We have three main balance systems which provide us with information about where we are in space. This allows us to maintain our balance in normal life. These 3 systems are:
- The Somatosensory System
- The Visual System
- The Vestibular System
The Somatosensory system provides us with information about what we are physically feeling from our surrounding. This includes sensations from our feet that we are standing on the ground, or from our back that tells us we are sitting in a chair. This occurs as we receive proprioceptive information from the skin, muscles and joint receptors, which are sensitive to stretch or pressure in the surrounding tissues. This allows us to determine the position of the body in relation to itself and to the environment.
Often times, if this system is not working well, we develop what is termed a surface dependency. This means that we are not utilizing our visual and vestibular systems effectively, and have a hard time staying balanced on moving, or unstable surfaces. As a result, activities such as walking along the beach, down a cobblestone road, or in our own back yard are quite challenging. If you find yourself avoiding, or struggling with these tasks, this system may need to be strengthened. With this impairment, it is common to use an assistive device, such as a cane or walker, to improve stability. You may also find yourself holding onto others, or the furniture when walking. Other symptoms of this system working ineffectively include walking slowly, with a wide stance, or the legs may shake when the feet are closer together.
We use our visual system to see where our body is in relation to the world, and to sense motion between ourselves and the environment. If this system is not working correctly, we can show signs of gaze instabilities. This can result from various components of our central and peripheral nervous system functioning inefficiently. These include factors such as gaze evoked nystagmus, abnormal saccades, convergence or smooth pursuits, or incorrect vestibular-ocular reflex (VOR) and VOR cancellation. For many people, if this system is not working properly, they experience dizziness when in crowded situations, or when driving. If you find yourself having a hard time processing everything going on when you walk through a busy mall, or shop at the grocery store, you may have a visual impairment. These instabilities can be improved and returned to normal with specific exercises to allow for central nervous system compensation.
The vestibular system provides us with spatial orientation. This system is comprised of a utricle and a saccule, which detect linear motions, and three semicircular canals, which detect angular motions. If any of these structures stop working properly, we develop an inner ear weakness, termed a vestibular hypofunction. This can occur if one or both vestibular systems are impaired. Symptoms of this include:
- Poor posture
- Constantly looking down to confirm location of ground
- Holding onto walls when standing and walking
- Difficulty walking in the dark
- Difficulty walking on uneven surfaces, such as grass, or sand
- Spinning sensations
Can this be Fixed?
If any of the three balance systems become impaired, the result is often dizziness and imbalance. However, these symptoms can be reduced, or even abolished, thus reducing the risk for falling. This is achieved through individualized and skilled Physical Therapy, with the goal of improving your independence and function with daily activities.