Although the balance is definitively not a simple skill, we are not aware of it when we are healthy. The central nervous system integrates the sensorial information originating from the eyes, joint position, and the organ of balance (vestibular system) to stabilize the body. For a proper function of this system, brain, cerebellum, spinal cord, and nerves innervating the organs should function properly. In addition, a healthy musculoskeletal system is critical. Any disturbance in any of these structures may cause balance problems. A correct diagnosis of the etiology is essential for the treatment of the balance disorder.
The balance means the stabilization of the gravity center on the supporting surface. The dysfunction of the balance system makes gait difficult and increases the risk of fall. The balance disorders due to the muscular atrophy and postural disorders are common in the elderly. Therefore, balance problems should be explored in an old patient with the following history:
1- 2 or more falls in the last 12 months
2- Hospital admission due to a recent fall
3- Gait and balance difficulties
Diseases such as stroke, Parkinson’s disease, multiple sclerosis may impair balance function and require balance rehabilitation.
After a cautious anamnesis, the eye movements are examined to determine the cause of dizziness and the vestibular system in the ear is checked with certain maneuvers. Following the general neurological examination, static and dynamic balance evaluation is performed. The static balance evaluation can easily be done while the patient is standing. There are several examination methods and standardized clinical tests for the evaluation of the balance.
Regarding the dynamic balance; parameters like standing up from the sitting position, standing on the balls of the feet, standing on one leg, stepping forward-backward and to the side, standing on sloped floors with different rigidity, changing the walking speed, turning head while walking, rotating, overjumping a hurdle can be examined. Thus the priorities of the rehabilitation can be determined. The risk of fall is evaluated and risk-reducing precautions are implemented.
After a proper diagnosis process, the treatment and rehabilitation period can be initiated. The balance disorder may occur alone or concomitant with dizziness. Exercises involving certain eye and head maneuvers can be tried for the relief of the dizziness. Treatment methods like tailor-made strengthening exercises, electrostimulation, computer-assisted balance training, virtual reality, robotic gait are used for the recovery of balance function.