Welcome to the final installment of Dr. Bartoe’s three part series on Balance! In the first blog post we discussed the Basics Of Balance and what balance actually is. In the second blog post, we looked deeper into how the brain measures and controls our balance and coordination. Now, in this last post, we will look at what happens when we lose our ability to balance and what can be done to treat balance issues.
As a brief recap of the last two posts, let’s take a look at what goes into balance and coordination. We know that the brain uses three systems to monitor where we are in space: 1. The Eyes, 2: The Vestibular System, and 3: The Proprioceptive System. Each system tells us different information about where our bodies are, including: how the world moves around us (our eyes), how our head is moving through space (our vestibular system), and where our joints and muscles are (our proprioceptive system). When all three systems work together as they are meant to, the brain gets a big old beautiful painting of where we are in relation to the world around us. This allows us to move in a way that keeps us upright and stable against gravity. When these systems do not tell the brain the same information, however, the brain tries to figure out what information is right and what is wrong. Imagine driving in a car while blindfolded. You have three people all telling you which way to go at once and they are all telling you to go in different directions. It would be quite difficult to determine who was telling you the best information and who wasn’t. You may hit curbs, miss turns, or even head off in the wrong direction. This is similar to what the brain has to deal with when either the brain loses its ability to coordinate the information or it receives conflicting information from the three systems.
There are many different types of balance disorders. Symptoms of these disorders can be spinning (vertigo), dizziness, nausea, inability to focus your eyes, or a feeling like walking on a swaying boat deck among others. A doctor trained in balance disorders will know that they must distinguish between a problem that originates in the brain or one that originates at the sensors in the eyes, inner ear, or body tissue. These highly trained doctors are able to determine if their patient needs to be referred to a specialist or if they are able to help the patient themselves. Some of these conditions require surgery. Others may respond well to medications. Many of them, however, respond incredibly well to brain-based therapies.
Functional Neurology is an approach to treating different brain and body conditions that is minimally invasive. It can be highly effective in balance disorder patients, especially those that are unable to find help elsewhere. Doctors who use Functional Neurology are trained to examine different areas of the brain and to measure how well they are working. If the doctor finds areas that are not functioning as well as they should, the doctor can often times prescribe therapies to rehabilitate and strengthen those areas. Imagine this like a physical therapist giving you exercises to help strengthen an injured arm. The exercises begin very light and simple. Then, as you progress and become stronger, the exercises become more intense with added weight and more complex movements. This is the same idea that we use for the brain but instead of increasing weight, exercises are made more intense in other ways. As we use the brain, it gets stronger and begins to work more efficiently. This is a concept called Neuroplasticity.
Looking back at our example of the 67 year old veteran suffering from instability, we saw that he had cerebellar dysfunction and proprioceptive problems. After finding out where the problems were coming from, we began to use Treatment Trials. A Treatment Trial is just a fancy way of saying that we made him use the areas that were not working right and then measured to see if he improved, worsened, or stayed the same. When the patient first came in, he nearly fell over during a test where he stood in a neutral stance and closed his eyes. For this patient, the simple activity of drawing an infinity sign in the air with one of his hands was enough to kick-start his brain and improve his ability to stand. After the treatment trial, we noticed that he was able to stand steady with his eyes closed. This told us loud and clear that our treatment trial designed to activate his cerebellum was enough to create a dramatic change in his stability. This was only one step in returning our veteran to being more stable, but it easily illustrates the way that brain-based balance therapies can work.
I must emphasize at this point that each person’s balance issues are unique to that person. Each condition requires a careful examination to ensure that the treatments are directed toward what that patient needs. If a patient is given the wrong therapies, their symptoms may worsen and a patient may be injured through a fall or other complications. Finding a doctor who is educated in treating balance conditions is important. There are many people in our city, state, and country suffering form balance disorders and unable to find help. Hope should not be lost though. Finding a doctor who practices Functional Neurology is a great place to start. These doctors spend hours upon hours studying and training to work with patients like this. Please let us know if you would like more information about balance disorders or need help finding a doctor to help you with a balance condition.