The Multi-System Nature of Balance
Balance is maintained by three sensory systems working together: vestibular (inner ear detects head movement and gravity), visual (eyes provide environmental orientation), and somatosensory/proprioceptive (joints and muscles detect position). Failure of any system causes imbalance.
Causes of Balance Disorders
Vestibular causes: BPPV, vestibular neuritis, Menière's disease, acoustic neuroma. Neurological causes: stroke, multiple sclerosis, Parkinson's disease, peripheral neuropathy. Musculoskeletal causes: lower limb weakness, hip and ankle dysfunction. Multisystem causes: aging, polypharmacy.
Clinical Balance Assessment
Berg Balance Scale, Dynamic Gait Index, computerized posturography, Romberg test with eyes open/closed, and vestibular-specific tests (Dix-Hallpike, Head Impulse Test) guide diagnosis and treatment planning.
Physiotherapy Treatment Approach
Balance rehabilitation targets the specific deficit: vestibular exercises for inner ear dysfunction, proprioceptive training for somatosensory deficits, strength training for musculoskeletal causes, and combined sensory conflict training for multisystem disorders.