CONDITIONS TREATED
Balance System
Physiologically, balance is the ability to maintain the centre of gravity of the body within its base of support with minimal postural sway. It functions both at rest and during movement of the body. It has been referred to as the sixth sense.
Psychologically, normal balance is vital to an individual's sense of well-being. The human being is the only animal able to move consistently in the upright posture on two legs alone. The complex sensory and motor connections involved require considerable practice in early childhood.
Sensation of balance
Normal balance is generally subconscious and we only have full cortical awareness when balance is lost. This loss of balance is very disturbing to the individual as it consists of unusual sensations. This disturbance is generally accompanied by fear and panic with the secondary autonomic effects of nausea and vomiting.
Equally important is the lack of sympathy by members of the public confronted by someone with loss of balance. The picture of a person swaying around and clutching for support whilst vomiting is generally assumed to be the result of excessive alcohol consumption.
Basic physiology of balance
To maintain normal balance the brain requires both complex sensory input and then needs to initiate well coordinated motor or muscle activity to maintain normal postural control.
The sensory inputs provide details of changes in the body's position within itself and in relation to the environment.
These sensory inputs are derived from:
- normal vision
- normal equilibroception (information from the balance organ in the ear)
- normal somatosensory feedback ( the perception of pressure on the feet and a sense of joint position)
The motor activity to maintain normal posture requires coordinated muscle movements along with pain-free easy movements of the joints. This motor activity is itself controlled by the normal somatosensory feedback.
The balance centers in the brain which correlate the sensory and motor activity must be intact and well vascularised.
Finally the individual must have confidence in all these balance mechanisms which will be derived from a lifetime of normal balancing.
Disordered balance function
With such complex motor and sensory systems involved it is easy to see how a slight malfunction in one or more areas can result in loss of balance. Disease in any of the following organs can cause imbalance.
Disordered balance function
Brain
- stroke damage
- neurological disease
- decreased blood supply
- the aging process
Eyes
- decreasing vision
- double vision
- alterations in spectacles
Ears
- ear disease involving the balance organ
Peripheral nerves
- diabetes
- hardening of the arteries
- neurological disease
Joints
- arthritis
- bone disorders
- orthopaedic surgery
- decreased activity from aging process or lifestyle changes
Muscles
- paralysis and contractures following stroke
- muscle wasting
- Sedentary lifestyle
In practice many patients have more than one cause for their loss of balance. Longstanding balance problems are often aggravated by the patient's loss of confidence in their balance function and with decreased activity they become out of practice of normal balancing.
Symptoms
Common reports of symptoms:
- Vertigo
- Imbalance
- Dizziness
- Spinning
- Giddy
- Floating sensation
Symptoms may come on suddenly or have a more gradual onset. They may be related to position changes or motion. It is useful to note one’s pattern as this will help your Consultant analysis your condition and guide appropriate management.
Symptom Management
Your programme will be specifically tailored to meet your needs however there are some common principles which will help you return towards your previous lifestyle. The aim of rehabilitation is for graded exposure to your symptoms alongside an appropriate exercise programme (which will be provided by your physiotherapist if indicated). It is important to bring on the symptoms to a manageable level to allow the system to compensate. Gradually over time you will find that you can do more and more before the onset of symptoms. This is the process of recovery.
Many people develop a cycle of over-activity and under-activity which can be hard to break. It is easy to do too much when you are feeling better however you may then feel worse resulting in a period of inactivity until your symptoms subside. One aim of rehabilitation is to help you to develop a more consistent pattern of activity so that you can manage more effectively on a day to day basis.
Principles of rehabilitation:
- Exercises and activities should bring on your symptoms to a manageable level in order for compensation to occur. Do not push beyond this as the aim is not for you to feel very unwell.
- Rehabilitation aims to re-establish more normal levels of activity to allow efficient functioning through the day on a long term basis.
- Tasks are introduced in a graded manner so that symptoms can be monitored and the task graded appropriately.
- Long term goals should be broken down into manageable steps and short terms goals set to provide structure to your programme.
- When symptoms are acute, it may be helpful to prioritise tasks to complete those that are most important first.
- Break activities up into manageable steps with short rests in between.
- Space tasks steadily through the day.
- Alternate periods of activity with periods of rest.
- Alternate heavy and light tasks.
- Vary activities through the day.
The following may assist with your rehabilitation programme:
- Routine: plan your day to allow time for activity and rest. Consider your week/month and try to space out activities appropriately.
- Life roles: consider delegating tasks to others when possible.
- Interests, values and goals: consider what is most important to you and make sure that you devote enough time to this area.
- Your physical and social environment: Communicate with those around you so that they understand your feelings.
As you progress through your rehabilitation programme, the aim is for you to have more control over your daily life and more consistency in your activity levels.
