It’s Balance Awareness Week so, in this month’s blog we look at this in more detail, Jane explains …

The vestibular system includes the parts of the inner ear and brain that process sensory information involved with balance. Vestibular disorders can be caused by disease, injury, poisoning by drugs or chemicals, autoimmune causes, traumatic brain injury, or ageing. Many vestibular disorders occur from unexplained causes.

Symptoms of vestibular disorders include dizziness, vertigo (a spinning sensation), loss of balance, tinnitus (ringing in the ears), fatigue, jumping vision, nausea/vomiting, hearing loss, anxiety, and cognitive difficulties.

Vestibular disorders impact patients and their families physically, mentally, and emotionally. In addition to physical symptoms such as dizziness and vertigo, vestibular patients can experience poor concentration, memory, and mental fatigue.

Many vestibular patients suffer from anxiety and depression due to fear of falling and the loss of their independence.
Size of the problem

• Almost 1 in 4 adults under 65 years report dizziness or vertigo, often causing occupational difficulties or preventing employment but less than 25 per cent had received treatment
• About 20 per cent with vestibular vertigo avoid leaving the house and 41 per cent require sick leave
• Over 38 per cent of those aged over 85 years fall annually; half in combination with dizziness or blackouts
• 2.4 per cent lifetime prevalence of BPPV (Benign Paroxysmal Positional Vertigo) alone, with only 8 per cent receiving effective treatment.

What is vestibular rehabilitation (VR)?
VR is an exercise-based programme to encourage the central nervous system to compensate for problems in the inner ear. Following thorough examination, a management plan may include:

• Eye and head movement exercises
• Exercises to improve standing balance and walking
• Specific techniques to reposition fragments in the inner ear which cause dizziness in BPPV (not carried out at the Centre)
• Education and advice on activities of daily living to improve confidence & function
• Advice on falls reduction/prevention.

• Significant improvement is achieved in:
• 80 per cent of patients with unilateral vestibular loss (e.g. labyrinthitis, acoustic neuroma surgery)
• 80 per cent of patients with BPPV after one treatment session
• Patients with a central cause (e.g. stroke) may show some improvement
• Use of VR in concussion, migraine, and nonspecific balance loss of the elderly may be helpful.

Manual therapists such as Physiotherapists/Osteopaths are ideally placed to provide early screening and intervention to minimise the impact on daily life of balance and dizziness disorders.

Lessons in The Alexander Technique can also help improve balance and movement for all, and greater functional reach (a clinical measure of balance) in elderly women to reduce the risk of falls.

If you would like some help contact us at the Centre for the best approach.

Sources:
http://www.csp.org.uk/publications/physiotherapy-works-vestibular-rehabilitation
http://vestibular.org/BAW
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Having a good sense of balance is essential in all walks of life and for all ages and as it is Balance Awareness Week this September, we look at what we need in order to balance.

There are three main systems; vision, somatosensory system and vestibular. The somatosensory system provides feedback from the skin, joints, tendons and muscles to tell you where you are in space. The vestibular system is a delicate part of the inner ear and it responds to changes and movements in your head position.  These three systems need to work together if we are to maintain a good balance.

All of our body is involved in maintaining balance but from the perspective of the somatosensory system one of the most important structures needed to function well is your foot. The sole of your foot is incredibly sensitive, and for good reason. It is constantly sending information from into the central nervous system so that you instantly and subconsciously change your body’s alignment.  The foot also promotes a stable pelvis in all weight-bearing activities by triggering a connection called the positive support response.

Why not try this exercise ….

• Sit on a stable chair with shoes and socks off.
• Feel the surface of the floor under your foot.
• Relax the toes.
• Without moving your knee or lifting your toes, slowly and smoothly move the pressure under the sole of your foot towards the outer border of the foot. This will lift your arch slightly.
• Then slowly move the pressure under the foot towards the inner border of the foot. This will flatten your arch slightly.
• This is called the listening foot as it is training the foot to pick up as much sensory information as possible. Try performing this on different surfaces, carpet, sand, bubble wrap etc. to make your foot listen.

Going back to the vestibular system and vision, the position of your head plays a vital role in getting accurate information to these systems for good balance. Excessive tension in the neck and shoulder muscles will pull your head out of position - a forward-head posture is a common symptom – and compromise your balance.

Try the following...

• Drop your head forward to look down at your feet and walk a few paces.
• Then look up and place your fingers in the groove behind your ears. Note, in between these two points and roughly level with your eyes is where your head sits on your spine.
• Let your hands rest by your side and the walk forward while allowing your head to balance on this spot. Notice the difference?
• Now walk while being aware of your feet ‘stroking’ the floor away as you move from the heel to ball of the foot.

Listening to your feet while maintaining a neck free of tension will improve both co-ordination and balance.

Check out our vestibular info blog and for more information on Balance Awareness Week, see http://vestibular.org/BAW
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