there is still a chance that you will get better.
What are these exercises? They include inner ear balance exercises. Our inner ear system is the major organ in our body that powers our balance. It tells our brain when our head or body is moving, so that the brain can tell the joints and muscles how to move to maintain balance. A classic inner ear exercise is to improve the vestibular-ocular reflex, or VOR. This is a reflex between the ears, the eyes, and the brain. Just to explain it a bit… If a person looks at a target and moves their head side to side, they are stimulating their VOR. The inner ear sends messages to the brain to tell the brain how far or how fast the person is turning their head, and the brain uses this information to coordinate the person’s eyes on the target while the head is turning. If the VOR was not working properly, then when the person turns their head, instead of keeping their eyes on the target, they would find that they are looking in the direction of the head turn. If the person’s VOR is not working properly, the patient could have complaints of dizziness, and be unsteady when walking, especially if turning their head to look at something to the side. Another exercises involves keeping the head still, but watching a moving target. If you would like to see this exercise demonstrated, click here to check out the segment on falls and balance that I recently did for ABC News 7.
According to the CDC, one out of three adults age 65 or older suffer falls each year.
These are only a couple of examples of exercises that improve one’s balance. I know it may sound complicated, but it makes perfect sense. If you have a good balance physical therapist, they should know these exercises and include it in your program to make your ability to use inner ear information stronger. This is just one example of how working with a qualified balance and vestibular therapist, and not just someone who went to PT school, can make all the difference.
Related Article: Trips and falls cause millions of injuries a year
Sitting old man waiting in hall, by Abraham van Strij
Medicine and technology are amazing. People who are deaf can get cochlear implants to restore their hearing, while others get corneal implants for their eyes. There are hip and knee replacements for arthritic joints, and the list goes on… If you have in inner ear balance problem, you may be wondering, “When will someone make an implant to restore my balance?"
Well, Dr. Jay Rubinstein from the University of Washington is definitely one of the researchers in the know. A few years ago, I met Dr. Rubinstein at a University of Colorado ENT meeting. At that time, he was reporting on his early results from implanting human subjects with his vestibular device. When I saw him again in February 2014, he was kind enough to give me an update.
His first studies were done on rhesus monkeys that had healthy inner ear systems with intact hearing and balance function. In order to start testing the device on human subjects, the device needed approval from the Food and Drug Administration (FDA), and the study had to pass strict scrutiny by an institutional review board (IRB) to prove that the research was ethical and would not harm the subjects involved. Dr. Rubinstein had to find a population of people who from a hearing and balance point of view had nothing to lose and everything to gain by participating in the study.
The first group of 4 people to be implanted had a condition called Meniere’s Disease. These patients had already lost their hearing and vestibular function (inner ear balance control) due to Meniere’s Disease before they were implanted. He has now been following these initial patients for one to three years. Because the device can be turned on and off, Dr. Rubinstein compared how the device benefits the person’s balance control, and also how the device improves the ability of the person to stabilize their vision and decrease the visual bouncing phenomenon called Oscillopsia. Oscillopsia is kind of like the effect one would get if watching an amateur video that someone took as they were walking down the street. It looks as if the world is bouncing. One goal of the implant is that by restoring inner ear function, the oscillopsia would stop.
So you must be wondering, what did he find? Dr. Rubinstein found that over time, the electrical response from the device declined. Based on these findings, he adapted the vestibular implant to make the responses generated more robust.
Sounds great, right? But not so fast. Because research on human subjects is very, very regulated, Dr. Rubinstein has to go back to the FDA to get the new device approved, and then has to submit a whole new IRB research protocol for approval! Once that hurdle is jumped, the next hurdle is funding. As you can imagine, this type of research is very expensive and takes a lot of money…
So you see, research takes perseverance. Dr. Rubinstein certainly has that! I am very grateful that he took the time to talk with me, and has allowed me to share these things with you! I told him that my patients are always asking me when there will be a cure for their problem, and I tell them – “they’re working on it...” Truly, hope is on the horizon.
Hi, everyone. I just wanted to let you know that if you live in Sarasota or Manatee County in Florida, there is a great event going on this weekend. It is the called the 3rd Annual Hearing Tech Expo, held on Saturday, March 8, 2014 from 9am-4pm.
Over 50 vendors who help people with hearing loss will be present. There will also be 14 seminars taking place. I will be giving one of the seminars, and the title of my talk is “Understanding Balance Problems, and what to do about them”. My talk is at 1:30 pm in the main auditorium of the Manatee Technical Institute (located on State Route 70, just west of I-75, and east of route 301).
This is a super event, and I hope you can make it. It is sponsored by the Hearing Loss Association, whose purpose is to educated, support, and advocate for the over 135,000 people who live in Sarasota and Manatee counties. Hope to see you there!