Balance & Gait Dysfunction

Ryan LaCorte Treatments

Balance and gait disorders are the primary mechanism for injuries within the home.  Falls are the leading cause of death due to injury in individuals over the age 65.  This alarming statistic should alert all individuals with balance and gait disorders to take preventative steps to reduce fall risk and incidence.  As we age the fall risk increases significantly due to many factors including, but not limited to, losses in muscle strength, flexibility and/or reduction in balance reflex reactions. There are many preventative steps that can be taken to help individuals avoid falls and maintain healthy, independent lifestyles.

Balance Disorders can arise from a number of different factors.  Simply stated, balance is your ability to maintain body position through different movement or even in a static position.   To understand balance disorders, you must first break down the elements controlling one’s balance.  Balance has three different systems, working together, to keep you upright.

Vestibular System

Despite the common diagnosis, the vestibular system is the least common cause for balance disorders.   The Vestibular system interprets motion, equilibrium and spatial orientation through structures located within the inner ear.  Linear or vertical movement is interpreted through the utricle and saccule.  Rotational movement is interpreted through the semicircular canals.  As the head rotates, fluid movement within the canals is picked up via sensory receptors.  These receptors will in turn transmit the movement to the brain.  Individuals with true vestibular symptoms will report a room spinning or moving sensation commonly known as Vertigo.   Most individuals with Vertigo will be severely limited in their functional activity and will be a high fall risk.  There are several mechanisms for inner ear dysfunction that can be differentiated through a thorough evaluation and testing.  Some mechanisms are easily treated while others may require the use of medications and/or accommodation/habituation treatments.   Such treatment is known as Vestibular Rehabilitation or VRT.  These treatments help the body adjust to the changes in vestibular perceptions.

BPPV (Benign Paroxysmal Positional Vertigo)

BPPV is the most common vestibular disorder.  While the cause of BPPV is not known, the mechanism is understood; crystals within the semicircular canal dislodge and interrupt the flow of fluid within the canal.  Additionally, these crystals will most commonly create fluid movement when the individual is side lying and send false information to the brain that head is moving.  This false information will not match the information being relayed by both the eyes and somatosensory systems.  This will generally cause an intense bout of Vertigo where one feels as if the room is spinning.  It is very important to understand that BPPV will NOT give you constant dizziness or effect your hearing, produce paraesthia (numbness or tingling) or effect your speech.  If you have any of these symptoms please contact a health care provider immediately.

The good news is that there is a very simple and effective intervention to treat BPPV known as the Epley Maneuver.  Following a thorough evaluation your therapist will assess whether or not you are an appropriate candidate for the Epley Maneuver and which treatment will be most effective.  Please see our Specialty Treatment section for further information.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

*** For more information please see the article “Physical Therapy and the Treatment of Vertigo” in publications, written by Alyssa Pillco, manager of our Toms River Location.

Migraine Headaches

Vertigo can frequently be the result of sever Migraine headaches.  Unfortunately to treat this mechanism we must first identify the mechanism of the Migraine.  Migraine headaches are generally thought to be a result of genetic factors or hormone levels.  However, at times, the headache can be resultant of cervical spine injury or mechanism (cervicogenic headache.)  In these cases, the symptoms can be controlled and even eliminated through physical therapy.  Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Labyrinthitis

Labyrinthitis is a term used for an inner ear infection that causes inflammation of the labyrinth within the inner ear.  Symptoms will commonly present as ear pain, loss of hearing, dizziness, vertigo, tinnitus (ringing in ears,) nausea, fever, fluid or puss leaking from ear, blurred vision or headaches.  A healthcare provider will help identify if this is the mechanism for Vertigo and address appropriately through antibiotics.  As your body recovers from the infection, a Vestibular Rehabilitation Program may be appropriate to help restore balance deficits and reduce fall risk. Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Vestibular Neuronitis

Vestibular Neuronitis is inflammation of the Vestibular Nerve.  The Vestibular Nerve carries information from the inner ear to the brain to help to control balance.  Most cases of Vestibular Neuronitis are secondary to viral infections and will gradually improve over a period of weeks.  As your body recovers, a Vestibular Rehabilitation Program may be appropriate to help restore balance deficits and reduce fall risk. Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Meniere’s Disease

Meniere’s disease is a disorder of the inner ear that results in vertigo as well as progressive hearing loss or tinnitus (ringing in the ear.)  Meniere’s disease usually affects only one ear, however the symptoms can be severe.  Unfortunately there is no cure for Meniere’s disease, however, there are multiple treatment that can help to reduce and relieve symptoms.  The symptoms of vertigo will be intermittent.  Through a Vestibular Rehabilitation Program, your physical therapist can help to reduce the symptoms of vertigo experienced with Meniere’s Disease.    Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Central Vertigo

Central Vertigo occurs due to a disease of the central nervous systems.  Frequently the disease involves the function of the 8th Cranial Nerve, the Vestibulocochlear Nerve.  The 8th Cranial Nerve transmits sound and equilibrium information from the inner ear to the brain.  When function is interrupted it can effect both balance and hearing.  Injury to the 8th Cranial Nerve can be due to hemorrhagic or ischemic issues (Stroke) as well as tumors, trauma, infection and disease attacking the central nervous system such as Multiple Sclerosis.  With some of these mechanisms, the body is able to recover from the attack on the central nervous system.  As the inflammatory process slows, the body will return to its prior state. Through physical therapy, we will re-educate the brain as the correct information is transmitted through the 8th Cranial Neve to centers of the brain.  However, with others, damage can be permanent and untreatable.  In these cases, you physical therapist will work with the patient to help adjust to limited or misinformation transmitted by the 8th Cranial Nerve or centers of the brain through Vestibular Rehabilitation Program.  This will help the brain to filter out the correct information and improve balance and reduce the effects of central vertigo.  Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Somatosensory Disorders

Somatosensory Disorders refers to the inability to sense and interpret body positioning through sensory receptors in the soft tissue and joints.  The human body is filled with receptors constantly giving the brain information on pressures on the skin and joints.  This information is interpreted by the brain to sense the body’s position.  This is one of the key components to maintaining balance.  However, when these receptors are unable to interpret the pressures, or nerves are unable to transmit this sensation, it can have a dramatic effect balance.

Peripheral Neuropathy

Peripheral Neuropathy refers to injury or damage to the peripheral nerves that bring information to and from the brain.  While there are many mechanisms for peripheral neuropathy including trauma, metabolic issues and vascular deficiency, the most common is circulatory deficits frequently seen in Diabetic patients (Diabetic Neuropathy.) It is important to recognize that peripheral neuropathy and circulatory deficits can occur in both diabetic and non-diabetic patients.  Symptoms consist primarily of numbness and pain predominantly in the hands and feet, however symptoms can be experienced throughout the body.  In some cases muscle weakness will also be present.  Due to the lack sensation and weakness, it can have a significant impact on balance.  Unfortunately, most types of peripheral neuropathy are not curable.  Most treatments involve the use of medications designed to manage the discomfort.  However, there is hope to improving you balance.  As stated earlier, receptors are found throughout the body, constantly giving information to the brain on pressures and positioning.  When the nerves in the lower leg are no longer functioning, we can train the body to utilize the receptors in other joints to interpret our positioning.  If the bottom of the foot is no longer transmitting information, we will train the receptors found within the feet, ankles and knees to interpret positioning.  Your physical therapist will assess your balance deficits and design activities to stimulate the receptors within the joints to better interpret positioning.  In doing so, your body will learn ways to control positioning based upon this information.  Additionally, the increase in activity will help with circulation and reduce further progression of neuropathy.    Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

*** For more information please see our article “Balance and Physical Therapy” written by Jennifer Vadas, manager of our Jackson Facility, in our publications.

Gait Disorders

Gait Disorders can arise from a number of mechanisms including arthritic joints, nerve injury, stroke, Parkinson’s Disease, Multiple Sclerosis, musculoskeletal injury or post-surgical conditions.  Through a thorough history and evaluation, your physical therapist will uncover the underlying mechanism behind your gait dysfunction.  They devise an appropriate treatment approach to address any issues limiting or hindering your ability to walk.  Additionally, your therapist will assess the need for any support bracing or assistive devices that are appropriate for your condition.  Not all patients are the same, and therefore interventions can vary as well.  Our skilled therapists will utilize their vast knowledge base as well as state of the art equipment to help you to reach your goals and restore your ambulatory function.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

***For more information please see our article “Am I at Risk for Falls?” written by Amie Gomez in our publications

*** For more information please see our article “Balance and Physical Therapy” written by Jennifer Vadas, manager of our Jackson Facility, in our publications.

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