Balance Issues
Amy Skolaut
Moving Well Physical Therapy

Are you ever concerned about your balance or perhaps that of a family member? Ask these questions:

Do you have a fear of falling?
Have you fallen in the last year with or without injury?

If you answer ―yes‖ to either one of these questions, than you are at risk for a fall. No one at any age should be afraid of falling or feel like loss of balance is compromising normal activity level. And yet, research repeatedly indicates about one out of every three people 65 years or older will fall at least once each year. Even more shocking is that falls are the leading cause of injury deaths for people over 65 years.

Falls often lead to painful and expensive consequences, not to mention a greater fear of falling. Avoidance behaviors may develop and ultimately lead to a reduced activity level. Inactivity is even more detrimental when we are older. That is because as we age natural changes occur in our body such as reduced flexibility and weakening of muscles, loss of joint motion, loss of nerve input, and even decreased circulation to the brain. All of these changes contribute to slowing of the body’s response to balance situations. The less active you become, the more likely these changes will affect you. This makes you more susceptible to a fall.

Balance should not be a high cognitive level which means, you should not have to think about it. It happens automatically through the collaboration of information received via:

1. Visual system - ability to see your environment and any obstacles or potential dangers in it (corrective lenses, light vs darkened area?)

2. Somatosensory system – provides information about where your joints are in space without looking at them (walking in grass or on sand versus walking on flat cement)

3. Vestibular system – the inner ear (ie, the semi-circular canals) provides information to your brain and eyes pertaining to the position of your head as it moves through space (rotational, horizontal, and vertical movement)

Although balance is a complex sensorimotor process, the interaction of these systems can be improved once a problem is discovered. The vestibular system is highly subject to impairment with age. With prolonged inactivity, for example, this system becomes less sensitive and unable to contribute well to balance situations. However, the vestibular system has a high level of plasticity—it can be changed at any age and with the right exercises. A physical therapist can provide you with the correct exercises.

The vestibular system can also house another problem observed within the geriatric population. You may have heard the term BPPV or Benign Paroxysmal Positional Vertigo, considered the most common cause of vertigo. About 50% of all dizziness in older people is due to BPPV, and the incidence increases 38% with each decade of life from ages 50-80 years. Characteristic symptoms can include dizziness when getting out of bed; bending over; when looking up or down, side to side. Treatment of the vestibular system by a physical therapist can be highly effective.

Falls can be prevented. Making home modifications, exercising, and reviewing medications to reduce side effects can help to reduce the potential of falls and improve your quality of life. Seeking a balance evaluation from your physical therapist is important in determining if you may benefit from therapeutic intervention to:

• Identify and exercise the specific system of balance that is weak
• Improve the quality of your gait (Would you benefit from a cane?)
• Learn the safe and efficient biomechanics of movement (transferring sit to stand)
• Determine if any balance strategies are lacking
• Address any musculoskeletal weaknesses, inflexibility, loss of mobility
• Identify and eliminate avoidance behaviors due to a fear of falling
• Evaluate and treat dizziness as related to BPPV
• Assess postural control

Amy Skolaut
Moving Well Physical Therapy