Seeking balance

October 7, 2016|

Life with a balance disorder can be debilitating. About 20 per cent of working age people will experience problems with balance in their lifetime which could have an effect on their employment, recreational activities, even simple daily life.

The brain controls balance using feedback received from the vestibular system in the inner ear, the eyes and sensors in the joints, muscles and tendons. Infections, head injuries, certain diseases, general aging and even anxiety and stress are just some of the factors that can affect the balance control system, to cause a balance disorder.

Symptoms of a balance disorder include:

  • Dizziness
  • Nausea
  • Vision problems
  • Fatigue
  • Tinnitus (ringing or other noise in the ears)
  • Falls
  • Hearing loss

The implications of balance disorders on people’s lives can be far-reaching.
“People who suffer from a balance disorder often give up doing the things they love to do,” says Specialist Neurologist and Neuro-otologist, Dr David Szmulewicz from the Balance Disorders Clinic at Epworth. “We’ve even had people quit their jobs only to find that the cause of their disorder is treatable or reversible.”

 “We recently looked after a patient who loved to read but because her balance disorder caused her eyes to jump from one line of text to the next,  it this was becoming increasingly difficult. For her, being able to resume this simple pleasure after treatment made the whole process a huge success.”

 Getting disorders diagnosed

 “Much of the insight we get into balance disturbance is through eye movement,” says Dr Szmulewicz.

“Various components of the body’s balance mechanisms are involved in directing the eye movements and certain balance disturbances will give signature, abnormal eye movements.”

Dr Szmulewicz and his colleague, Neurologist and Rehabilitation Physician Dr Michael Tan, have been involved, along with a range of other collaborators, in developing tests and equipment that can quickly, accurately and painlessly identify these abnormal eye movements.

“It has been a significant paradigm shift,” says Dr Szmulewicz. “This level of testing was previously either not possible or required hours of complex, vomit inducing tests.”

“The other plus is that now we can generally have a diagnosis, or at least have a good sense of direction, in the first consultation.”

While the majority of balance disorders can be treated relatively simply with lifestyle modifications, medication or help from a balance specialist in fields including physiotherapy, psychology and speech pathology; a small number require surgery.

 Getting the diagnosis right is the critical step.

“The research strongly shows that tailored treatment is the most successful,” says Dr Tan. “One-size-fits-all treatments may only help around 10 per cent of people whereas if you tailor it you increase the magnitude of your success significantly.”

The majority of patients who present at clinics like the one at Epworth have what’s known as "Episodical Vertigo" (recurrent episodes of dizziness that don’t get any worse.)
between these episodes most sufferers say their functioning is normal or close to normal.

“Most cases of Episodical Vertigo have an underlying cause our specialists can treat,” says Dr Szmulewicz.

“Constant or progressive balance disorders on the other hand are less common and tend to indicate a neurological condition or an underlying disease requiring more urgent attention.”

“The rehabilitation approach needs to be multi-disciplinary. With a range of vestibular and neurological physiotherapists on staff along with occupational therapists, psychologists, neuropsychologists and speech therapists all contributing to holistic treatment.”

“My analogy is that it’s a little bit like a racing car coming in to the pit crew. A team of specialists each make their assessments and then meet as a group to form an optimal treatment plan.”

Find out more about Epworth HealthCare's Vestibular rehabilitation program here.

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