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Balance Challenges

An exciting and successful new treatment for dizziness and balance disorders has emerged over the past ten years called VESTIBULAR REHABILITATION and BALANCE RETRAINING. This treatment is being used at some of the nation’s leading medical centers including: John Hopkins, Walter Reed Army Medical Center, and Mayo Clinic, and leading universities. Thousands of patients throughout the country are getting better and returning to normal lives because of these programs. Many of these specially designed therapies have been developed and used to treat astronauts and pilots with lingering or chronic inner ear related equilibrium problems.


The first step to getting better is the proper diagnosis. According to the National Institute of Health, 85% of all equilibrium problems can be directly related to an inner ear disorder. Changes in the inner ear may occur for many reasons, including illnesses, infections, trauma, or simply the natural aging process. For some individuals who have experienced Meniere’s disease, labyrinthitis (inner ear infection) or vestibular neurinitis (inflammation of the balance nerve), the sense of “not feeling quite right” or dizziness may linger for years after the original occurrence. For others, the loss of surefootedness causes a constant fear of falling and possibly a more serious injury.


Think of each inner ear as a propeller on an airplane. In order for the airplane to fly in a straight line each propeller must produce an equal number of revolutions per second. If one of the propellers stops or slows, the airplane will veer off course, or fly in circles. Likewise, when there is a change in one of the human vestibular system’s outputs we experience the feeling of turning or motion, which we call dizziness or vertigo.

Now imagine that the airplane has a very sophisticated on-board computer that could be programmed to adjust and correct for the difference between the two propellers to keep the airplane flying a straight course. In the case of a human balance disorder, the brain acts as the body’s on-board computer. Vestibular Rehabilitation and Balance Retraining actually re-programs the vestibular system’s connections within the brain to adjust to the imbalance.


There are four general categories of therapy. More than one of these may be indicated to make the patient better as quickly as possible.

1. Canalith Repositioning/Liberatory Maneuver
Designed for an inner ear condition called Benign Paroxysmal Positional Vertigo (BPPV). This condition occurs when the salt-like crystals in the inner ear called otoconia, become dislodged and float within the canals of the vestibular system. Treatment includes one or two 20 minute visits as the crystals are gently repositioned.

2. Vestibular Rehabilitation
Designed for the patient whose symptoms may be severe and who requires supervision during exercise. Therapy sessions include the use of vestibular therapy equipment which most people enjoy. For older patients, there is an emphasis on fall prevention. Typically the patient participates in two or three 60 minute sessions per week, with an average of eight to twelve sessions. As the patient progresses, home exercises are added to accelerate the results.

3. Balance Retraining
For individuals who have a loss of balance, unsteadiness or loss of surefootedness. Most of these patients do not report dizziness or motion intolerance. We emphasize practical solutions to the common problems of difficulty getting around in the dark, walking on uneven surfaces and moving unencumbered on ramps and stairs. Fall prevention, movement coordination, and improved participation in everyday activities are all high priorities of the program.

4. Self-Directed Exercises
Home Based therapy which the patient does on his own. Each program is individually and especially designed for the patient based on test results and the situations which bring on symptoms. This approach is most commonly used with patients that do not require supervision during exercise. Best results occur when the patient spends 20-30 minutes per session two to three times a day. Most patients report a significant reduction in their symptoms within a two to four week time span.
For more information on vestibular disorders please visit: https://www.dizzy.com


The majority of patients we see have tried to find help for their balance disorder, but were often told “…they’d have to learn to live with it. “ It is important to remember that just as each patient’s problem is unique to them so is the therapy and the outcome. Through Vestibular Rehabilitation and Balance Retraining, the vast majority of our patients find the relief they’ve been seeking. Don't give up!

The American Institute of Balance is a nationally and internationally recognized leader in the development of evaluation, treatment, and therapy protocols for patients with dizziness and balance problems.


Dizziness or loss of balance is the second most common complaint heard in doctors’ offices. National Institute of Health statics indicate that dizziness will occur in 70% of the nation’s population at sometime in their lives. Although very common acute or chronic problems with equilibrium may indicate serious health risks, or limit a person’s everyday living.

Equilibrium disorders fall into two categories. The first is dizziness, vertigo or motion intolerance that may occur in acute or sharp attacks lasting only seconds or sometimes for several hours. This condition may be caused or worsened by rapid head movements, turning too quickly, walking or riding.

The second is a persistent sense of imbalance, unsteadiness or what some people refer to as a loss of surefootedness.

The good news is that diagnosis and treatment options have become more effective over the past ten years. There is hope for many who once thought there might be no relief


Many people believe that loss of balance and unsteadiness are a natural result of aging. In fact, fear of falling is the number one health concern of individuals in their later years – not founded as the National Institute of Health statistics indicate that balance – related falls account for half of the accidental deaths in the population over 65. In addition, nearly 300,000 hip fractures and 3 billion dollars in medical expense result from balance related falls each year.

Human equilibrium is a complex interaction which requires correct input from the inner ear, vision and somatosensory (contact with the earth as perceived by our feet, muscles and joints). All three signals must then be correctly received by our central nervous system. Then the brain must execute the correct movement of our musculoskeletal system, so that we may maintain our center of gravity. If any one or several components of this system do not work properly, the patient will suffer loss of balance

The natural aging process may affect any one or all of these senses, as well as the brain’s ability to interpret them and then to react quickly. It is very common to hear from someone who has fallen that they saw the curb or step but just weren’t able to react fast enough or to keep their balance.

With proper diagnosis and therapeutic exercises, called Balance Retaining, many older adults are able to return to more active lives.


  1. Vertigo dizziness or imbalance will affect 90 million Americans sometime during their lifetime.
  2. Each year, over 9 million people consult with their doctors with complaints of dizziness -the number one malady for those over 70.
  3. Balance related falls account for more than one-half of the accidental deaths in the elderly.
  4. Balance related falls cause over 300,000 hip fractures a year in individuals over 65 years of age.
  5. Inner ear disorders such as Meniere’s Disease, benign positional vertigo, perilymph fistula, and endolymphatic hydrops, have symptoms which are virtually indistinguishable to most people. Because imbalance and vertigo can affect a person’s ability to stand and walk, to see or think clearly, to read or watch television, and to make decisions; diagnoses are sometimes confused with multiple sclerosis and clinical depression.
  6. Children with treatable vestibular disorders are sometimes incorrectly diagnosed as learning disabled, dyslexic, or psychologically disturbed.
  7. Blows to the head and whiplash are frequent causes of balance dizziness.
  8. Ear infections can also lead to vestibular disorders.

The American Institute of balance is nationally and internationally known for its expertise in testing and rehabilitation, helping thousands of patients who were told “learn to live with it” to return to normal lives. AIB’s evaluation protocols and therapy programs are used by physicians, audiologists, and therapists, clinics, and hospitals world wide.

Dizziness, Vertigo, Motion Intolerance

The primary organ of equilibrium in the human body is located in the inner ear which serves as both the sensory organ for spatial orientation and head movement as well as hearing. If for any reason there is an abnormal increase or decrease in the signal being sent to the brain, from any of the balance canals, the brain will perceive this as an exaggeration or hallucination of motion. The result is what we commonly term dizziness or vertigo.

Illness, infections, disease, head trauma, and the natural aging process may cause changes in the equilibrium portion of the inner ear. For others, motion sickness may be traced to their early childhood. Motion tolerance may be experienced as either a sense of exaggerated motion or an inability to watch moving objects while stationary.

Although symptoms may only last for several days it is not uncommon, if left improperly diagnosed or treated, for them to linger for years. The good news is that 90% of all causes of dizziness can be found through a thorough evaluation. Eighty-five percent are caused by inner ear disturbance and can be treated medically, surgically, or with Vestibular Rehabilitation.
For more information or vestibular disorders please visit: https://www.dizzy.com


  1. A feeling of motion, spinning, or falling when moving your head quickly, or changing Your position? (e.g. getting in and out of bed)
  2. Uncomfortable trying to get around in the dark?
  3. Walking down grocery store aisles or through the mall is upsetting?
  4. Your feet just won’t go where you want them to?
  5. A sense of unsteadiness? A feeling you are not sure footed?
  6. A fear of falling or stumbling?
  7. Looking at moving objects such as escalators or looking out the side window of a car makes you queasy?
  8. Difficulty keeping your balance as you walk on different surfaces? (e.g. tile to carpet)
  9. A feeling like you are drifting or being pulled to one side when walking?
  10. No one really understands how frustrating all this is?

If you answered Yes to one or more of these questions, a vestibular and equilibrium evaluation should be considered.