A woman who wanted to walk her dog, and a veteran who wanted to pay his respects at military funerals were both stopped by the same problem: balance. For various reasons, people sometimes find balance problems get in the way of things they want to do. Fortunately, Valley health care systems can offer help.
“Balance is so important because having balance problems could affect the ability to do something that we all might take for granted,” said Carmela Carr, wellness specialist at Geisinger Health Plan. “Poor balance could affect your daily living or your quality of life. The last thing people want to do is stay home just because they’re concerned about falling.”
“Balance tends to be a team approach,” said Janine Fee, a certified vestibular physical therapist at Evangelical Community Hospital. Comparing balance to a baseball team, she added, “Every player on the field has a reason for being there. If some players are not working to their full potential, the team may not do that well.”
Three “outfielders” are vital for balance: feet, inner ears and eyes. If any one of them is sitting on the bench, that leaves our balance with only two players.
Balance as a ballgame
Problems with feet can include peripheral neuropathy, in which people have a hard time feeling the bottoms of their feet or knowing where their feet are in space, said Cailin McCullion, a physical therapist at UPMC.
“If they’re on uneven surfaces, it’s really hard for those people to discern, ‘Where am I,’ which results in poor balance, stumbles and falls,” McCullion said.
“Sometimes there are things we can’t fix,” Fee acknowledged. “But we can offer solutions to help accommodate that downed player.”
In some cases, a cane or walking stick can be a big help, transferring the feeling of balance to the hand rather than the foot and bringing that third player back on the field.
Problems with the inner ears can result from viruses, Meniere’s disease and Benign Paroxysmal Positional Vertigo (BPPV), which can bring on brief episodes of spinning or imbalance that occur while lying down or making certain movements.
“The vestibular component is basically saying there are receptors in our inner ear that inform us of our head position relative to gravity and certain head movements,” McCullion said.
“We can usually get BPPV corrected so the third player plays to full potential again,” Fee said.
Many problems can arise in our vision, including difficulty with depth perception as we age. Something as simple as placing bright yellow tape on stair steps at home can help people more accurately judge the height of their steps, Fee said.
During an examination, one of the ways a therapist can pinpoint a balance problem is by removing the three outfielders one at a time. If a person becomes dizzy when his or her eyes are closed, chances are they are relying too heavily on their vision.
“As we age, the visual system becomes the dominant player for maintaining balance,” Fee said. “Then we give the patient exercises to do while their eyes are closed because we want to get the other two players to work harder.”
Along with those three outfielders — eyes, inner ear and feet — the balance baseball team relies on its pitcher, the brain.
“The cerebellum gathers information about balance and sends a signal to the infielders so they can complete the play by reacting with the ultimate goal of, ‘I’m not going to fall. I’m going to keep my balance,’” Fee said.
Balance can be affected by a number of infielders, like lack of strength, poor posture, pain, flexibility and even a fear of falling, which causes people to become more sedentary. Neurological diseases like stroke, Parkinson’s disease and multiple sclerosis can cause balance problems that cannot be “fixed,” but therapists try to stimulate other areas to help with balance.
The first step in improving balance is talking with the patient and educating them on strategies to overcome their challenges, McCullion said.
Patients can benefit from exercises like balance training, in which an individual practices tasks on a firm surface then on a softer, more compliant surface.
Strengthening exercises can give a person the muscular strength they need to correct their balance on uneven surfaces and grassy terrain. Legs and ankles have to be strong to create a balance reaction that prevents us from falling.
Fee demonstrated how posture affects our center of gravity. Standing straight, the center of gravity is low on the torso. If someone leans forward to maneuver, they shift their center of gravity from their lower torso to the area around their chest, making them less stable. Someone with a sore knee might shift their center of gravity to the right or left, relying more on their stronger knee and throwing their balance off-kilter.
“In the exam, I’m looking at all these factors that can contribute to balance issues,” Fee said. “We can design an individualized treatment plan geared toward their deficits or weaknesses.”
Vestibular rehabilitation can bring welcome relief to patients with inner ear problems. As a vestibular rehabilitation certified therapist, Fee teaches patients exercise-based therapy that helps alleviate symptoms of vertigo and balance issues. She pointed out that Evangelical is one of the only facilities in the region to use specialized vestibular goggles to more accurately assess dizziness and determine its cause.
She also demonstrated the NeuroCom, a computerized assessment tool that gauges a patient’s balance and gives therapists objective data to guide an appropriate treatment.
“The NeuroCom analyzes how eyes, ears and the sense of touch (in feet) work together for balance,” Fee said.
She demonstrated on a colleague, asking Gretchen Walter, physical therapy assistant, to stand on the NeuroCom’s base while it measured the amount of “sway” in her stance. Fee then altered Walter’s sense of sight (asking her to close her eyes) and touch (having her stand on a thick mat) with the NeuroCom still assessing the sway.
Results can highlight problem areas that require interventional treatment. Even better, patients can see their own movements on the computer screen.
“I’m excited,” Fee said. “This is like a video game. Patients can see what they’re doing as they exercise. Exercise is one of the best things to keep your body strong, and the more fit you are, the better balance you get.”
Cindy O. Herman lives in Snyder County. Email comments to her at CindyOHerman@gmail.com