Tests of Balance

Balance and equilibrium help us stay upright when standing and know where we are in relation to gravity. Our balance system also helps us walk, run, and move without falling. Balance is controlled through signals to the brain from your eyes, the inner ear, and the sensory systems of the body (such as the skin, muscles, and joints). This balance system is also known as the vestibular system, and is located in the inner ear.

If you are experiencing lightheadedness, a sensation of losing your balance, or a sense of feeling unsteady, you may be one of the millions of Americans who experience dizziness. Dizziness is one of the most common complaints and affects 20% to 30% of the general population. In fact, dizziness is a common reason that adults seek medical attention.

When your balance is impaired, you may feel unsteady, woozy, or disoriented. You may have blurred vision or experience a sensation of movement. It may seem that the room is spinning (vertigo). You may not be able to walk without staggering, or you may not even be able to get up. Sometimes nausea, vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, and anxiety accompany the dizziness and balance problems.

Balance system assessment is often recommended when a person has:

  • Rapid, involuntary eye movement (also known as nystagmus)
  • Complaints of vertigo or dizziness
  • Balance dysfunction
  • Gait abnormalities
  • Suspected pathology or disease of the vestibular system

Videonystagmography (VNG) testing is used to determine if a vestibular (inner ear) disease may be causing a balance or dizziness problem, and is one of the only tests available today that can decipher between a unilateral (one ear) and bilateral (both ears) vestibular loss. VNG testing is a series of tests designed to document a personís ability to follow visual objects with their eyes and how well the eyes respond to information from the vestibular system.

This test also addresses the functionality of each ear and if a vestibular deficit may be the cause of a dizziness or balance problem. To monitor the movements of the eyes, infrared goggles are placed around the eyes to record eye movements during testing. VNG testing is non-invasive, and only minor discomfort is felt by the patients during testing as a result of wearing goggles. The patient will be given instructions to follow carefully in preparation for the test. Certain medication cannot be taken for at least two days before testing. Failure to follow instructions will result in the need to reschedule the evaluation.

Unfortunately, in many cases, the dizziness and balance difficulties cannot be treated medically or surgically. In these cases, the balance problem itself may need to be treated through balance rehabilitation.

Audiologic (hearing), balance, and medical diagnostic tests help indicate whether you are a candidate for vestibular (balance) rehabilitation. Vestibular rehabilitation is an individualized balance retraining exercise program. The retraining teaches compensations that may decrease dizziness, improve balance, and improve general activity levels. Clinicians, such as physical therapists or occupational therapists, are trained to provide vestibular rehabilitation. Therapy with a clinician who specializes in vestibular rehabilitation may be effective in minimizing or relieving some of the symptoms. This is especially true if the dizziness is caused by head movement, motion sensitivity, or certain positions. Rehabilitation is also excellent for recovery of balance and improving daily functional activities.