1. What causes balance disorder?
Cerebral hemorrhage or cerebral vascular occlusion is frequently seen in patients with stroke (paralysis) due to the clot in the brain, in the treatment of brain injury and during the process of regaining the functions after the brain tumor surgery, together with the impaired balance and increased risk of falling. Hip fracture, shoulder fracture, head trauma and muscle injuries caused by the falls due to impaired balance can also be encountered frequently. For this reason, balance training supported by computer-aided technologies is very important.
In addition, robotic and computer aided systems are used in the rehabilitation of balance disorders that can be caused by various reasons such as the Parkinson’s Disease, Multiple Sclerosis (MS), nerve damage, geriatric problems caused by muscle and bone weakness due to advanced age, painful joint problems and fractures.
Various examination methods and standardized clinical tests are available for the rehabilitation of balance.
2. Balance Disorder Rehabilitation and Prevention of Fall
Despite the fact that we do not realize when we are healthy, balance is not a simple skill. The central nervous system integrates the senses of vision and joint position, as well as the sensory information coming from the balance organ in the ear in order to keep our body in balance. Therefore, the nerves that go to the brain, cerebellum, spinal cord and organs must be intact. Therefore, it is imperative to have a healthy musculoskeletal structure. Disruption in any of these structures can lead to balance problems. For the treatment of balance disorder, first of all, the source of the problem must be determined correctly.
Balance is the ability to keep the body center of gravity stable on the support surface. Impaired balance makes walking difficult, and increases the risk of falling. In the diseases of brain and nervous system, and in the elderly patients, imbalance is frequently encountered due to reasons such as muscle wasting, loss of strength, joint problems, posture disorder and involuntary contractions. Accordingly, balance disorders should be investigated in individuals with the following characteristics:
Individuals with the history of 2 or more falls in the last 12 months
Individuals, who present to the physician due to a recent fall
Individuals, who have walking and balance problems.
Individuals with stroke, brain injury, brain tumor, Parkinson’s disease, multiple sclerosis (MS), transverse myelitis and nerve ending diseases called polyneuropathy
First of all, after taking the clinical history of the patient, it is appropriate to test the balance organ in the ear with certain maneuvers using the eye movement examination in terms of the causes of dizziness. After the general neurological examination, the evaluation of balance is performed in a static and dynamic manner. Stable balance is performed while standing still, and can be measured more easily. Various examination methods and standardized clinical tests are available for the rehabilitation of balance. Computer-aided measurement tools (such as posturography), in which wearable technologies can also be used, increase the sensitivity and objectivity of dynamic balance assessment. Posture, speed of movement, acceleration, reactive and compensatory responses can be determined. Therefore, it is possible to make a more precise evaluation in mild diseases compared to clinical examination.
Parameters such as standing up from a sitting position in dynamic balance, rising on the toe, standing on one foot, stepping forward-backward-to-side, standing on grounds of different slopes and hardness, changing the walking speed, turning the head while walking, turning and overcoming the obstacles can be examined. Therefore, the problems, which should be given particular importance in balance rehabilitation, are determined. The risk of falling should be determined, and measures are taken for reducing the risk.
After the correct diagnosis, the treatment and rehabilitation process begins. The problem of balance present together with dizziness or by itself. Exercises including certain eye and head maneuvers can be performed in order to reduce dizziness. Treatment practices such as individualized strengthening exercises, electrical stimulation, computer-assisted balance training, virtual reality and robotic walking are performed with the aim of improving balance.
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