Balance Disorders and Children Feature Image

What causes a balance disorder?

A balance disorder may be caused by an infection (viral or bacterial) in the ear, a head injury or blood circulation disorder that affects the inner ear or brain. Many people can experience problems with their balance as they get older. Balance problems can also be caused by some medications.

To understand balance disorders, it is important to understand how balance normally works. Your body relies on three separate systems, each sending signals to your brain via a nerve:

  • In your neck, body, legs and feet are points that sense pressure and send the information to your brain, giving it information about where your body is in relation to the world (this is known as proprioception). Messages are sent when you do anything, turn your head, move, and walk on different surfaces. This is your Skeletal System.
  • The nerve endings in the retina, located at the back of your eyes, has light-sensitive cells called rods and cones. When you look at anything, light hits your retina, then the rods and cones send electrical signals to your brain through the optic nerve. Your brain uses these signals to interpret what you’re seeing and creates a visual image. Each of your eyes get slightly different images and information about the same object, which assists in depth perception and is essential to maintaining balance. This is your Visual System.
  • Located in your inner ear (also known as your labyrinth) are the cochlea, involved in hearing and semicircular canals, which affect balance. Connecting them is the vestibule which contains sensory organs known as the utricle and saccule. These sensory organs affect your balance and equilibrium. When you turn your head rapidly, the liquid in the semicircular canals move the tiny hairs lining the cochlea, sending a message that travels through the vestibulocochlear nerve to your brain about the movement. Then your brain responds by sending messages to the muscles needed to maintain balance and help the eyes stay focused. This is your vestibular System.

Your ears, eyes, bones, and muscles work together to keep you steady and upright. When one or more of these systems is not working properly, it can be hard to get around and just function from day-to-day. The simplest things like walking and riding a bike can become difficult and frustrating.

The Vestibular System

When you think about balance, the role your ears play might not come to mind, but ears are crucial to maintaining balance.

The structure in your inner ear, called the labyrinth, is primarily in control of your sense of balance. The Labyrinth is made of bone and soft tissue. At one end it has a detailed system of loops and pouches called the semicircular canals and the otolithic organs, which help us maintain our balance. At the other end is a snail-shaped organ called the cochlea, which is what we use to hear. The technical or medical term for all of the parts of the inner ear involved with balance is the vestibular system (see Figure 1).

Figure 001

The vestibular system in relation to the ear. Credit NIH Medical Arts.


How does the vestibular system work?

Figure 002

Figure 2: The role of the cupula in balance Credit: NASA

Your vestibular system is a very important system in your body and works in conjunction with the other two sensory systems in your body, which are your visual system (eyes) and skeletal system (bones and joints). Your Vestibular Systems job is to check and maintain the position of our body when you are moving around, sitting or lying still. It also helps you focus on objects even when the position of your body changes. This is done by detecting mechanical forces, such as gravity, that act upon your vestibular organs when you move. The two sections of the labyrinth help us with these tasks: the semicircular canals and the otolithic organs.

 

Your semicircular canals are three loops, fluid-filled and arranged roughly at right angles to each other. They communicate to your brain when your head moves in a rotating or circular way, like nodding your head up and down or when your look from right to left.

Each of these three canals has a wider base containing a raindrop-shaped structure filled with a gel-like fluid (see Figure 2). This structure, called the cupula, sits on top of a group of sensory cells known as hair cells. Hair cells have long threadlike extensions, called stereocilia, extending into the fluid. When you move your head the fluid inside your semicircular canal moves too, causing the cupula to bend and the stereocilia within it to lean to one side. This leaning movement creates a signal that travels to your brain to tell it the movement and position of your head.

Figure 003

Your otolithic organs (see Figure 3) occupy the space between the semicircular canals and the cochlea. They are two fluid-filled pouches called the utricle and the saccule. These organs let your brain know when your body is moving in a straight line, such as when you walk, ride a bike or are sitting in a car. They also tell your brain the position of your head with respect to gravity for example: sitting up, leaning back, or lying down.

Just like your semicircular canals, your utricle and your saccule have sensory hair cells. They line the bottom of each pouch, and their stereocilia extend into an overlying gel-like layer. Sitting on top of the gel are otoconia, tiny grains made of calcium carbonate. When you tilt your head, gravity pulls on the otoconia, which then moves the stereocilia. This movement, again, creates a signal telling your brain your head’s position.

Your visual system combines with your vestibular system to keep objects in focus when you move your head and keep you aware of your position when you walk or travel in a vehicle. Sensory receptors in your joints and muscles help you maintain your balance when you walk around or stand still. The brain receives, interprets, and processes the information from these systems to control your balance.

Symptoms

Depending on the type of balance disorder your child has and what is causing it, symptoms can be different from child to child. Some children may experience severe symptoms, making it hard for them to carry out even basic tasks. Other children may only have mild symptoms you barely notice.

A majority of children with balance disorders have symptoms of disequilibrium, an unsteady, “woozy” feeling which makes it hard for him or her to stand up, walk around, turn corners or climb stairs without stumbling, bumping into things, falling or tripping.

You may find your child walks with their legs too far apart or is unable to walk without staggering. Walking in the dark or over uneven surfaces can be tricky too. A child with a balance disorder will commonly appear uncoordinated and clumsy.

Vertigo is another common symptom of a balance disorder. You may think Vertigo is a sudden sensation- when you feel like the room is spinning or you’re moving when sitting or standing still. Children may describe Vertigo as feeling like they’re rocking, floating or “on a merry-go-round.” Children might just feel dizzy, lightheaded or disoriented.

Your child’s vision can also be affected by a balance disorder. Items may appear to bounce or look blurry whenever they move their heads. This is called oscillopsia, and it can make reading and writing really tough for your child.

Symptoms your child may also display include:

•   Involuntary eye movements (called nystagmus)
•   Difficulty or discomfort when looking in bright sunshine or at lights (especially fluorescent, flashing or moving lights)
•   Discomfort in situations with “busy” visual patterns, crowds, heavy traffic and busy areas like shopping centres.
•   Depth perception difficulties, affecting hand-eye or eye-foot coordination, making things like catching or kicking a ball difficult.

Balance issues also can impact hearing. Sounds might seem muffled, especially amid background noise. Kids might also have bothersome, distracting ear problems like ear pain, pressure or “fullness” in the ears, and tinnitus (ringing or other sounds like whirring, humming or buzzing).

Any balance-related symptoms can take a toll on your child both physically and emotionally causing other symptoms like:

•   Frequent headaches or migraines
•   Nausea, vomiting and diarrhea
•   Motion (car) sickness
•   Changes in heart rate and blood pressure
•   Fatigue
•   Seizures
•   Fear, anxiety or panic
•   Depression

Symptoms involving your child’s movement, sight, hearing and just how they feel day-to-day can really affect their ability to keep up in class regardless of their grade or age. Balance problems can make it hard to remember things, concentrate, pay attention and follow directions. Children might not be able to hear the teacher or focus their eyes on the chalkboard or their books. They will often become frustrated and appear like they are not concentrating. These struggles can start to become a disruption to their class. Children with balance disorders affecting hand eye or foot eye coordination will frequently avoid sports of all kinds.

The most aggravating part for your child will be feeling like they’re trying their very best but still unable to do some things they want or need to do but not knowing why.

How will my child’s balance be tested?

We will obtain a necessary medical history from you and your child, check their visual clarity as well as perform a simple hearing test. We will do a physical evaluation that may include checking reflexes, sensation, muscle strength and tone, coordination, gait and stance.

Then we will do a series of simple, non-invasive balance tests, using the sensitive CAPS™ force platform and additional special software. We will also look for signs of nystagmus (a rapid, jerky movement of the eyes that often indicated the presence of a balance disorder).

What is a CAPS™ force platform

A CAPS™ force platform is an extremely sensitive force platform and specially designed software combined in a product years ahead of anything else available today (the CAPS™ is so unique, it has been awarded 2 separate U.S. patents, 1 for its design and 1 for the way it works).

The CAPS™ is so sensitive it can display your heartbeat and respiration. In fact, it is so sensitive it can even measure the forces caused by someone simply blowing breath across its surface.

The extraordinary sensitivity of the CAPS™ allows The Ashgrove Spinal Centre’s Chiropractor, Dr Bailey, to measure otherwise imperceptible, undetectable movements you are always making when you are standing, even though you appear to be absolutely still.

The CAPS™ can detect abnormal balance in just 25 seconds, instantly comparing your results to normative data established by testing hundreds of people at a major medical school.

The CAPS™ then generates a report, quantifies your balance and provides Dr Bailey with an objective balance score. It even provides warnings when results are abnormal for your age.

Then What?

After all these steps have been performed, Dr Bailey will review the results to determine if your child’s problem originates in their vestibular system, central nervous system, or somewhere else in their body.

Then once serious medical conditions are ruled out, it is important to manage your child’s condition in a conservative way. If Dr Bailey concludes your child’s problem would benefit from the type of specialised treatment he is trained to provide, those treatments will be discussed with you and your child and a treatment plan will be agreed upon.

Dr Bailey is a fully qualified and registered health professional who is highly trained to diagnose and/or treat conditions of the neuromuscular skeletal system. Dr Bailey works with many other medical professionals and will always refer to your child’s GP, Pediatrician or other Medical Specialist if your child’s condition is not one that is suitable to be treated with chiropractic care or if your child’s condition requires further evaluation and/or more testing.

If my child needs treatment, what will be involved and how long will it take?

Depending on the cause of your child’s balance disorder, treatments may vary. Some of the common treatments we provide usually involve only some simple, but very specialised manipulations and/or exercises.

Your child may be given balance therapy (also called vestibular rehabilitation); this includes training exercises used to help strengthen balance skills and coordination. Exercises might involve bending down, standing or walking with eyes open and then with eyes closed, swimming or walking barefoot on various uneven surfaces. Children often do very well with vestibular therapy because they’re better able to adapt to balance problems than adults.

During the course of your child’s treatment, they will be tested with the CAPS™ several times. This way, the results of the treatment will be immediately measured and documented. Some children’s CAPS™ scores are higher after having only one treatment, others require multiple treatments and multiple CAPS™ testing before they achieve optimum results.

Most of our balance patients experience an immediate improvement in their balance following treatment. In fact, many experience a dramatic improvement.

In a small percentage of cases, a treatment may actually make your child’s balance temporarily worse, but when this happens we will know it immediately because their CAPS™ score will instantly reflect a change. We will then “reverse direction,” modify the treatment and test them again.

As mentioned before, after treatment, most of our patients experience great improvements not only in their balance, but more importantly in their overall quality of life!

Other Treatments

If your child has a balance disorder called Benign paroxysmal positional vertigo (BPPV) or positional vertigo, Dr Bailey might prescribe a series of simple movements, called the Epley maneuver, to help dislodge the otoconia from the semicircular canal. You start the Epley maneuver by sitting upright, with the help of a trained therapist, then quickly lie down on your back, turn your head to one side, and wait for a minute or two before sitting back up again. For some people, one session will be all that is needed, others may need repeat treatments over several days before their dizziness is completely resolved.

What is Benign paroxysmal positional vertigo (BPPV) or positional vertigo?

Benign paroxysmal positional vertigo (BPPV) or positional vertigo is a brief, intense episode of vertigo occurring because of a specific change in the position of the head. If your child has BPPV, they may feel like their spinning when they look for an object on a high or low shelf or turn their head to look over their shoulder. Your child may also experience BPPV when they roll over in bed. BPPV is caused when otoconia tumble from the utricle into one of the semicircular canals and weigh on the cupula (See Figure 3 above). The cupula can’t tilt properly and sends conflicting messages to the brain about the position of the head, causing vertigo. BPPV sometimes may result from a head injury or from listening to loud music with head phones on.

Children who have a family history of hearing or vestibular problems, dizziness or motion sickness might be more prone to balance disorders.

It is important to remember, Dr Bailey is a fully qualified and registered health professional who is highly trained to diagnose and/or treat conditions of the neuromuscular skeletal system. Dr Bailey works with many other medical professionals and will always refer to your child’s GP, Pediatrician or other Medical Specialist if their condition is not one that is suitable to be treated with chiropractic care or if their condition requires further investigation.

For further information:
Balance Assessment BPPV 

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