Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And today we're talking about balance therapy with Heather Wengler. She's a Physical Therapist with Bryan Health. Heather, I'm so glad to have you join us. I love this topic. It's something that I've dealt with in the healthcare field for so many years. What are the most common balance issues that you see every day? Tell us a little bit about our balance systems.

Heather Wengler, PT: In order to talk about balance, we have to talk about all the things that go into it. So we have three sensory systems that provide information to our brain about what's happening. So we have our sensations from our feet and our joints that let us know about where our feet and legs are positioned. You'll hear the words proprioception and kinesthesia, and that just refers to the sensations when we're standing still or when we're moving. Our second system that gives information to our brain is our vision, and that tells our brain where our head and our body are in relation to the world around us.

It gives us information that helps us prepare for balance and make reactions based on what we're seeing. And then last we have our vestibular system. This is the balance system that's inside our inner ear. It's actually quite tiny, but it gives really good information about movements in three dimensions.

So if you tilt, you turn, you bend over, it gives information like if you're in a moving car that's forward or you're on an elevator moving up. That's the vestibular system. Our brain gets all that information and then has to process it and make sense of it. So sometimes when we have a balance issue, it's within one or more of those sensory systems, and then sometimes it's related to how the brain processes the information and how it gives a motor output.

So, as the brain processes information, it uses the information differently based on whatever situation we're in. So if you're in the dark, your brain will use information from your legs and your feet and your inner ear to assess and make adjustments for balance because the vision won't be accurate and reliable.

If you're on something super soft, maybe some sand or something like that, you can't really trust that information that your feet is giving to your brain and your brain will prioritize the sensations from your eyes and your ear to make sense of your balance. So as our brain processes this information, you know, it prioritizes which system to pay attention to.

 And then we make a movement and those messages are sent to our muscles to move our body in a way to keep our balance and to move our eyes so we see clearly while we're moving. If you feel off balance or you're dizzy, one of these systems may not be working as well.

Host: This is so interesting. And even I have felt sometimes you take a step, you mentioned proprioception and I take a step and for a second, I don't realize I took that step and I think to myself, Ooh, I almost just didn't step down. It's such a weird feeling, but tell us a little bit about aging, because Heather, people assume that balance issues are a natural part of aging.

Do you see balance issues as you've described in young people as well or mostly only older people? Is this a normal part of aging?

Heather Wengler, PT: It's not a normal part of aging. That's a bit of a misconception. And here at Bryan Health, we see patients from, you know, pediatrics through adolescence, adulthood, and to people who are moving on and we see sixties, eighties, nineties, and we work on balance. So sometimes people think that it is just a natural part of aging, but really it's typically related to something else that's happened to us.

Maybe we've had an injury to our foot or our knee. We might've had a disease or an illness process that maybe affects our eyes or how our joints feel, whether or not our inner ear is working as well, but essentially if everything's working well, you should have good balance. So if you think of yourself as this otherwise healthy person, and you're noticing you don't have the best balance, it would be something to get checked out.

I would say the other thing that we sometimes see is just from deconditioning, like lack of activity. If you're a healthy person and then you sit around and you don't do a lot, your balance reactions can degrade.

Host: Well, thank you for explaining that. So tell us about balance therapy. How does it work? What is it?

Heather Wengler, PT: We do an assessment here at our Center for Dizziness and Balance at Bryan West, and we look at how these different sensory systems work together. We do have something here that's called the Balance Master. And it allows us to do some computerized dynamic posturography, which is just some fancy words for, we essentially can measure how you sway, how your center of gravity responds to different conditions.

And we can also assess your motor responses too if the floor were to move forward or to tilt. That's one part of the assessment. And then we also look at how you do when you're walking and balancing and we add in and take away different sensations and assess how you perform compared to other adults similarly aged, things like that.

 So with balance therapy, we make a customized program to address which sensory systems or system is involved to help improve how your brain is getting that information, or we may end up targeting the systems that are intact if you maybe have an issue with one of those.

And we make a specialized program essentially to meet your needs to help improve your balance as best as you can and to normalize your reactions in different situations.

Host: So then how does someone know if they need balance therapy? I mean, obviously if somebody falls, they have a fall or many falls where they find themselves a little nervous about their balance, but are there other signs or symptoms? Tell us who could really benefit from balance therapy.

Heather Wengler, PT: I thought about this you know, how I would let someone I know or love if they needed to maybe come and work with someone like me for some balance therapy. And I would say the first thing would be to maybe pay attention if you notice your body swaying more as you try to stand still. You may find that you're leaning on a surface to do a task like brushing your teeth, like you should be able to brush your teeth and not have to lean on your counter while you do it, for instance.

So you can start maybe noticing things like that. The other big one that we often see is if you're reaching out for things as you walk, then you may be adjusting for your balance and seeking extra sensation from your hands. I often ask people, do they need to touch something or do they want to touch something if I notice that they're holding on to things as they walk past them, but that's a typical sign that we sometimes see when they're needing to hold themselves up rather than balancing. Another thing we often see would be what I would consider a fall in the balance world, but maybe other people don't necessarily consider it. So think of it like this. If you're falling onto something as you go about your day, that would be a red flag that something is going wrong, but it's not as obvious as it sounds.

With this line of work, to us, what we consider a fall is when you land on something that you didn't intend to. So it doesn't necessarily mean you fell on the floor. So if you went to stand up, and as you're, as you're getting up, you end up falling back onto the couch, that's considered a fall because you hadn't intended to go back to the couch.

You intended to walk away from it. And that potential for an injury exists if you hadn't landed where you did or in a safe manner. Same thing like if you lost your balance, and you avert a fall. What we think of that as like falling to the floor if you end up landing on something else, that's something that you have to consider. Those are signs that you would benefit from some balance therapy. I would say, lastly, the other thing would be if you start to notice that you're avoiding certain things like, if you don't want to walk into open space, like your backyard or into parking lots, things like that.

If you find that kind of like we were talking about before, if you're needing to hold on to something, that would make you hesitant to perhaps walk into open space. And that would be a concern.

Host: That was great advice right there. And we can listen again as many times and get those concerns so that you or a loved one really can help prevent falls because that's what this is really all about. Tell us about what you've seen as far as success rates with balance therapy, the quality of life before and after.

Heather Wengler, PT: We see a huge change in quality of life, both from the number of falls someone is having. We can sometimes reduce that dramatically. I sometimes meet people who've had a weekly, daily, falls to where they're not having falls and they'll last 30 to 60 days before they're discharged. As we work with someone on their balance, the program is designed to kind of meet their goals for what they need, but most patients want to be able to return to life in their active roles that they have.

And that includes going out in the community. Doing their grocery shopping, doing the sport activities, like maybe golfing or pickleball. Those are activities that are realistic to get back to as we age and need balance issues. We see people return back to work, return back to sports. And I think that is really meaningful.

And I would say more than anything, we help people get back to the community, doing the things that they love to do.

Host: That's great. What an excellent service this is. Tell us a little bit about your team at the Bryan Center for Dizziness and Balance. Are appointments referral based. Tell us how it works.

Heather Wengler, PT: So we do work on a referral basis and that referral can be sent just like any other referral would be, to the Bryan Scheduling Center, and they help connect that to the department, we'll reach out to you to get that scheduled and do all the necessary steps, including working with insurance verification and all of those kinds of things.

I do work with another colleague. Her name is Laura Corbridge and together her and I have over 40 years worth of experience handling and helping patients work through balance and dizziness type disorders.

Host: As we wrap up, I'd like you to offer your best advice. You're a physical therapist, you do this every day. The importance of balance for our overall health, wellbeing, our feelings of self esteem and security because posture and risks of falls and the injuries that come with that, they're all kind of rolled up into this very intricate system that is our balance system.

Give us your best advice, Heather.

Heather Wengler, PT: My best advice would be to stay active, whether that's in your home, in your job, in your community. And if you start to notice that you are having extra sway, having extra baubles, maybe falling into things, falling into walls that you didn't intend to do, you should seek out some help to get that addressed.

This is something that really is life altering if you have a balance issue, and we would never want somebody to be afraid of moving, be afraid of leaving their homes, and we certainly don't want it to lead to something catastrophic like a head injury or a broken bone. We would want people to get help as soon as they notice something.

Host: Great advice. Thank you so much, Heather, for joining us. And I'd like to thank our Bryan Foundation partner, Samson Construction. To listen to more podcasts from our experts, you can always visit bryanhealth.org/podcasts and check them out. We've got so many great ones on there. That concludes this episode of Bryan Health Podcast.

I'm Melanie Cole until next time. Thanks for listening.