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    by Brian Hutchinson, PT, MSCS, Former Can Do MS CEO

    Loss of balance can be frustrating. It is most commonly seen with activities such as walking, climbing stairs or transfers. It can also be a problem with sitting or standing.

    Balance problems can result directly from plaques in the cerebellum, the balance and coordination center. It can also result from other impairments commonly seen with multiple sclerosis, such as visual disturbances, loss of sensation, spasticity or weakness. 

    Because there are no medications available to improve balance, we rely upon exercises and compensatory techniques to improve balance and safety.

    If you have balance problems:

    • Speak with your physician about seeing a physical therapist.
    • A physical therapy evaluation can help identify what is causing the balance difficulties and gear any intervention toward those impairments.
    • The evaluation may include specific tests to identify the area or areas of difficulty; these tests may be ‘low-tech’ or ‘high-tech’, but both are designed to identify areas of weakness and ‘hone-in’ on the problem.

    Some interventions commonly used to improve balance include:

    Vestibular rehabilitation: these are exercises and techniques designed to induce brief periods of vestibular loss; they are performed several times per day with the end goal being adaptation to vestibular deficits; exercises may include eye or head movements, distorting or eliminating visual input and changing or moving weight bearing surfaces

    Symptom management: through medications and physical and occupational therapy; these will help with management of symptoms such as spasticity or fatigue which may indirectly affect balance

    Exercise: a regular exercise program can help improve balance also; exercises should be functionally oriented addressing the area of specific deficits; for example a person who experiences balance difficulty climbing stairs, should consider exercises which simulate stair climbing. The use of balance boards, therapeutic balls and biofeedback can be very useful, but should be directed by a physical therapist

    Compensation: compensatory techniques are often recommended for individuals with balance difficulties; this can include the use of an ambulatory aid for a person experiencing balance difficulties with walking; it may mean using a handrail when climbing or descending a flight of stairs; it may also mean resting if balance difficulties present themselves primarily when fatigued; all are appropriate compensation techniques and should be discussed with your physician and/or rehabilitation professional.

    Balance problems can be ongoing or transient. The key to improving balance is dentifying what is causing the balance problem. Since balance is very complex it requires a complete evaluation. These evaluations and subsequent interventions can be frustrating because balance evaluation and training are designed to identify and exploit these deficits. The good news is that balance deficits can be improved with a proper integrated approach. Gradually you will see improvements and realize YOU CAN improve your balance.

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