A Special issue on Vestibular Rehabilitation

Life is like riding a bicycle. To keep your balance you have to keep moving.

At the outset, let me start by expressing my gratitude to you, as with this issue, PHSYIOTIMES completes five years of incessant service and this has been possible only with your continued faith and patronage. As you are aware, vestibular disorders are very common and often very debilitating. They affect the lives of people of all ages and backgrounds. Loss or disruption of normal vestibular function results in vertigo, loss of balance and orientation, and falls. With an aging population, the incidence and cost of balance disorders will increase. By age 75, balance disorders are one of the most common reasons for seeking health care.

It is an established fact that physiotherapists play a vital role in rehabilitation of people suffering from various balance disorders by adapting a multifaceted treatment approach incorporating strength training, fall prevention strategies, sensory and motor balance re-training, eye-head coordination exercises, gait/transfer training, and functional dynamic activities to optimize body function and assist them in returning to daily activities and recreation. This issue covers all you need to know about balance disorders as an important part of the rehab team managing such cases. The issue has been put together by Dr. Vimal Telang, who is working with AIIPMR, Mumbai, a premium rehab institute of the country along with reputed and expert authors from different faculties. We acknowledged Dr.Telang and all the author’s contribution in bringing out this special issue on balance.

GUEST EDITORIAL: Mrs. Vimal M.Telang

Human beings in their course of phylogenetic & ontogenetic development have evolved progressively to maintain balance in body and mind in the circumstances faced in development to bipedalism. Bipedalism has challenged the force of gravity to maintain not only an upright posture but also move, walk, run, jump, skip etc. With the increase in life span and emerging life style disorders across the globe, prevention and management of disorders causing balance importance has been increasingly g... Read More

MENTOR SPEAKS: Balance, Unsteadiness & Falls - DR. M.G. MOKASHI

Balance in life is an essential feature. Words, ‘equilibrium’ or ‘steadinesses also carry, the same shade of meaning. If a prefix ‘im’, ‘in’, or ‘un’ is attached respectively, the opposite meaning denotes unstable state. When a person is described as ‘imbalanced’, besides physical state, it could be related to mental state (temperament) at that time or even a state of being out of mind, often. Equilibrium refers to balanced phy... Read More

PHYSIO SPEAKS: In Conversation with the "Shabaski" Person - DR.JAYANT JOSHI

With the face of a saint, with eyes that are gentle, kind, appealing; yet inquisitive, a greeting to one and all, an ear for all, a word of advice, honest, humble & fearless, moving around hands in his pocket humming a song, who still at the age of 83yrs connects with one and all with the same enthusiasm is the stalwart Dr. Jayant Joshi. I first met him when he was an external examiner at my Masters practical  exam in 1984, the twinkle in his eyes and the very reassuring smile still ... Read More

REVIEW ARTICLE: Brain & Balance : Understanding Functional Neuroanatomy Of Balance - DR.SHAGUPHTA T SHAIKH

INTRODUCTION: Balance control was once assumed to consist of a set of reflexes that triggered equilibrium responses based on visual,vestibular or somatosensory triggers1. Balance is no longer considered one system or a set of righting and equilibrium reflexes. Rather, balance is considered a complex motor skill derived from the interaction of multiple sensorimotor processes2.

NEUROANATOMY OF BALANCE: All of the body's voluntary movements are controlled by the brain. One of the b... Read More

COVER STORY: Balance Impairment & Physiotherapeutic Consideration - DR.VIMAL TELANG

The force of gravity is a constant force the human body needs to encounter.Human beings have an inherently unstable system except when fully supported in lying; it cannot be in a state of stable equilibrium unless a control system is continuously acting.  Maintaining the line of gravity within the base of support is essential to prevent a fall.

Equilibrium is defined as any condition in which all acting forces are cancelled by eachother resulting in a stable balanced system. Ou... Read More

EXPERT OPINION: Neurological Disorder With Balance Impairments - DR.SATISH KHADILKAR & DR.RAKHIL YASDAV

Clinical Neurology is the art and science of anatomical localization and etiological diagnosis. Good history and examination recognize impaired function and lead to localization. Expert clinicians subsequently put their differential diagnosis in order of priority.  In the current era of investigations, clinical approach helps in choosing appropriate investigation; and hence the correct diagnosis. Output of this exercise is aimed at satisfactory management of patient’s problems.

... Read More

GUEST COLUMN: Vestibular Rehabilitation: Controversies & Consideration - DR.CARLTON PEREIRA

Most people don’t find it difficult to walk across a gravel driveway, transition from walking on a sidewalk to grass, or get out of bed in the middle of the night without stumbling. However, with impaired balance such activities can be extremely fatiguing and sometimes dangerous. Imbalance are common complaints in both the adults and the general population. The patient who complains of Dizziness often presents a diagnostic and management dilemma to the attending ENT, Audiologist or Phys... Read More

SPECIAL ARTICLE: Inside The Ear-Key To Maintaining Balance - ARCHANA ACHARYA

Equilibrium may be defined as the capacity to maintain the posture and spatial orientation at rest and during movement. There are three main systems responsible for the sensory input for maintenance of equilibrium visual, somatosensory and vestibular. At rest or on stimulation the afferent information from the three systems is coordinated and processed in the CNS to recognize the subject’s position. Result is, motor output is generated to maintain equilibrium.

The vestibular s... Read More

FEATURE ARTICLE: Cervicogenic Causes Of Imbalance - DR.S.SHUKLA

Our body coordinates three sources of sensory information to establish coordination, balance and equilibrium. Information from our eyes, our inner ears, and the joints of our body all supply information to the brain. A problem in any one of these three areas can send "incorrect" information to our brain and give us symptoms of imbalance. Problems in these systems can be peripheral in origin, related to disorders of the eyes and optic nerves, proprioceptive nerve endings and nerve bu... Read More

BOOK REVIEW: Vestibular Rehabilitation - Susan J.Herdman

Recognized as one of the world’s leading authorities on the subject, Susan Herdman delivers the most current information available about the management of patients with vestibular disorders in her updated 3rd edition text. With an increased emphasis on evidence-based practice, PT students and practitioners will more clearly understand the scientific basis for successful treatment and readily relate the rationales to clinical practice.

The book is sectioned into four parts; Sec... Read More

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