Cause Of Imbalance Research Articles

Vertigo in children

Vertigo in children is a challenging complaint for which potentially numerous etiologies exist. The history, often obtained most reliably from the observations of parents or caretakers, contains key information that directs the diagnostic evaluation. Using this information, the clinician may then categorize the complaint of vertigo according to its quality (paroxysmal or unremitting), and its association with the following: hearing loss; loss of consciousness or postural control; or any neurologic symptoms. The differential diagnosis may then be approached in an algorithmic method and narrowed down to isolate the most common disease processes that may account for the specific symptomatology. Current studies support the growing evidence that otitis media is one of the leading causes of imbalance in children.

Control of compensatory stepping reactions: Age-related impairment and the potential for remedial intervention

Stepping is a prevalent and functional reaction to loss of balance, yet this element of postural control has only recently begun to receive due attention. It is likely that the impaired ability to execute compensatory stepping reactions is an important contributor to the unsteadiness, loss of balance confidence, and risk of falling that is associated with aging and age-related pathology. Even healthy, active older adults appear to experience difficulty in controlling stepping reactions, as evidenced by a tendency to require multiple steps to recover equilibrium. There seems to be a particular problem in controlling lateral stability. When stepping in response to forward or backward loss of balance, older adults often experience difficulty in countering the tendency of the body to fall laterally during the step. When stepping in response to lateral loss of balance, they often have problems controlling movement of the swing foot so as to avoid collision with the stance limb. The problems in controlling lateral stability may be particularly relevant given the prevalence of lateral falls in older adults and the links to risk of hip fracture. With regard to mechanisms, early findings implicate age-related loss of cutaneous sensation from the plantar surface of the foot as an important contributing factor. Loss of strength may also play a role. Neural lesions, due to stroke or Parkinson' s disease, can result in profound difficulties in controlling the reactions. It is expected that studies of compensatory stepping will lead to development of new and improved diagnostic and therapeutic approaches for detecting and treating specific causes of imbalance and falling. Potential areas for remedial intervention include sensory aids, footwear, strength training, and balance training. Such interventions, if proven effective, may have a significant impact on the ability of clinicians to help older adults maintain as active and independent a lifestyle as possible, without undue fear or risk of falling.

The role of limb movements in maintaining upright stance: the "change-in-support" strategy.

Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important functional role in maintaining upright stance than has generally been appreciated. Contrary to traditional views, change-in-support reactions are not just strategies of last resort, but are often initiated well before the center of mass is near the stability limits of the base of support. Furthermore, it appears that subjects, when given the option, will select these reactions in preference to the fixed-support "hip strategy" that has been purported to be of functional importance. The rapid speed of compensatory change-in-support reactions distinguishes them from "volitional" arm and leg movements. In addition, compensatory stepping reactions often lack the anticipatory control elements that are invariably present in non-compensatory stepping, such as gait initiation. Even when present, these anticipatory adjustments appear to have little functional value during rapid compensatory movements. Lateral destabilization complicates the control of compensatory stepping, a finding that may be particularly relevant to the problem of falls and hip fractures in elderly people. Older adults appear to have problems in controlling lateral stability when stepping to recover balance, even when responding to anteroposterior perturbation. Increased understanding and awareness of change-in-support reactions should lead to development of new diagnostic and therapeutic approaches for detecting and treating specific causes of imbalance and falling in elderly people and in patients with balance impairments.

Office Management Of The Dizzy Patient

This article has attempted to set out in a logical, step by step fashion the approach to a dizzy or vertiginous patient. All that has been said will not apply to every patient. The investigator must above all be patient and thorough in obtaining the history--this is by far the most important step in the process. The physical examination is tailored to the complaint. Investigations include examinations of hearing, balance, serum chemistry, and radiology. Most otolaryngologists limit themselves to the diagnosis and limited medical management of dizziness and vertigo. It is required, however, that any physician treating dizzy patients have an understanding of the larger medical and surgical picture. A systematic and thorough approach to the dizzy patient will often yield the diagnosis, exclude otologic causes for imbalance, and ultimately set the patient on a proper course of treatment.

Functional Disorders of the Foot.

This is a highly practical treatise on a subject which should be of great interest to the pediatrician and to the general practitioner as well as to the orthopedic surgeon. It is unfortunate that the medical profession as a whole has not recognized the great amount of disability and discomfort produced by functional and anatomic disorders of the foot and has failed, therefore, to give these conditions the serious study and attention they deserve. Symptom-producing conditions of the foot constitute a real economic as well as a medical problem. The chapters on the evolutionary development of the foot, on anatomy and physiology and on the primary causes of imbalance of the foot are elementary, but they represent fundamental knowledge which must be assimilated before accurate diagnosis and adequate treatment are possible. The authors point out, correctly, that the early recognition and treatment of functional imbalance of the foot in early