Balance problems and dizziness

There are various systems in the body that are responsible for maintaining balance, and the brain plays a key role in this skill. Unfortunately, problems with balance and dizziness can therefore develop after brain injury, causing a wide range of difficulties and affecting people’s quality of life.

The human balance system

The human balance system is a complex interaction of the following systems:

• The vestibular system - this is made up of parts of the inner ear, which respond to movements of the head in order to build up a picture of the body’s position in space.

• The brain - information from the vestibular system is passed to different parts of the brain for processing. Key areas include the cerebellum, the brainstem, the basal ganglia and the cerebral cortex.

• The proprioceptive system - this is the system that processes the sense of body position and movement.

• The visual system - vision provides vital information to the brain about where we are in space and how we are positioned relative to other objects.

How to cope with balance problems and dizziness after brain injury

Balance problems and dizziness are different for everyone. The strategies that will work for you personally will depend on the exact nature and cause of the problems. Therefore, some of the following tips might be helpful to you, while others might not be.

Keep a balance diary

Keeping a balance diary is a good way of recording when and where you experience issues. You can then identify triggers and patterns, and pinpoint activities that you have particular difficulties with.

Note-taking apps on smartphones can be a convenient way to keep a diary, or you could keep a pocket-sized diary with you at all times so that you can make notes at any time.

It can be helpful to take your diary along with you to medical appointments, as the information could be helpful for the medical professionals in putting together a treatment plan.

Consider psychological support

Talking therapies such as counselling and cognitive behavioural therapy (CBT) can help you to develop coping strategies to deal with anxiety. They can also help you to adjust to your changed circumstances. Discuss getting a referral to talking therapies with your GP.

Talk to family and friends

Keeping things bottled up and suffering in silence can be the worst thing you can do. Sharing your feelings with people you trust can help you to get things off your chest and make others in your life better aware of any support needs you may have. Other people can also be a good source of helpful advice and tips.

Try one thing at a time

There are often multiple things that can be affecting your balance. If you change too many things at once, you won’t be sure which ones have made a difference. Try changing one thing at a time and monitoring how you feel afterwards to better identify what helps.

Stay active

It can be very tempting to avoid doing activities that you have difficulties with, but this can make balance issues worse, or cause you to become isolated from friends. Try to stay active and find ways to adapt activities that you enjoy so that you can continue to do them safely.

Carry a Headway Brain Injury Identity Card with you

Our Brain Injury Identity Card can help to explain the effects of brain injury to others quickly and access support when needed. Some people with balance issues have been accused of being drunk, so showing people the card can help them to understand the real issue.

It is very important to work with a professional who specialises in balance problems for the tips in the following section. None of these tips should replace expert, professional advice, and you should discuss these with your GP, rehabilitation team or other suitably qualified healthcare professionals before you try any of them. You must also remember never to change, stop or reduce any medication without discussing this with your doctor first.

Consider trying different exercises

Strength-building exercises can be helpful for some, especially core-strengthening exercises that target the upper body and abdominal regions, such as press-ups, sit-ups, pull-ups and weight training.

Stretching exercises such as yoga, Pilates and Tai Chi may also be helpful.

Walking can be a good, gentle introduction back into activity, or a useful exercise in itself.

Swimming, dancing and aqua aerobics are other exercises that can help with building fitness, strength, flexibility and balance.

Consider using exercise equipment such as gym balls and balance boards to help. Physiotherapists with experience in brain injury can offer advice on suitable equipment.

Other exercises can include weight adjustment (practice shifting your balance over your feet without moving your feet), standing on one leg and gradually increasing the time you do this (be very careful and make sure you have someone else there and/or something stable to lean on if you lose your balance), and practising walking on different surfaces.

Consider balance training techniques

As well as strength and fitness exercises, there are a number of training techniques to consider when working to improve balance.

• Use a guardrail to hold onto while your balance improves.

• Some people practise walking on their hands and feet until their balance improves.

• Consider wearing protective headgear while you are still unsteady.

• Practising walking on grass or other soft, stable surfaces can be helpful.

• Try to keep correct posture, as upright as possible with head and eyes level.

• Practice walking down a chalk line.

• Practice movements while leaning on a chair or other solid, stable object.

• Try to make activities fun and enjoyable so that you are more likely to stick with them.

• Build activities up slowly so as not to dent your confidence by taking on too much too soon.

• Try to vary your activities.

Use compensatory strategies

Exercises and training techniques sometimes can’t help or will require a lot of practice and time before you notice an improvement. You should therefore also try to learn strategies that allow you to compensate for the problem.

Some suggestions are as follows:

• If necessary, walk with another person supporting you.

• Consider making adaptations around the home, such as installing handrails and handles so that you can hold onto something as you move around. An occupational therapist can help with choosing and installing these. You might be able to get help for the cost of making adaptations through a government grant.

• Focusing your eyes on upright, solid objects like lampposts can help when walking in the street.

• Using a cane, crutch or walking frame can be helpful, as this not only provides support but also feedback as you move.

• Touching objects with your hand as you walk past them can provide feedback, support and a sense of distance.

• It might help to wear good quality footwear with soles that allow the feet to feel the ground, which can give you feedback from the ground as you walk.

• Try to avoid uneven floors.

• Avoid sudden head movements and swivelling your eyes.

• Use slow, gradual movements when turning around or turning over.

• Consult a physiotherapist to learn how to fall safely.

Coping with balance problems in the dark

Balance problems can worsen in dark conditions. This is because visual cues are very important for balance. If you have particular difficulties in the dark, the following suggestions might help.

• Keep lights and lamps readily available, in easy-to-access spots around the house. Directional lights can be very useful as they can be aimed in the direction you need.

• Put glow-in-the-dark stickers on light switches and door handles so you can always locate them in the dark.

• Make sure you have help in dark places, such as cinemas.

• Carry a small pocket flashlight or consider downloading a torch app for your smartphone.

Getting professional help for balance problems and dizziness after brain injury

It is important to have a specialist assessment to diagnose and treat balance problems and dizziness. Many hospitals have balance clinics which provide assessment and treatment.

Professionals typically involved include:

• Ear, nose and throat specialists (ENT) - specialists in the investigation and treatment of ear, nose and throat conditions.

• Neurologists - specialists in the investigation and treatment of issues with the brain and spinal cord.

• Physiotherapists - specialists who help to restore movement and function.

• Ophthalmologists - specialists in the investigation and treatment of eyes.

• Audiologists and otologists - specialists in the investigation and treatment of ear issues and hearing.

Types of treatment and therapy offered for balance problems and dizziness include:

• Vestibular rehabilitation (VR) - this is the main treatment for most types of balance problems. It helps the brain to minimise dizziness symptoms caused by imbalances between different parts of the inner ears. The brain learns to rely more on other signals from the balance system, such as joints and limbs. This process is known as ‘vestibular compensation’. VR involves a programme of head, eye, neck and body exercises under different visual situations (for example, with the eyes open or closed, or with background objects moving or stationary), on different surfaces and in different environments.

• Vascular vertigo treatment - treatment is aimed at lowering blood pressure and cholesterol. Increased exercise, eating a healthy diet and cutting down on smoking and alcohol can all help.

• Traumatic endolymphatic hydrops - regulating the diet can be helpful towards controlling traumatic lymphatic hydrops. This can include cutting out caffeine and reducing sugar, salt and alcohol intake.

• BPPV treatment - includes undergoing a series of head and upper body movements aimed at clearing crystals trapped in the inner ear.

• Talking therapies - balance issues and dizziness can cause people to feel anxious and stressed. It might lead to people avoiding social situations and reducing contact with friends. Talking therapies such as cognitive behavioural therapy (CBT) and counselling can help people suffering from stress, anxiety and depression. CBT can be particularly effective for learning relaxation techniques to reduce anxiety and for helping people to recognise and manage the triggers for vestibular problems. Once you understand these triggers, you can develop the strategies to cope with them.

• Medication - anti-vertigo or anti-sickness medication can help in some cases. These should usually only be taken for a short time, as they may interfere with vestibular compensation if taken for too long.

• Eyewear - certain types of glasses, such as bifocal and varifocal lenses, might make you feel disoriented and worsen balance problems. If you think your eyewear might be contributing