This document discusses balance and vestibular rehabilitation. It explains that balance relies on the integration of the visual, vestibular, and somatosensory systems. Deficits in any part of the kinetic chain from the foot to the trunk can impair balance. Rehabilitation of various areas like the ankle, knee, pelvis, and hip can help address weaknesses and improve balance. The balance system can become deficient due to illness, injury, or medications, forcing the brain to rely more on vision which can lead to an inefficient gait and increased falls risk for older adults. Regular exercise and physical therapy if needed can help prevent falls by maintaining strength and mobility throughout the kinetic chain.

1. Balance and Vestibular
Rehabilitation

2. The Balance

3. Possible causes of Balance deficits
The Dynamic Balance Walking
 Kinetic Chain
 Running transfers force of
the foot hitting the ground
up the kinetic chain to the
knee, hip, pelvic region,
lower back and to the
upper back and cervical
region
 Abnormal and inefficient
movement can cause
balance deficits, injury to
joints and soft tissue
facilitating adaptation to
movement and loss of
performance-loss of
balance

4. Gait Analysis
 Kinetic Chain
 When the foot hit the
ground force is
transmitted up the leg to
the trunk
 Distribution of forces is
critical to safe and
effective walking
 Abnormal balance to the
forces leads to injuries

5. Rehabilitation of the
Ankle-Foot Complex
 Forces at the foot
 For proper balance the
Therapist must first
assess the position of
the foot and provide
the proper:
 Flexibility
 Mobility
 Strength
 Strength and control to
the upper leg and trunk

6. Pronation of the Foot

7. How mal-alignment affect the
entire body and therefore
balance deficits

8. Rehabilitation of the Knee
 Knee Joint
 Middle joint of the kinetic chain
 High level of three dimensional
forces
 Requires high level of ligaments
and muscular support
 Patella position and smooth
movement is critical to proper
function
 Position of knee (posture) is
essential to acquire both static
and dynamic balance
 Strength deficits at hip or ankle
can affect the stress on knee joint

9. Rehabilitation of Pelvic
Injuries
 Force transmitted to the Sacral
Joint and lumbar region
 Three dimension forces on
joint
 Key Stone of lower trunk core
stability
 Low back imbalance can present
radiculopathy that can mask true
problem
 Key is core stabilization to improve
trunk control with balance
requirement
 A strong foundation will allow for
improved adaptation to balance
issues

10. Rehabilitation of Hip Injuries
 Hip joint
 Ball and socket joint
 High level of stability
 Limited mobility
 Critical for straight hip
control
 Balance of
musculature flexibility
and strength is
essential

11. Balance System: Schematic of
System
Vestibular
Visual
Somatosensory
Sensory-specific
Input
Vestibular
Nuclear
Primary
Processor
Central Integrator
Vestibulo-ocular
Reflex Eye Mvmt
Vestibulo-Collic
reflex (neck
movement)
Vestibulo-spinal
Reflex
Postural Mvmt
Muscular Output
Adaptive
Cerebellum
Adaptive Feedback

12. Outer, Middle and Inner Ear
Outer
Ear
Inner Ear
Middle Ear

13. Balance System
 Three systems work in harmony to allow
us to maintain an upright and functioning
posture
 Vision
 Inner Ear (vestibular System)
 Muscles (of the entire body)

14. Balance System
 The system usually works well but it can become
deficient if we become sick, injured or from the
treatment with some particular medications
 If this happens our brains adapt to utilize the
system that is still operational and neglect the
system that has been affected
 This leads to reduced function and fear of falling
 Overall quality of life is reduce and leads to
dependency to individual

15. Balance Adaptations
 What typically happens is that a person
will start to utilize their eyes to be the
primary sensory to keep them upright
 Typical situation
 Steps become smaller
 Feet further apart (waddle when you walk)
 Steps are shallow and short
 Eyes become focused on the ground
 Arm swing is reduced

16. Results of changes in walking
pattern
 Falls occur
 Falls are leading cause of fatal and non fatal
injury for older Americans
 Nearly 20,000 older Americans die from fall-
related injuries every year
 One in three seniors over the age of 65 will
fall at least once this year
 Falls threaten seniors’ safety and
independence

17. How do we prevent falls
 Falls are among the most preventable
cause of high medical treatment costs
among older adults
 What is needed is:
 Education
 Screening
 Exercise/Physical Activity (if you don’t use it
you will loose it)
 Physical Therapy (Only if necessary)

18. Questions
 Dr. Charles Curtis DPT, Cert. MDT
 Vestibular Competency