Medicine:Balance disorder
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A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness, or wooziness, or having a sensation of movement, spinning, or floating. Balance is the result of several body systems working together: the visual system (eyes), vestibular system (ears) and proprioception (the body's sense of where it is in space). Degeneration or loss of function in any of these systems can lead to balance deficits.[1]
Signs and symptoms
Cognitive dysfunction (disorientation) may occur with vestibular disorders. Cognitive deficits are not just spatial in nature, but also include non-spatial functions such as object recognition memory.[citation needed] Vestibular dysfunction has been shown to adversely affect processes of attention and increased demands of attention can worsen the postural sway associated with vestibular disorders. Recent MRI studies also show that humans with bilateral vestibular damage (damage to both inner ears) undergo atrophy of the hippocampus which correlates with their degree of impairment on spatial memory tasks.[2][3]
Causes
Problems with balance can occur when there is a disruption in any of the vestibular, visual, or proprioceptive systems. Abnormalities in balance function may indicate a wide range of pathologies from causes like inner ear disorders, low blood pressure, brain tumors, and brain injury including stroke.[citation needed]
Presyncope
Presyncope is a feeling of lightheadedness or simply feeling faint. Syncope, by contrast, is actually fainting. A circulatory system deficiency, such as low blood pressure, can contribute to a feeling of dizziness when one suddenly stands up.[4]
Related to the ear
Causes of dizziness related to the ear are often characterized by vertigo (spinning) and nausea. Nystagmus (flickering of the eye, related to the Vestibulo-ocular reflex [VOR]) is often seen in patients with an acute peripheral cause of dizziness.[citation needed]
- Benign paroxysmal positional vertigo (BPPV) – The most common cause of vertigo. It is typically described as a brief, intense sensation of spinning that occurs when there are changes in the position of the head with respect to gravity. An individual may experience BPPV when rolling over to the left or right, upon getting out of bed in the morning, or when looking up for an object on a high shelf.[5] The cause of BPPV is the presence of normal but misplaced calcium crystals called otoconia, which are normally found in the utricle and saccule (the otolith organs) and are used to sense movement. If they fall from the utricle and become loose in the semicircular canals, they can distort the sense of movement and cause a mismatch between actual head movement and the information sent to the brain by the inner ear, causing a spinning sensation.[5]
Diagnosis
The difficulty of making the right vestibular diagnosis is reflected in the fact that in some populations, more than one-third of the patients with a vestibular disease consult more than one physician – in some cases up to more than fifteen.[6]
Treatment
There are various options for treating balance disorders. One option includes treatment for a disease or disorder that may be contributing to the balance problem, such as ear infection, stroke, multiple sclerosis, spinal cord injury, Parkinson's, neuromuscular conditions, acquired brain injury, cerebellar dysfunctions and/or ataxia, or some tumors, such as acoustic neuroma. Individual treatment will vary and will be based upon assessment results including symptoms, medical history, general health, and the results of medical tests. Additionally, tai chi may be a cost-effective method to prevent falls in the elderly.[7]
Vestibular rehabilitation
Many types of balance disorders will require balance training, prescribed by an occupational therapist or physiotherapist. Physiotherapists often administer standardized outcome measures as part of their assessment in order to gain useful information and data about a patient's current status. Some standardized balance assessments or outcome measures include but are not limited to the Functional Reach Test, Clinical Test for Sensory Integration in Balance (CTSIB), Berg Balance Scale and/or Timed Up and Go[8] The data and information collected can further help the physiotherapist develop an intervention program that is specific to the individual assessed. Intervention programs may include training activities that can be used to improve static and dynamic postural control, body alignment, weight distribution, ambulation, fall prevention and sensory function.[9]
Bilateral vestibular loss
Dysequilibrium arising from bilateral loss of vestibular function – such as can occur from ototoxic drugs such as gentamicin – can also be treated with balance retraining exercises (vestibular rehabilitation) although the improvement is not likely to be full recovery.[10][11]
Research
Scientists at the National Institute on Deafness and Other Communication Disorders (NIDCD) are working to understand the various balance disorders and the complex interactions between the labyrinth, other balance-sensing organs, and the brain. NIDCD scientists are studying eye movement to understand the changes that occur in aging, disease, and injury, as well as collecting data about eye movement and posture to improve diagnosis and treatment of balance disorders. They are also studying the effectiveness of certain exercises as a treatment option.[12] Recently, a study published in JAMA Otolaryngology-Head & Neck Surgery found that balance problems are an indicator of mortality potentially due to altered metabolism of vestibular system.[13]
References
- ↑ "Balance disorders in the elderly". Neurophysiol Clin 38 (6): 467–78. December 2008. doi:10.1016/j.neucli.2008.09.001. PMID 19026966.
- ↑ "Does vestibular damage cause cognitive dysfunction in humans?". J Vestib Res 15 (1): 1–9. 2005. doi:10.3233/VES-2005-15101. PMID 15908735.
- ↑ "Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans". Brain 128 (Pt 11): 2732–41. November 2005. doi:10.1093/brain/awh617. PMID 16141283.
- ↑ "Balance Disorders Symptoms, Causes, Treatment – What are the symptoms of a balance disorder?". MedicineNet. http://www.medicinenet.com/vestibular_balance_disorders/page2.htm#what_causes_a_balance_disorder.
- ↑ 5.0 5.1 "Clinical practice guideline: benign paroxysmal positional vertigo". Otolaryngol Head Neck Surg 139 (5 Suppl 4): S47–81. November 2008. doi:10.1016/j.otohns.2008.08.022. PMID 18973840.
- Lay summary in: "ENT doctors release national guideline on treatment for common cause of dizziness". EurekAlert.org (Press release). November 1, 2008.
- ↑ "Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults". ORL J Otorhinolaryngol Relat Spec 77 (4): 197–218. 2015. doi:10.1159/000433549. PMID 26366566.
- ↑ "Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 70 (22): 2067–74. May 2008. doi:10.1212/01.wnl.0000313378.77444.ac. PMID 18505980.
- ↑ "8". Physical Rehabilitation. 5. F. A. Davis Company. August 2006. ISBN 978-0-8036-1247-1.
- ↑ "13". Physical Rehabilitation. 5. F. A. Davis Company. August 2006. ISBN 978-0-8036-1247-1.
- ↑ Horak FB (2010). "Postural compensation for vestibular loss and implications for rehabilitation". Restor Neurol Neurosci 28 (1): 57–68. doi:10.3233/RNN-2010-0515. PMID 20086283.
- ↑ "Vestibular rehabilitation of older adults with dizziness". Otolaryngologic Clinics of North America 44 (2): 473–496. 2011. doi:10.1016/j.otc.2011.01.015. PMID 21474018.
- ↑ "Balance Disorders". https://www.nidcd.nih.gov/health/balance.
- ↑ "Association of Balance Function With All-Cause and Cause-Specific Mortality Among US Adults". JAMA Otolaryngol Head Neck Surg 147 (5): 460–468. May 2021. doi:10.1001/jamaoto.2021.0057. PMID 33704356.
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