Το whom the Balance Disorders Clinic is addressed?

At St. Luke's Hospital there is a Clinic for Balance Disorders which is addressed to all patients suffering from dizziness, vertigo, instability. Its purpose is to examine separately all the subsystems that contribute to maintaining the correct and functional balance and to identify any deficits. 

Physiology of balance

For balance, several individual systems need to function properly: 

• The central nervous system as coordinator
• The vestibular (labyrinth) with the sensory organ, the inner ear
• Vision with an important controlling role

Dizziness and vertigo

Symptoms that indicate a balance disorder, such as dizziness and vertigo, are among the most common causes of visiting clinics of various specialties.

• Vertigo always hides a feeling of rotation and is usually due to problems of the labyrinth. 
• Dizziness is an unpleasant experience that causes fear and insecurity in all the people who happened to experience it.

Causes of balance disorders

The loss of balance can be due to a multitude of reasons, such as:

• Otologic disorders. Otologic disorders affect labyrinthine function, with the most common condition being positional vertigo. This is a benign disease, which can be often treated easily and the patient is relieved from the discomfort of days or even weeks sometimes.
   
• Neurological diseases. Acute vascular episodes and neurodegenerative diseases can be hidden behind an episode of dizziness. Our role in these cases is to quickly make a correct diagnosis for a disease that can be potentially life-threatening for the sufferer.
   
• Problems of the musculoskeletal system. More important are those of the cervical spine that burden the balance and make it laborious. These patients constantly feel instability, resulting in fatigue and frustration even for their daily activities. Individual rehabilitation programs are of great help to the above category of patients. 

Philosophy of the Clinic

Our goal is to improve the quality of life of patients who have been suffering for a long time, as well as the immediate therapeutic intervention in acute episodes.

Therapeutic approach

The therapeutic approach ranges from simple counselling and medication to individualised programs for the restoration of labyrinthine function and the enhancement of proprioception. Treatment begins with the diagnosis. Magic solutions do not exist to such a difficult problem, but we can certainly develop strategies for recovery.

Due to the complexity of the imbalance, its successful approach requires: 

• Orderliness
• Knowledge
• Patience
• Good relationship between the patient and the attending physician 
• Modern diagnostic equipment

Diagnostic tests

The tests are numerous and are performed depending on the clinical picture and the history of the patient. Particular emphasis is given to the calculation of the risk of falling in the elderly and the chronically ill. These tests help us find the root cause and recommend the optimal therapeutic intervention.  

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Labyrinth

As for the labyrinth, we examine all five sensory organs (3 semicircular tubes and 2 vesicles). With the head impulse test, we can calculate the damage of each semicircular tube separately. The test is used both in the acute phase and to monitor the rehabilitation of the condition. 

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Determination of the visual vertical

By determining the visual vertical we can find out if the patient feels correctly in the environment, so that he can harmonize with gravity. When our whole body is at an inclination, we understand how much more difficult the balance is and therefore more intense and the burden on the muscles and joints.

Eye movement test

In patients with concomitant neurological diseases, we check their eye movement, looking for lesions more centrally in the brain and cerebellum that may be related to the symptoms. For the right balance, a stable field of view is needed.

There are many tools at our disposal today. Above we briefly mentioned only a few of them. Depending on each case, we proceed to the required tests, in order to shed light on every small detail that is necessary for the right balance.

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What is Vestibular Rehabilitation?

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Vestibular Rehabilitation Therapy (VRT) is a specialised form of therapy to improve the symptoms caused by vestibular disorders. It often includes exercises - head position manipulations and/or a progressive program of exercises designed to reduce vertigo and dizziness, visual problems and improve balance in general, ultimately aiming to reduce the risk of falls. After a disorder of the vestibular system, the central nervous system can compensate for the reduced functioning of the inner ear. Essentially, the brain compensates for the wrong information from the labyrinth that has the disorder by making more use of alternative signals coming from other body systems, in order to maintain the overall balance.

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This can be achieved through various exercise strategies, which are applied in the specialised department of dizziness - vertigo and balance disorders at St. Luke's Hospital. When this central (or cerebral) decompensation is achieved, patients' symptoms are alleviated and allow them to return to everyday life more quickly and more safely.

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To whom this modern treatment of balance disorders is addressed?

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It is addressed to patients who suffer chronically from vertigo due to vestibular neuritis, labynthitis and Meniere's disease. Also, in central vertigo aetiology, there are special protocols which aim to balance the proper functioning of the brain, so as not to disturb the patient's balance by intense visual stimuli and stressful situations.

In the elderly who suffer from underlying neurological or orthopaedic problems, we are able, in the rehabilitation department, with the cooperation of physiotherapists, to reprogram the overall neuromotor behaviour, in order to achieve better balancing behaviour and reduce the risk of falling.

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