Patients with balance and dizziness (inner ear) disorders are often referred to physical and/or occupational therapy for primary symptoms of balance disorders and movement-related dizziness. In addition, many of these patients have developed secondary symptoms associated with reduced activity levels, such as decreased strength, loss of range of motion, and increased tension, leading to muscle fatigue and headaches. Therapy helps to alleviate primary and secondary symptoms.

Frequency of Balance and Dizziness Disorder
The balance and dizziness problem of dizziness and disequilibrium is second only to low-back complaints in frequency of occurrence among adults. Dizziness in itself is not a disease, rather the symptom of a problem within the peripheral and/or central nervous system. There are many causes of dizziness; however, it is estimated that 85% of dizziness is a result of pathology within the peripheral balance and dizziness system.

Symptoms of balance and dizziness disorders include:

• Vertigo
• Dizziness
• Nausea
• Balance and equilibrium problems
• Poor tolerance for change in direction and speed of movement
• Gravitational insecurity
• Poor awareness of position in space
• Difficulty with motor planning and execution of movements
• Visual motor problems
• Anxiety and stress

In assessing a patient with a balance and dizziness disorder, your Therapist focuses on five major areas:

Musculoskeletal assessment
This test includes range of motion, strength, sensation and coordination.

Occulomotor testing
Oculomotor control is tested, visual-balance, dizziness interaction and gaze-fixation suppression are assessed.

Postural control
This examination includes sitting, standing, movement strategies, and sensory organization.

Balance and gait assessment
Static and dynamic balance skills are assessed, including balance during gait (walking). The patient’s use of appropriate movement strategies in balance control is also examined.

Vertigo assessment
A questionnaire and movement tests are used to identify triggers of dizziness, its frequency of occurrence, symptom severity, and lifestyle impact. .

After balance and dizziness assessment, a list of patient problems is generated, short- and long-term goals are established, and the patient is placed on an appropriate exercise program.

The exercise treatment of a patient with balance and dizziness disorder focuses on improving balance function, decreasing dizziness symptoms, and increasing overall activity levels for long-term retention of gains made in therapy. A patient may receive only balance and dizziness habituation exercises, if balance function is not affected.

Balance and dizziness habituation Exercises: repetitive exposure and exercises to help the brain habituate or attenuate the vertigo response

Balance Retraining Exercises: exercises to improve coordination of muscle responses and organization of sensory information for balance control

General Stamina and Endurance: a home-centered program of aerobic activity to ensure that the patient maintains balance and dizziness improvements.