Balance is a critical component to human movement and independence. It is essential to strength train and practice balance exercises on a regular basis. We always talk about age related balance issues but stress is rarely ever mentioned as a risk factor when it comes to balance. It is imperative to visually and physically assess all clients who come to you with acute, severe, or chronic stress. In this article we would talk about age related balance issues and Psychogenic Gait Disorder which is a balance disorder caused by stress and trauma.
What Causes Age-Related Balance Problems?
According to Healthline, balance is an intricate process that involves many systems of the body, vestibular system, inner ear, eyes, the brain, muscles, sensory nerves, the labyrinth of the inner ear, heart, and blood vessels. If there is an issue with any of these areas of the body, an individual will be at risk for falls and even injury. As individuals age, they are more prone to balance problems and will begin to show symptoms of being off balance. The body can somewhat compensate for up to 50% loss of function of the vestibular system, but clients will likely have difficulty walking, unsteadiness, and overall issues with balance. The ear consists of two parts, which are the cochlea for hearing and the vestibular system for balance. The vestibular system consists of three semicircular canals that separate the vestibule, which contains vestibular ganglion cells that detect movement every time an individual moves their head. Most of these cells die off by the time an individual turns eighty years old. If someone has been moving a lot, it could take time for the vestibular system to calm down, which can initiate the feeling of dizziness or that the room is spinning. As we age, it takes longer to adjust to positional changes, which may cause older adults to feel dizzy or off-balance more often.
A doctor will test for balance disorders by ordering audiological testing, videonystagmography (VNG), and magnetic resonance imaging (MRI). Most tests are administered to stimulate the inner ear so the doctor can tell which position or movement is giving the patient a problem. The tests that are categorized under VNG testing are ocular mobility where the patient watches moving and stationary dots on the wall. The next test is the rotational chair, in which the chair moves slowly to see if there is any reaction from the inner ear. Positional Nystagmus is a test where the head and body are moved in different positions to try and see if there are any symptoms such as dizziness. Lastly, caloric testing may be done by filling the ear with water or air to see if one ear responds differently. If one ear shows a difference, this could indicate an inner ear condition. According to the National Institutes of Health, a decline in balance starts to occur between the ages of forty and fifty, and one in three individuals over the age of sixty-five will experience a fall each year. Below is a chart that shows the vestibular decline and symptoms as we age.
| % of Loss | Impairment or Symptoms |
| 0 | Nothing |
| 50% to 70% | Somewhat unsteady |
| 70% to 90% | Mild oscillopsia, scared to drive at night |
| 90% to 100% | Oscillopsia, sensory ataxia, moderately
unsteady |
Adapted from: “Modeling of Age Related Vestibular Decline.” Age Related Vestibular Decline, 6 Dec. 2018, www.dizziness-and-balance.com/disorders/bilat/model-age.htm.
Treatment For Balance Problems
Treatment for these clients will depend on the cause of the balance disorder. Individuals may have to seek the help of a Physical Therapist or Occupational Therapist, and be prescribed medications by a Physician to help with conditions like vertigo. Rehabilitation professionals give patients exercises so they can obtain better balance and prevent falls, injury, and possibly dependence on others.
If you notice these postures, work on flexibility and exercises to help correct them. If your client assumes this position for too long, it will become a habit and harder to correct in the long run. Clients may also have to see a Physical Therapist if posture becomes worse or is staying the same. It is essential to do a visual as well as a physical assessment of each client that you are currently working with. If you notice any mild to severe balance problems, we recommend that you refer your client to their primary physician or physical therapist to have their balance tested and symptoms looked at.
What Is Psychogenic Gait Disorder
One in three people ages 65 and over fall each year, while more than 2 million older adults go to the emergency room for an injury from a fall per year. According to Health and Human Services, 8% to 10% of individuals with balance issues are treated for Psychogenic Gait Disorder. This is a disorder that can be caused by a neurological condition such as epilepsy, a mental health condition, chronic stress, physical or emotional trauma, history of physical or sexual abuse, or childhood neglect. This condition is a psychogenic motor disorder that affects how an individual walks as well as speech but cannot be explained as a neurological disease.
The Journal of Rehabilitation Medicine states that individuals who attended an outpatient physical therapy program for three weeks saw a significant improvement in their ability to walk, quality of life, and functional independence.
A one year follow up showed that participants kept the results that they had seen after physical therapy had ended the previous year. According to Research Gate, Individuals who require six to twelve months of treatment will usually have long term disability. It is also important to note that individuals who have psychogenic gait disorder may also have anxiety and depression.
What To Look For
The signs and symptoms of psychogenic gait disorder are the dragging of one leg, sudden buckling or collapsing of the knee, small slow steps, excessive swaying, extra movements of arms and legs that disrupt balance, crouching, and anxiety about falling. A neurologist must examine the client to get a diagnosis for this disorder. Treatment is multidisciplinary and usually includes physical therapy, occupational therapy, and seeing a psychologist. Each program is specifically tailored to an individual since the cause and symptoms of the disorder are different for each person. If you suspect your client may have Psychogenic gait disorder refer them to their primary physician. These individuals will need the help of a healthcare team in order to get better. The healthcare team will decide if the client can continue an exercise program at this point. Sometimes the client may have to wait a few months before being able to train with you again. The physical therapist may have exercises that he/she would like you to continue during your training sessions when the client returns. Keeping open communication with the healthcare team is extremely important as your client recovers.
Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.
