Balance Disorders

Because balance disorders may be caused by a wide variety of one or more abnormalities involving various body systems, interpretation and treatment of imbalance can be quite challenging.  For example, normal gait requires integration of:

  • Visual (eyes)
  • Vestibular (inner ear)
  • Auditory (hearing)
  • Cerebellar (coordination center of the brain)
  • Basal Nuclei (deep brain centers)
  • Sensory (nerve fibers sensing position of limbs, joint and head movements)
  • Muscular (various muscle groups)

and considerations for structural abnormalities, including

  • Arthritis
  • Joint problems and joint surgery
  • Back and neck problems

not to mention Psychologic factors (fear of falling) and Medications (polypharmacy) that may contribute to abnormal gait and imbalance.

There are many classification systems used to characterize and study disorders of gait and balance, perhaps the most straightforward involves a neurologic hierarchy system:

  • Cortical (outer part of brain) and Subcortical (deep to the outer part of brain), examples include
    • Stroke or Tumor causing a Spastic Gait affecting the opposite side of the body
    • Normal Pressure Hydrocephalus causing a Magnetic Gait
    • Psychologic factors, including a fear of falling causing a Cautious Gait
  • Basal Nuclei (deep nuclei of the brain) and Brainstem
    • Parkinson's
    • Parkinson's Plus Syndromes
      • Progressive Supranuclear Palsy (PSP)
      • Cortico-Basal Degeneration (CBD)
      • Multisystem Atrophy (MSA) - (formerly known as Shy-Drager, OPCA)
      • Diffuse Lewy Body Disease or Dementia with Lewy Bodies (DLB)
  • Thalamus (deep brain structure), Cerebellum (coordination center) and Brainstem disorders may cause Ataxia
  • Spinal Cord disease leads to Spastic Gait
  • Peripheral Nerve disorders include
    • Proprioception (limb and joint position in space) loss causes a Sensory Ataxia or Slapping Gait
    • Visual loss causes Visual Disequilibrium
    • Vestibular nerve loss causes a Cautious Gait if unilateral (one side) or an Ataxic Gait if bilateral (both sides)
  • Neuromuscular Junction (contact point of nerve and muscle) and Muscle disorders may cause a Waddling Gait







Spastic Gait

Parkinsonian Gait

Ataxic Gait


Normal Pressure Hydrocephalus


Bilateral Vestibular Loss

Slapping Gait
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