Balance and Vestibular Rehabilitation

The Balance

Possible causes of Balance deficits

The Dynamic Balance Walking Kinetic Chain

Running transfers force of the foot hitting the ground up the kinetic chain to the knee, hip, pelvic region, lower back and to the upper back and cervical region

Abnormal and inefficient movement can cause balance deficits, injury to joints and soft tissue facilitating adaptation to movement and loss of performance-loss of balance

Gait Analysis

Kinetic Chain When the foot hit the

ground force is transmitted up the leg to the trunk

Distribution of forces is critical to safe and effective walking

Abnormal balance to the forces leads to injuries

Rehabilitation of the Ankle-Foot Complex

Forces at the foot For proper balance

the Therapist must first assess the position of the foot and provide the proper:

Flexibility Mobility Strength Strength and control

to the upper leg and trunk

Pronation of the Foot

How mal-alignment affect the entire body and

therefore balance deficits

Rehabilitation of the Knee

Knee Joint Middle joint of the kinetic

chain High level of three

dimensional forces Requires high level of

ligaments and muscular support

Patella position and smooth movement is critical to proper function

Position of knee (posture) is essential to acquire both static and dynamic balance

Strength deficits at hip or ankle can affect the stress on knee joint

Rehabilitation of Pelvic Injuries

Force transmitted to the Sacral Joint and lumbar region

Three dimension forces on joint

Key Stone of lower trunk core stability

Low back imbalance can present radiculopathy that can mask true problem

Key is core stabilization to improve trunk control with balance requirement

A strong foundation will allow for improved adaptation to balance issues

Rehabilitation of Hip Injuries

Hip joint Ball and socket joint High level of

stability Limited mobility Critical for straight

hip control Balance of

musculature flexibility and strength is essential

Balance System: Schematic of System

Vestibular

Visual

Somatosensory

Sensory-specific Input

Vestibular

Nuclear

Primary Processor

Central Integrator

Vestibulo-ocular Reflex Eye Mvmt

Vestibulo-Collic reflex (neck movement)

Vestibulo-spinal Reflex

Postural Mvmt

Muscular Output

Adaptive

Cerebellum

Adaptive Feedback

Outer, Middle and Inner Ear

Outer Ear

Inner EarMiddle Ear

Balance System

Three systems work in harmony to allow us to maintain an upright and functioning posture Vision Inner Ear (vestibular System) Muscles (of the entire body)

Balance System

The system usually works well but it can become deficient if we become sick, injured or from the treatment with some particular medications

If this happens our brains adapt to utilize the system that is still operational and neglect the system that has been affected

This leads to reduced function and fear of falling

Overall quality of life is reduce and leads to dependency to individual

Balance Adaptations

What typically happens is that a person will start to utilize their eyes to be the primary sensory to keep them upright Typical situation

Steps become smaller Feet further apart (waddle when you walk) Steps are shallow and short Eyes become focused on the ground Arm swing is reduced

Results of changes in walking pattern

Falls occur Falls are leading cause of fatal and non

fatal injury for older Americans Nearly 20,000 older Americans die from

fall-related injuries every year One in three seniors over the age of 65

will fall at least once this year Falls threaten seniors’ safety and

independence

How do we prevent falls

Falls are among the most preventable cause of high medical treatment costs among older adults

What is needed is: Education Screening Exercise/Physical Activity (if you don’t

use it you will loose it) Physical Therapy (Only if necessary)

Questions

Dr. Charles Curtis DPT, Cert. MDT Vestibular Competency