Horizon Balance and Dizziness Center

Dizziness Articles

       

        The onset of dizziness is a very traumatic and scary experience. The first episode can bring on anxiety and panic. Those that have dizziness and have not been tested to determine the cause may be living with it unnecessarily.

        Since there are so many causes of dizziness, it is important to see a doctor specifically trained in balance and dizziness that can provide education and a clear plan of treatment. Many people go from doctor to doctor looking for relief or an explanation that will put their fears to rest, but never find anything. The field of balance and dizziness is very specialized area with continual research and specific standardized test that are not regularly taught to all physicians. Therefore, there can be much confusion and uncertainty about the treatment of imbalance and dizziness.

          The most successful treatment follows these simple steps:

                - Physician: to rule out life-threatening conditions and provide proper medication

                - Audiologist: test inner ear function

                - Physical Therapist: balance and dizziness exercises

                - Re-assessment by the physician to determine progress and changes

        The following are summarized articles about elderly people and imbalance.

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Falling Results in Death

        There is clear evidence that falls pose a real threat to life in the elderly population. Statistically there is a reason to do all we can to prevent falls.

                - 95% of hip fractures result from falls

                - 25% of elderly fall victims sustaining a hip fracture die within one year

        How is falling reduced? The answer is to treat the entire person. It is very easy to assume that the elderly are fallers and there is nothing that can be done to minimize falls except for making their surrounding safer, but there is more that can be done than that. Medical research over the last 20 years has supported a specific approach to treating the elderly faller. The most important aspect of the treatment is the assessment. The vestibular, neurological, orthopedic, and visual systems must be assessed and a treatment diagnosis attained.

        The most common treatment diagnosis are BPPV, unilateral vestibular loss, bilateral vestibular loss, central vestibular impairment, motion sensitivity, disuse disequilibrium and fear of falling. Each one of these categories presents specific problems and requires a specific treatment. The balance center can assess the entire person and apply the correct treatment to effectively help prevent falls. The best time to enter a balance program is at the time of initial signs of imbalance.

        Disuse equilibrium can easily occur after a fall or after the first feeling of instability. Once the fear of falling is present; the person's confidence plummets and the inactivity causes deterioration of general health, strength and flexibility until death. It sounds harsh but this is the main reason that 25% of elderly fall victims who sustain a fractured hip die within a year. It is not the hip fracture that results in death; it's the fear of falling  and disuse equilibrium that causes inactivity and makes the body more susceptible to disease.

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Older Adults Do Not Seek Help for Dizziness

        The elderly go to the doctor for many reasons but rarely go primarily for dizziness or balance problems. A study of 100 consecutive patients referred to the Baylor Medical Center Geriatric Clinic showed that 61% had dizziness, although they were not seeking intervention for dizziness. 77% of these patients had balance disorders and 9% had BPPV (Oghalai JS et al, May 200).

        Why do older adults fail to seek medical attention for dizziness> The fact is that many have sought help for their dizziness at one time but were told that as they age, dizziness and imbalance is normal. Thereafter, they feel that their condition is not treatable and they must live with it. The danger of this line of thinking is that they instinctively reduce their activity and begin to slide into a sedentary lifestyle that reduces social and physical activity. Depression and anxiety are usually associated with this as are further visits to the doctor for management of the resulting progressive and chronic medical problems.

        Early intervention is crucial and many times the patient must be asked if they have dizziness or imbalance in order to identify the need for further assessment.

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The Dilemma of Imbalance

        Dilemma: The state of uncertainty, perplexity, or difficulty

        The dilemma of imbalance is in the complexity of the balance systems and the uncertainty of the course of intervention. The cerebellum and brain stem (Central Nervous System) process balance sensory information. The three primary systems are somatosensory (feet), visual, and vestibular (inner ear)¹. All of which are continuously sending sensory input signals to the CNS to keep the body balanced. If one or more systems are not functioning at 100% then imbalance can occur. These balance systems are tested for functionality by completing a Posturography.

        The CNS is very adaptive and can recalibrate and substitute sensory information to overcome impairments. Assessment and training of the sensory systems and their integration into balance processing is the key to successful fall reduction and stability². The important thing to realize is that people who fall or are unstable may become non-fallers and more stable with appropriate training.

¹ FB, et al: Postural strategies associated with somatosensory and vestibular loss. Exp Brain Res 82:167,1990.

² Shumway-Cook, A. and Horack, FB: Rehabilitation Strategies for Patients with Vestibular Deficits. Neurol. Clin. 8:441, 1990.

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Confidence and Fear: Doing More to Keep People on Their Feet

        Everyone has experience a moment of exhilarating confidence and a debilitating rush of fear; they are very strong motivators. Confidence promotes interaction and productive activity while fear inhibits interaction and encourages avoidance.

        The most common phrase that I hear is, "I have a fear of falling".  The more important thing to know is that most people do not want to feel that way. They want independence and mobility. Many times a fall will begin a spiraling cascade of undesired events if there is no attempt to improve the condition that initially caused the fall. The fall instills a fear that leads to restriction of activity, decreased confidence in walking, and may result in the use of a walking aid (walker, cane, spouse...).

        Weakness and cardiovascular atrophy occur due to inactivity. As deconditioning progresses it is harder to get around and the desire to be active drifts further away. Depression can also be a factor that strengthens the tendency to withdraw from activities. The end result is a person that is very weak, dependent, and is at high risk of falling.

        This happens all the time but does not have to. If a balance assessment is performed immediately after a fall or after an initial feeling of imbalance; then the appropriate treatment can be given. Through therapy, a patient can see results such as: increased confidence and reduction of subsequent falls. Blaming age, neuropathy, eyesight, or inner ear problems on falls or imbalance and then doing nothing to improve what can be improved upon can sentence a person to a nonproductive, digressing condition.

        The technology is available and the research is conclusive that balance retraining is effective and underutilized. We understand balance and how to improve it while instilling confidence, activity, and safety. Horizon Balance and Dizziness Center is dedicated to helping people live more fulfilling lives.