Do you Know Balance disorder?


Last reviewed on: 23rd September, 2020

A balance disorder is a disruption that causes an individual to feel unstable, for instance when standing or walking. It may be supported by emotions of giddiness, or wooziness, or having a sense of motion, spinning, or drifting. Balance is an outcome of numerous body systems working together: including the Visual system (eyes), vestibular system (ears) and proprioception, failure of function in any of these systems can bring to balance deficits.

Proprioception is the feeling through which we detect the position and movement of our body, including our sense of equilibrium and balance, senses that depend on the impression of force.

SIGNS AND SYMPTOMS
When balance is undermined, an individual has difficulty pursuing an upright direction. For example, an individual may not be able to walk without staggering, or may not even be able to stand, and sometimes may have falls or near-falls. The following are some symptoms of balance disorder;
  • A feeling of dizziness
  • Lightheadedness
  • Difficulty reading and seeing.
  • Disorientation
  • Sometimes nausea, vomiting, diarrhea and faintness
  • Changes in heart rate and blood pressure
  • Fear, anxiety, or panic
NB:
The symptoms may start and vanish over a short time or may persist longer.

CAUSES 
It is caused by a disruption in any of the vestibular, visual, or proprioceptive systems. Defects in balance function may specify a wide range of pathologies from causes like inner ear syndromes, low blood pressure, brain tumors, and brain injury plus stroke. 

The following are important terms used by physicians to describe balance disorder, check out and understand. 

Vertigo 
Vertigo is the feeling of spinning or having the room spin about you. Most people find vertigo very troublesome and report associated with nausea and vomiting. 

Disequilibrium 
Disequilibrium is the sensation or emotion of being off-balance, and is most often defined by frequent falls in a specific direction, and it is not often correlated with nausea or vomiting. 

Presyncope 
Pre-syncope is a feeling of lightheadedness or faint, syncope means fainting. People with low blood pressure are more likely to feel dizziness when suddenly stands up. Difficulties in the skeletal or visual systems, such as arthritis or eye muscle imbalance, may also cause balance complications.

TREATMENT 
There are several choices for treating balance disorders. One choice includes treatment for a disease that may be endorsing to the balance problem. These diseases includes ear infection, stroke, multiple sclerosis, spinal cord injury, Parkinson's, neuromuscular conditions, acquired brain injury, cerebellar dysfunctions or ataxia, also some tumors, such as acoustic neuroma. 

Treatment will be based upon assessment results including symptoms, medical history, general health, and the results of medical tests. 

Another treatment choice is balance training, prescribed by an occupational therapist or physiotherapist. Physiotherapists frequently administer consistent outcome measures as part of their valuation in order to gain useful information and data about a patient’s existing status. 

The success of these exercises or training depends on their being performed correctly. The following are important exercises that can be used at home or hospital 

1. Vestibular rehabilitation exercises 
Involves retraining the brain to recognise and process signals from the vestibular system, in coordination with a message from vision and joints muscle, the brain will regain balance control and minimize dizziness symptoms (Vestibular compensation). The following are vestibular rehabitation exercises that can be performed at home or hospital. 

1.1. Cawthorne-Cooksey Exercises 
Involves lessening the neck and shoulder muscles, training the eyes to move autonomously of the head, practicing good balance in everyday conditions, practicing the head movements that cause dizziness 'aid on vestibular compensation' improving general coordination and promoting natural unprompted motion. 

Before starting any of these exercises, it is important to choose a safe environment in order to reduce risk of injury. If you feel unusual or dizziness don't complete any exercises, also while doing these exercises sometimes you may experience mild dizziness which is normal. 

Each of the exercise below should not be completed more than 10 times, at first start slowly but as you gain experience overtime exercise will be easier and you will do them more quickly than before. 

Check out the following Cawthorne Cooksey exercises; 

1. In bed 
A. Moves your eyes up and down from side to side, focusing on finger movement about 30cm to 90cm away from face. 
B. Move your heads by bending forwards and backward, bending from side to side.

2. Sitting 
A. Move your head and eye the same as in part 1 above 
B. Pullover and round shoulders 
C. Kneel forward and take up objects from the floor 
D. Kneel side to side and take up objects from the floor 

3. Standing 
A. Move your head, eye and shoulder as in part 1 and 2 
B. Shift from a sitting to a standing posture with eyes open, then closed 
C. Shoot a ball from hand to hand above eye level 
D. Shoot a ball from hand to hand under the knee 
E. Shift from a sitting to a standing position, rolling around in between 

4. Moving 
A. Move up and down a slope 
B. Move up and down steps 
C. Shoot and catch a ball 
D. Any exercise involving kneeling, pulling and pushing


IMPORTANT 
It is advisable not to attempt any of these exercises without first consulting a specialist for detailed assessment, suggestion and recommendation. Some of these exercises will not be applicable for everyone, and some are only acceptable for certain situations. 

1.2. Gaze stabilization exercises 
The purpose of gaze stabilization exercises is to increase vision and the ability to focus on a stationary object while the head is moving. Your psychotherapist should assess you and say which exercises are appropriate for you. The following are procedures for performing these exercises; 

1. Look straightforward and focus on a letter (for example, an ‘B’) held at eye level in anterior of you. 
2. Shift your head from side to side, keeping your eyes attentive on the target letter. Figure up the speed of your head movement, it is vital that the letter stays in focus. If you get too dizzy, slow down. 
3. Start performing these exercises for a length of time that fetches on mild to moderate symptoms; this might be for 10 seconds. Later, you can build up to one minute (time important for brain adaptation). 
4. Build up slowly to repeat three to five times a day, you can also do these exercises with an up and down movement. 

Progressions with this exercise can include inserting the target letter on a busy background; you should start the exercise while seating and then change to standing. 

1.3. Canalith repositioning procedures 
The purpose of canalith repositioning procedures (CRPs) is to train people with benign paroxysmal positional vertigo (BPPV). It is believed that BPPV may be caused by crystals becoming removed from their usual place inside the inner ear, and moving into another area within the ear that is accountable for sensing spinning (the semicircular canals). When the crystals move around in this part of the ear it causes dizziness or faintness. Canalith repositioning procedures involve a sequence of definite head and upper body movements that may be able to move the crystals back to their right place in the ear. 

The two main CRP cures are the Epley manoeuvre and the Semont (Semont-Liberatory) manoeuvre. It is important that these manoeuvres are only performed by a skilled specialist to inhibit the risk of neck and back injuries. The manoeuvres are not suitable for everyone, it will not be suitable if you have pain or difficulty in your neck or if you have had a neck injury. 

1.4. Brandt Daroff exercises 
These are a treatment that can be implemented at home without the direction of a specialist; it is imprecise exactly how these exercises work. Frequent head movements may work by moving the crystals back to their right position inside the inner ear (as with CRPs).

Repeated exposure to movements that incite dizziness symptoms clarifies your brain not to pay attention to the signals it is receiving from the ears as much (meaning vestibular compensation). The procedures of these exercises are as follows; 

1. Sit on the edge of the bed and twist your head 45 degrees to one side. 
2. Fast lie down on your opposite side (to the left if you twisted your head to the right, and vice versa) so that the back of your head behind your ear touches the bed. 
3. Hold this point for about 30 seconds or until the faintness symptoms stop. 
4. Reoccurrence to the sitting position. 
5. Recap steps 1-4 on the other side. 

IMPORTANT 
You ought to repeat these steps three times or until you have accomplished six recurrences on each side, unless your medical professional recommended otherwise, you ought to do these exercises two to three times a day for two weeks. 

These exercises can probably make you feel dizzy while you accomplish them, but it is essential to keep it up in order to feel better 

2. Medication 
Relaxing drugs are often recommended for vertigo and dizziness, but these commonly treat the signs rather than the core cause. Lorazepam (Ativan) is frequently used and is a calming which has no effect on the disease development, but rather assists patients cope with the sensation. 

Anti-nauseates, like those recommended for motion sickness, is also often recommended but do not affect the diagnosis of the disorder.

Posted by: Lusubilo A. Mwaijengo

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