Feeling Unsteady? A Neurology Balance Test Could Figure Out Why

Balance is not something we usually think about until it is impaired. When our bodies have a proper sense of balance it happens naturally and is easy to take for granted; that is, until we don’t have that sense of balance anymore. According to the National Institute on Deafness and Other Communication Disorders, about 40% of the United States population will experience a form of balance problems or dizziness over the course of their life. Balance disorders can happen at any age but are more common in older people.

“Our balance depends on three systems in our body taking in sensory information from our eyes, inner ear, joints, and muscles. When there is an error in the sensory information intake or the motor output from the brain, people experience decreased steadiness or loss of balance. This can cause people to limit themselves and decrease their activity levels due to fear of falling,” says Dr. Courtney Brown, Doctor of Physical Therapy and Neurologic Clinical Specialist, Neurologic Rehabilitation, Baystate Health.

A balance disorder can make you feel unsteady, giving you the sense that you are moving or spinning. “The simplest definition of a balance disorder is anything that makes you feel unsteady or disrupts your balance,” says Dr. Brown. This can result in a fall, one of the major causes of trauma. One out of five falls causes a serious injury such as a broken bone or a head injury. Over 800,000 patients a year are hospitalized because of a fall injury and falls are the most common cause of traumatic brain injuries. Balance issues can also signal serious conditions such as multiple sclerosis, cardiovascular disease, or low blood pressure. Still, up to 80% of balance disorders have no clear diagnosis. Even so, determining the cause of your balance problem when possible through testing is important to identify appropriate treatment.

Proper testing and balance assessment with a healthcare professional can lead to specific treatments to help manage the symptoms. Before your balance test appointment, it’s helpful to understand what to expect, different aspects of the testing, and what the outcome might be.

What are the symptoms of a balance disorder?

• Feeling unsteady while standing up or walking
• Dizziness or lightheadedness
• Loss of balance while walking
• Feeling like you are in motion or spinning, even when standing still (vertigo)
• Ringing in the ears (tinnitus)
• Feeling like you are going to faint or a floating sensation
• Blurred vision or double vision
• Confusion

What are common causes of balance disorders?

There is a wide range of diagnoses that can cause or contribute to having balance issues. The following provides an overview of the diagnoses your healthcare professional may be looking for at your appointment.

• Neurological disorders. Stroke, multiple sclerosis, Parkinson’s disease, spinal cord injury, traumatic brain injury, concussion, Guillain-Barre syndrome, and ataxia are examples of neurological conditions which can impact a person’s balance.
• Vestibular. Benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere’s disease, acoustic neuroma are all related to the inner ear.
• Medication. Dizziness and balance difficulties can be a side effect of certain medicines such as tranquilizers, hypertension medication, anticonvulsants, and cancer treatments.
• Somatosensory. Peripheral neuropathy, impaired proprioception, and numbness in feet are issues stemming from our ability to feel sensations such as pressure, pain, or warmth.
• Cardiovascular. Hypotension and fainting can be caused by heart-related issues.
• Other impairments. Decreased strength, increased spasticity in muscles, drop foot, decreased flexibility, fatigue, impaired sleep, or pain could contribute to balance problems.

A balance test can determine the cause of your balance disorder. With that information, you can take steps to help manage or treat your condition.

What happens during a balance test?

Balance testing may be done by a primary health care provider or a specialist in disorders of the ear like an audiologist who specializes in diagnosing and treating hearing loss, or an otolaryngologist (ENT), who specializes in treating diseases and conditions of the ears, nose, and throat. A neurologist or movement disorders specialist may complete a physical examination, or refer you to a physical therapist for a Falls Risk Assessment. Your primary care provider will determine the most appropriate specialist to assess your symptoms.

• Your ENT or audiologist can assess any difficulties with hearing and dizziness.
• Your primary care provider, neurologist, or physical therapist can assess for orthostatic hypotension (a drop in your blood pressure with changes in position from sitting to standing).
• Your neurologist or movement disorder specialist will perform a history and physical examination of your eye movements, cranial nerves, speech, coordination, gait, and sensation. They may order imaging including MRIs or CT scans to determine a neurological cause of your balance symptoms.
• Your physical therapist can perform a Fall Risk Assessment to evaluate your strength, gait (walking pattern), balance, and endurance.

Will I need to do anything to prepare for a balance test?

It is recommended that you wear loose, comfortable clothes. Check with your healthcare provider: depending on the test, you may need to make changes to your diet or adjust medications for a day or two before your test. Your provider will give you any special instructions to follow.

Are there any risks to balance tests?

Certain tests may make you feel dizzy or nauseous. These feelings usually go away within a few minutes, but you may want to plan for someone to drive you home in case the dizziness lasts for a longer period of time.

What do the results mean and how is a balance problem treated?

If your results were not normal, your healthcare provider will determine the best treatment plan. This may include some of the following:

• Balance retraining exercises. Physical therapy can help strengthen your muscles, improve your flexibility with stretching, perform balance training to uptrain your eyes, inner ear, and proprioception, and complete gait training to promote a normal walking pattern. They may also recommend an assistive device such as a cane or walker.
• Positioning procedures. For dizziness, a physical therapist can complete treatment to reduce your dizziness symptoms and perform exercises to improve the stabilization of your eyes.
• Diet and lifestyle changes. Incorporating healthy habits including proper sleep hygiene, healthy eating, and regular exercise can help you stay steady.
• Medications. These may be needed to help any underlying causes of your balance problems, especially with dizziness or other neurological conditions.
• Surgery. If you have Meniere's disease or acoustic neuroma, your treatment team may recommend surgery. Stereotactic radiosurgery might be an option for some people with acoustic neuroma.

Your healthcare provider is your best resource to learn more about your balance disorder.

Balance disorders can be mild, or so severe that you may have trouble walking, climbing stairs, or doing other normal activities. If you are experiencing balance problems, it’s natural to be concerned if your doctor recommends that you undergo neurological balance testing. However, having an accurate and thorough diagnosis is the first step in understanding your potential balance disorder and relieving your symptoms.

Our team of experts at Baystate Health is here to help. We care for patients from throughout western Massachusetts who have balance, dizziness, and gait issues. Call us today to schedule an appointment at 413-794-5600.