Artwork: Here is a Sign by Forrest Best, 1970
How do you know if you or someone you love, such as an elderly parent, may need balance therapy? Below are 5 signs that balance therapy could be right for you. If it is, contact a physical therapist that specializes in balance therapy so that you can improve your health and decrease your risk of falling.
The bottom line is we want you around for a long time! A fall could cause an injury that would jeopardize your livelihood, and your functional independence. For those older folks, it could mean the difference between living independently on your own, or having to go to a nursing home- so take it seriously!
5 signs that a Person needs Balance Therapy:
1. Any fall that created a serious injury in the last 12 months.
2. Two or more falls without injury in the last 12 months.
3. Needing more that 1 attempt to rise from a chair.
4. Walking touching the walls & furniture for support.
5. Having a fear of falling is a significant risk factor for falls.
If you answered “yes” to any of these 5 signs, don’t wait to do something about it. Find a qualified vestibular specialist who can help you improve your balance. You can use these web sites to look for vestibular specialists in your area.
1. The Vestibular Disorders Association website
2. The American Physical Therapy Association Neurology section has a Vestibular Rehabilitation Section where you can search for vestibular specialists state by state.
Be empowered. Balance therapy CAN change your life!
This is the time of year when one can reflect on our lives and the things we want to improve on for the upcoming year. Why not make it your goal to improve your balance? One way to decide if your balance needs improving is by having your balance tested. Balance testing can be high tech, or low tech. The low tech testing is something that you could do at home, without fancy equipment, and it is based on a physical performance test. In other words, we ask a patient to perform a balance skill, and then see if they can do it or not. A person with good balance, and no history of inner ear pathology or neurological problems should be able to do the test.
One such test is called the Rhomberg Test. When I do this test with my balance therapy patients in Sarasota, Florida, I have the patient stand in a corner about 2 inches away from the wall, with a chair in front for safety. Then, I am standing by just in case. If you decide to try this test, have a friend or family member stand by to make sure you do not fall and get hurt.
The test is this- the person must stand with their feet together, with no space in between the feet. (If you are knock-kneed and cannot get your feet together, then put your knees as close together as you can). Next, you stand as still as you can, trying not to sway. The goal is to be able to do this for 30 seconds without falling, needing to open your eyes, take a step, or touch the wall or chair for support.
When standing with the eyes open, the person is using their vision, their inner ear system, and their somatosensory system to help them balance. Somatosensation is the sensation that allows your joints and muscles to send information to the brain to tell you if you are steady, or swaying. If a person cannot perform this test for 30 seconds, then they are at high risk for falling.
The second part of the Rhomberg Test is performed with the eyes closed. Again, the goal is to stand for 30 seconds. When the eyes are closed, the brain must rely on information from the inner ear, and feeling the ground in order to maintain balance. If a person falls in this test, they are reliant on their vision to maintain balance. This means that they would be at increased risk of falling if walking in a darkened setting, or on a complaint surface such as grass in the back yard when the sun is setting, for example.
How did you do with the testing? If the answer is “not so good”, make it your 2015 New Year’s Resolution to do something about it before you fall and get hurt. What should you do? Talk to your doctor about your balance, and find a physical therapist who specializes in treating inner ear balance problems. You could find a balance specialist in your area if you go to the Vestibular Disorders Association website. They allow you to search for a physical therapist in your area by entering your zip code. I believe you can achieve the goal of better balance in 2015! Happy New Year!
Painting: Planting the New Year’s Pine by Keisai Eisen, 1830s.
Basically, our brain relies on sensory input that tells it where our body is in space. Then the brain deciphers this information, and tells the joints and muscles what to do to maintain balance.
Where does the brain get its sensory information from? The 3 main sets of information the brain relies on come from our eyes, our ears, and the joints and muscles.
1. The eyes provide visual feedback as to where we are in relationship to our environment. For instance, if I walk outside and have to cross a crooked sidewalk, I see what is coming and subconsciously my brain tells my legs what to do to adjust my steps and maintain my balance.
2. A second set of sensory information comes from the nerve endings in our muscles and joints that tells that brain how we are shifting our weight on our legs, and if we are standing or walking on something firm, or soft, or slanted. We call this proprioception.
3. A third set of information comes from our inner ear system, (we actually have two of these, one in each ear). The ears act like little gyroscopes to tell the brain if we are moving. They tell the brain how far, how fast, and in what plane of motion we are experiencing movement.
The brain takes this sensory information, and then tells the joints and muscles what to do to maintain balance.
If you understand this concept, then watching Nik Wallenda walk a couple weeks ago between the skyscrapers in Chicago, will be even more meaningful to you. As some of you may have figured out, Nik Wallenda and I both live in Sarasota, Florida. A friend said to me, “Hey, Nik Wallenda is practicing for his Chicago walk tonight at 6 pm, do you want to go watch and show our support?”. How could I say no to that?!!! After watching him practice, I knew he could do it, and I was able to watch the Discovery Channel to see his triumph.
Here are some pictures I took of him when he was practicing in Sarasota.
As you can see here, he is walking on the wire up an incline. He is using his vision, his proprioception (feeling the alignment of his body on the wire), and his inner ear system. You could even argue that he is using his hearing too, but that is a topic for another blog. His brain is getting this SENSORY information, and then tells his joints and muscles what to do to maintain balance and walk the wire. At every second, this system is analyzing and reanalyzing, and deciding what to do next. When walking with his eyes open, his vision and inner ear system are sending very reliable information on what is happening, and his proprioceptive system is also sending information, but it is more variable because the wire can move and be unpredictable.
In this picture, Nik is walking blindfolded. WHATTTT!!! He essentially deprived his brain of very reliable information, and now he only has the sensation from a wire that can move, and from his inner ear system. His inner ear system is sending the most reliable information in this condition.
Nik- blindfolded on his way to the tower. Doing what he does, walking the wire blindfolded, with only 2 sets of information for his brain to utilize is astounding. When watching the Discovery program that night, I remember his wife and mother saying that they were most worried about the blindfolded portion. When they said that, I thought to myself, me too!!! Now I hope you can understand from a physiological standpoint why this was so unbelievable. Hopefully one day, Nik will be a guest blogger on my blog, because his mission is to inspire people. I bought one on his signed posters that day to put in my office to help inspire my patients with balance problems. It says at the bottom, NEVER GIVE UP-DARE TO BE GREAT! Thanks, Nik Wallenda for all you give to others.
Time to check my messages…
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