HOW YOU CONTROL YOUR BALANCE

The balance control process
Loss of balance control
Inevitable?
Identifying and treating balance disorders
Balance can be improved

Balance is vital to normal every day life activities such as getting out of a chair and walking, bending over to put your shoes on, washing your hair, driving a car or going grocery shopping. Just about everything you do in your daily life, whether for work or leisure requires balance control, and most of the time you don't have to think about it. If balance problems develop, though, they can cause profound disruptions in your daily life. In addition to increased risk for falls, balance disorders can shorten your attention span, disrupt normal sleep patterns, and/or cause excessive fatigue.

The balance control process

Ability to maintain balance is a complex process that depends on three major components: (1) your sensory systems for accurate information about your body's position relative to your environment; (2) your brain's ability to process this information; and (3) your muscles and joints for coordinating the movements required to maintain balance. The sensory systems include your sense of touch (feet, ankles, joints), your vision and your inner ear motion sensors. For example, we rely on our feet and joints to tell us if the surface we are standing on is uneven or moving. We rely on our eyes to tell us if the environment around us is moving or still. And we rely on our inner ears to tell us if we are upright or leaning, or standing still or moving.

Balance SensorsNormally, balance control is accomplished "automatically" without requiring our conscious attention. When our balance "auto pilot" is disrupted, we have to exert intense conscious effort to try to overcome the abnormal sensations and maintain control of our balance. This intense effort, in turn, is what leads to the common secondary symptoms such as shortened attention span and fatigue.

[back to top]

Loss of balance control

In a normal healthy individual our senses of touch (feet, ankles, joints), sight (eyes) and inner ear motion sensors work together in harmony with the brain. A person with a balance disorder, however, may have a problem in any one of these systems, or in multiple systems. In some individuals, one or more of the senses are missing and the person does not realize they are losing their balance. In other people, the brain gets confused and creates an inaccurate sense of falling when in fact the person is in balance. The risk of developing one or more of these problems increases with age as our senses or brain centers are exposed to degenerative or infectious diseases, or the effects of injuries accumulated over a lifetime.

[back to top]

Inevitable?

Is a loss of balance control an inevitable consequence of aging? No. The natural aging process produces changes in our bodies as we grow older, but these changes do not necessarily result in a loss of balance control or mobility. Healthy seniors are quite able to perform daily life activities normally with few physical limitations. In fact, recent studies have indicated that, elderly fallers are different from their healthy, age-matched counterparts1,2,3. Dizziness among older adults can also be caused by a collection of subtle degenerative or infectious processes or injuries that in combination result in a balance problem4.

Some individuals experiencing balance problems have an obvious medical diagnosis such as diabetes, Parkinson's disease, or even a stroke that are primary sources of the problem. In other individuals with balance difficulties, the cause can even be subtle undetected forms of these diseases. However, diseases are not the only reason our senses and movements may be compromised. A history of injuries, such as concussions, ear infections, or serious sprains or fractures, may contribute to a loss of balance control over time. In addition, various combinations of medications, both prescription and over the counter, can be detrimental to our senses or brain and cause either temporary or permanent damage.

[back to top]

Identifying and treating balance disorders

Because of the complexity of balance control, not all balance problems are the same. As mentioned above, some individuals lack information from a sensory system and do not realize they are losing their balance, while for others, the brain gets confused and creates an inaccurate sense of being off balance. Because of the wide variety of balance problems, determining the cause of a balance disorder and what treatment options are the most appropriate can be difficult. In the last twenty years, however, there have been significant advances in evaluation and treatment approaches to balance disorders that have proven to be highly effective and offer relief to those suffering from imbalance or dizziness. There are also medical professionals and clinicians who are specially trained to apply these evaluation and treatment methods.

[back to top]

Balance can be improved

It is not uncommon for individuals with a history of balance problems to regain their balance control through accurate diagnosis followed by specific medical treatment and/or rehabilitation exercises. One famous example is astronaut John Glenn. Following his historic space flights in the 1960's, Glenn experienced balance problems that disqualified him from service. After a rehabilitation program, Glenn was able to return to space at the age of 77 and he performed as well as his younger colleagues. You can recover from balance disorders and regain your control. And you can do this even at an advanced age!

If you are suffering from a balance disorder, it is important that you seek out medical professionals who are qualified in this area. A listing of clinicians is included on this site, as well as an extensive list of additional resources.

[back to top]

References:
  1. Horak, F.B., Shupert, C.L., & Mirka, A. (1989). Components of postural dys-control in the elderly: a review. Neurobiology of Aging, 10, 727-738.
  2. Whipple, R. & Wolfson, L.I. (1989). Abnormalities of balance, gait, and sensori-motor function in the elderly population. In Duncan, P.W. (Ed.), Balance: Proceedings of the APTA Forum, American Physical Therapy Association, Alexandria, VA, 61-68.
  3. Lizardi, J.E., Wolfson, L.I. & Whipple, R.H. (1989).Neurological dysfunction in the elderly prone to fall. Journal of Neurological Rehabilitation, 3 (3), 113-116.
  4. Tinetti, et al (2000). Dizziness among older adults: A possible geriatric syndrome. Annals of Internal Medicine 132:337-403)
  5. Tinetti, M.E. & Speechley, M. (1989). Prevention of falls among the elderly. The New England Journal of Medicine, 320 (16), 1055-1059.