Balance Control & Tests

Ability to maintain balance is a complex process that depends on three major components: (1) your sensory systems for accurate information about your body's position relative to your environment; (2) your brain's ability to process this information; and (3) your muscles and joints for coordinating the movements required to maintain balance. The sensory systems include your sense of touch (feet, ankles, joints), your vision and your inner ear motion sensors. For example, we rely on our feet and joints to tell us if the surface we are standing on is uneven or moving. We rely on our eyes to tell us if the environment around us is moving or still. And we rely on our inner ears to tell us if we are upright or leaning, or standing still or moving.

Normally, balance control is accomplished "automatically" without requiring our conscious attention. When our balance "auto pilot" is disrupted, we have to exert intense conscious effort to try to overcome the abnormal sensations and maintain control of our balance. This intense effort, in turn, is what leads to the common secondary symptoms such as shortened attention span and fatigue.

To determine the cause of a balance problem, you will first be asked to describe your problems and symptoms and will be given a physical examination. Based on your descriptions and exam results, your doctor will develop a working diagnosis. Depending on what he or she determines, your doctor may then order tests designed to confirm the diagnosis. The test results also determine how key components of your balance systems are functioning.

There is a possibility that your problem does not have one specific cause. If no single cause is identified, your doctor may also use the test results to design an exercise-based treatment program that can maximize your functional abilities and minimize disruptive symptoms.

Because of the complexity of balance control, not all balance problems are the same. As mentioned above, some individuals lack information from a sensory system and do not realize they are losing their balance, while for others, the brain gets confused and creates an inaccurate sense of being off balance. Because of the wide variety of balance problems, determining the cause of a balance disorder and what treatment options are the most appropriate can be difficult. In the last twenty years, however, there have been significant advances in evaluation and treatment approaches to balance disorders that have proven to be highly effective and offer relief to those suffering from imbalance or dizziness. There are also medical professionals and clinicians who are specially trained to apply these evaluation and treatment methods.

While most balance disorders are caused by inner ear abnormalities, many balance disorders are caused by central nervous system abnormalities, cardiovascular problems or both. There are specific observational tests that can help your doctor figure out what is causing your balance problems.

Assessment of Eye and Head Movement Functions: The ability to coordinate movements of your eyes and head is essential to seeing objects in your environment clearly while you are in motion during such tasks as walking, running, or driving a car. To test your eye movement control, you may be asked to shift your direction of gaze from one object to another as quickly as you can. You may also be asked to look as far as you can to the left, right, up, and down while facing directly forward. To test eye and head coordination, your physician may observe how accurately you can stay focused on an object while shaking your head.

Assessment of Cerebellar Function: This includes specific physical examinations to evaluate your cerebellum, the part of your brain that is essential to your ability to control balance and movements. When your cerebellum has been damaged you can still move, but your movements become jerky, making it harder to get your hands or legs to stop moving just where and when you want them to. Your doctor can test how well your cerebellum is working by asking you to reach out and touch points with your index fingertip, tap your hand rhythmically, and move your arms and legs accurately.

Assessment of Walking Function: Your doctor can learn about your balance and movement control by observing how well you walk. He or she may ask you to walk in a straight line without veering from side to side and then quickly and accurately turn and walk in the opposite direction without hesitating or stumbling. A more challenging walking task is called "heel to toe" walking, where each new step is placed directly in front the preceding step.

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