Dizziness and imbalance are often not a normal part of aging. There are many potential causes that are not always identifiable. Seeing specialists who focus on neurological balance treatment can help identify the underlying causes and provide effective individualized treatment, unlike visits to general doctors that may not resolve the issues. Key to getting better is taking control and seeking evaluation and treatment from experts in dizziness, vertigo and balance like the Center for Balance, rather than assuming the symptoms must be accepted as normal aging.

1. DIZZINESS AND IMBALANCE IS NOT
A NORMAL PART OF AGING
The Center for Balance
www.centerforbalancecincinnati.com
Dr. Patrick Shumrick BS, MHS, DPT
Blue Ash Office: 513-891-0934
Anderson Office: 513-231-2700

2. DEALING WITH DIZZINESS, VERTIGO AND BALANCE
DEFICITS CAN BE CONFUSING
 There are many reasons people have these symptoms,
some are easily identifiable, many are not
 Can cause feelings of depression, frustration,
loneliness, and isolation (“no-one knows how I feel”)
 Medical help can involve many doctor visits, multiple
tests, medications, and in the end, there may be no
answers, yet the symptoms remain
 Many people go for long periods of time
before getting the right help; seeing us
 Many people are unaware the there are
successful treatments for these symptoms
 Many of our patients ask why they were not sent to
The Center for Balance in the first place

3. OUR APPROACH
 Comprehensive evaluation: Our clinicians perform a thorough evaluation of your symptoms.
This involves assessment of your dizziness, vertigo, and balance; assessing the three balance
systems in our body we use.
 Patient education: Patient education is key to successful treatment. Dizziness, vertigo and
balance deficits involve many systems in our body.
 Patient involvement: Once an individual understands how their balance systems work, their
present symptoms, and our treatment course, they are excited play an active role in their
treatment plan.
 Individual treatment approach: The Center for Balance clinics are neurological treatment
based. Dizziness, vertigo and imbalance are neurological based deficits; this is all we do.
Many of our patients complain of being first sent to an orthopedic based clinic with no results.
They ask us why they were sent to a place that does not specialize in treating neurological
based symptoms. We spend one-on-one time with each patient.
 Comfortable setting: Our clinics are comfortable, quite, and there are patients with similar
problems being treated at the same time. People suffering from these symptoms do not
respond well to loud, gym like treatment settings.

4. BALANCE DEFINITION
Balance is simply
maintaining our center of
mass over our base of
support! Sounds simple, it
is until you have a
balance problem.

5. BALANCE DEFINITION
The Ability to Control your Body’s Center of Mass (you upper trunk) over your Base of
Support (the surface you are standing or walking on). We experience many different
surfaces each day that we have to deal with (flat, firm, uneven, compliant, with or
without obstacles). There are two types of balance we use during activities of daily Living:
1. Static Balance: Involves standing, reaching, turning, bending,
twisting, tandem, standing on 1 leg. We use static balance when
daily activities involve performing tasks not involved with walking,
or activities in smaller spaces.
2. Dynamic Balance: Involves walking on level surfaces,
uneven surfaces, walking with head movements,
turning, bending, and negotiating
around obstacles. We use dynamic balance
during ambulation, transitional movements,
and moving across varying surfaces.

6. DIZZINESS/VERTIGO
 50% of Adults Complain of Dizziness in Their Life
 2nd Most Common Complaint to Family Physician
 60% of head injury or stroke patients complain of dizziness
 Vertigo is the illusion of objects moving in the environment

7. IMPACT OF FALLS
 30% of community dwelling population over age of 65 will fall, 50%
repeatedly
 Increases to 42-50% over 75 years of age
 Falls result in approximately 300,000 to 500,000 hip fractures per year
 Falls are the leading cause of death due to injury in people over 75 years of
age
 More than 40% of people hospitalized from hip fractures do not return home
and are not capable of living independently
 20-25% of those who have fallen pass away within one year

8. IMPACT OF FALLS
 More than 90 percent of hip fractures are associated
with osteoporosis
 90 percent of hip fractures in older
Americans are the result of a fall
 For those living independently before a hip fracture,
5 to 25 percent will still be in long-term care
institutions a year after their fracture.
 Most falls happen to women in their
homes in the afternoon

9. Falls occurrence as a
percentage of all injuries
HAMILTON COUNTY

10. Age Groups: Percent of Population and Falls Deaths
2005
0
10
20
30
40
50
60
70
80
Age Group
Percent
Percent of Population
Percent of Fall Deaths
Birth - 19 20-64 65 +
HAMILTON COUNTY

11. Hospitalizations from falls as a percentage of all
injury hospitalizations.
HAMILTON COUNTY

12. BIGGEST RISK FACTOR
THE BIGGEST RISK FACTOR FOR DIZZINESS AND BALANCE
DYSFUNCTION IN THE ELDERLY THAT MAY LEAD TO FALLS………… IS
THE FACT THAT PATIENTS AVERAGE 5 MD VISITS OR MORE BEFORE
COMING TO THE CENTER FOR BALANCE! IF YOU FEEL DIZZY OR
FEEL YOU ARE OFF BALANCE, YOU NEED TO HAVE A FULL
DIZZINESS/VERTIGO AND RISK OF FALL ASSESSMENT. MANY OF OUR
PATIETNS ARE TOLD THERE IS NOTHING THAT CAN BE DONE FOR
THEIR SYMPTOMS, OR THE THEIR SYMPTOMS ARE A NORMAL PART
OF AGING; YET WE GET THEM BETTER!

13. WE USE THREE SYSTEMS TO
MAINTAIN BALANCE
 Somatosensory System
 Visual System
 Vestibular System

14. USING SOMATOSENSORY INPUT TO
MAINTAIN BALANCE
Somatosensory input involves messages sent to our brain about
positioning of our joints in our legs; “joint sense”. Receptors in our
muscles, tendons, joint capsules called proprioceptors tell our brain if
our hip, knee, and ankle joints are aligned (stationary) or moving
(dynamic). Based on this information, your brain contracts muscles
around the joints to stabilize them. An example of this would be
when we are standing on a slanted surface, information from the
joint receptors is sent to our brain and our brain contracts muscles
around the joints to steady us. Somatosensory input is used primarily
for smaller balance disturbances.

15. USING VISUAL INPUT TO MAINTAIN
BALANCE
When we are not able to use somatosensory input to maintain our
balance, as in standing on uneven or compliant surfaces that takes
away our joint sense, we use our vision to maintain balance. Our
vision orients us to an object we are looking at (person to object
recognition). In other words, our brain will use visual input while we
are looking at an object to orient us to vertical. Many people with
balance issues rely on visual input to determine how our body is
aligned.

16. USING VESTIBULAR INPUT TO MAINTAIN
BALANCE
The most important, and yet most overlooked system we use to
maintain our balance is our vestibular system (inner ear). Our
vestibular system relays information to our brain about how our
head is moving through space; in other words, if we are moving our
head side to side, up and down, as well as our head moving
through space in a straight line. Our vestibular systems determines
body movement from movement in the environment, if we are
moving or if the world is moving. Based on information from our
vestibular system, our brain controls our trunk and moves our eyes
as our head and body is moving. Vestibular deficits cause dizziness
with head and eye movements, vertigo, and imbalance.

17. COMMON DESCRIPTIONS OUR PATIENTS
USE TO DESCRIBE THEIR SYMPTOMS
 Dizziness/Light headedness with quick head and eye movements, quick turns,
getting up from a chair
 Room spinning lying on one side, reaching overhead, bending down
 Fear of falling, afraid to leave home alone, walk alone, walk in the dark
 Unable to walk a straight line especially with head movements
 Frustration/Decreased quality of life/restriction of social activities
 Interferes with household responsibilities or work
 Difficulty concentrating, depression, isolation, functionally disabled

18. KEYS TO GETTING BETTER
Taking control of getting better! In the state of Ohio
you do not need a doctor referral to come to us for
a dizziness/vertigo evaluation and a fall risk
assessment. Just call and we will take care of the
rest, including scheduling, insurance verification
and even send our findings to your physician. The
Center for Balance is a neurological based physical
therapy clinic; dizziness, vertigo and balance
deficits are neurologically based issues. You would
go to a specialist for a any other medical issue, why
not specialists in treating these symptoms. The
Center for Balance is the only clinic in Cincinnati
that exclusively evaluates and treats individuals
suffering from dizziness, vertigo, and balance
deficits.