Balance Disorders Feature Image

Balance Disorders

A very simple explanation of a Balance Disorder is a feeling of unsteadiness or dizziness. The feeling you are moving, spinning or floating, even when you are standing still or lying down. Balance disorders can be caused by some health conditions, medications you are taking, or a problem with your inner ear or brain.

Chiropractors are fully qualified and registered health professionals who are highly trained to diagnose and treat conditions of the neuromuscular skeletal system. The Ashgrove Spinal Centre’s chiropractor, Dr Bailey, has also completed a Masters Degree of Functional Neurology with The Carrick Institute and is a member of The Australian Academy or Functional Neurology.

What is Chiropractic Functional Neurology?

Chiropractic Functional Neurology is a specialist level training offered to chiropractors whom have first completed a Masters of Chiropractic. It involves over 400 hours of extra study in functional neurology at an accredited higher educational institution.

What are the symptoms of a balance disorder?

If your balance is compromised, you may feel as if the room is spinning, stagger when you try to walk or feel unstable or fall when you try to stand up. Some of the symptoms you might experience are:

•   Dizziness or vertigo (a spinning sensation)

•   Falling or feeling as if you are going to fall

•   Lightheadedness, faintness, or a floating sensation

•   Blurred vision

•   Confusion or disorientation

Other symptoms that may present when you have a balance disorder:

•   Nausea and/or vomiting, diarrhoea

•   Changes in heart rate

•   Changes in your blood pressure

Some symptoms people often miss that are signs of a balance disorder are:

•   Fear

•   Anxiety

•   Panic

•   Feeling constantly tired

•   Depression

•   Inability to concentrate

Symptoms may be sporadic, last for a short time or have been present for a long time. Some people have had a balance disorder their whole lives but have never been diagnosed or treated.

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’s important to understand how balance works normally. 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 gets 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; there are also 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 moves the tiny hairs lining the cochlea, sending a message that travels through the vestibulocochlear nerve to your brain about the movement. Your brain then 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, day to day. The simplest things like walking and driving 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 move 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.

How will my balance be tested?

We will obtain a necessary medical history from you, check your visual clarity and perform a simple hearing test. We will do a physical evaluation that may include checking your 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 indicates 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 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 problem originates in your vestibular system, your central nervous system or somewhere else in your body. Once serious medical conditions are ruled out, it is important to manage your condition in a conservative way. If he concludes your problem would benefit from the type of specialised treatment he is trained to provide, those treatments will be discussed with you 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 GP or other Medical Specialist if your condition is not one that is suitable to be treated with chiropractic care or if your condition requires further evaluation and/or more testing.

If I need treatment what will be involved and how long will it take?

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

During the course of your treatment, you will be tested with the CAPS™ several times. This way, the results of your treatment will be immediately measured and documented. Some patients 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 balance temporarily worse, but when that happens we will know it immediately because your CAPS™ score will instantly reflect a change. We will then “reverse direction,” modify the treatment and test you 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 you have 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 begin 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 to 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 you have BPPV, you may feel like you’re spinning when you look for an object on a high or low shelf or turn your head to look over your shoulder (such as when you back up your car). You may also experience BPPV when you 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 just from getting older.

For further information:
Balance Assessment BPPV 

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