Gait and Balance Problems Health Article

Vestibular hypofunction

While problems with central processing of vestibular input can create balance and gait difficulties in individuals with CNS problems, peripheral vestibular hypo-function (the under-functioning of inner ear structures associated with balance) also is a common contributor to balance deficits. Peripheral vestibular hypofunction may result from temporal bone fracture, acoustic neuroma, ototoxicity (damage to the eighth cranial nerve due to aminoglycoside antibiotics), or unknown causes. One or both sides may be damaged, resulting in dizziness and vertigo that lead to decreased balance.

Although these are some of the main pathologies that are known to cause balance and gait problems, any disease process or trauma resulting in impairments of sensory processing, neuromuscular response, musculoskeletal function, or cognition can result in balance and gait disturbances. Due to changes that take place in the proprioceptive (self-awareness of movement) and vestibular systems, even normal aging has an effect on balance and gait.

Diagnosis

The pathologies that underlie gait and balance problems are diagnosed by physicians using a variety of methods, including signs and symptoms, diagnosis of exclusion, imaging, etc. Discussion of specific diagnostic criteria for each disease process that could contribute to a balance disorder is beyond the scope of this entry.

A physical therapy diagnosis of decreased balance or abnormal gait is made based on a thorough examination that includes a patient history and systems review. In addition, tests and measures may be used to assess any or all of the following possible contributors to balance and gait disturbances: aerobic endurance, cognitive status, cranial and peripheral nerve integrity, assistive devices, muscle strength, range of motion, posture, reflexes, sensory integrity, and functional abilities. Balance, gait, and locomotion may be tested in a variety of ways, which usually include observation or video analysis of quiet standing, active standing, or functional activities. In some clinical tests such as the Clinical Test for Sensory Interaction on Balance, the physical therapist will purposefully manipulate the environment to change one component of sensory feedback (e.g., the patient stands on foam to challenge the somatosensory system). In some cases, the physical therapist manipulates the individual (e.g., the Hallpike-Dix maneuver). Other tests include a variety of functional skills that must be completed. A large number of balance tests exist; the key is choosing the right one. It is important to understand the purpose of a test before using it and to match that purpose with the impairments and goals of the patient or client being tested. For example, a test that measures stability in quiet standing may be appropriate for a patient who is recovering from a stroke, but not so appropriate for an athlete training to return to professional sports.