Balancing act

"Sudden onset" is key to recognizing stroke. Sudden weakness or numbness on one side or inability to speak or understand, or vision loss or loss of balance or any combination indicates possible stroke. "If it's a possibility, get to the hospital and let the professionals figure it out. If it's a false alarm, that's wonderful. I hope it is. If it is a stroke, the sooner you get help, the more effective treatment will be."

People can take surprisingly simple steps to protect their balance. Good lighting, especially for people who are elderly or have vision acuity problems, is extremely important. So is making sure that pathways are clear and there are no rugs to trip over.

People should tell the doctor immediately if a medicine makes them "dizzy or woozy or so they don't think straight," says Dallen Lovell, a physical therapist at Mountain Land Physical Therapy of Holladay, who specializes in orthopedic manual therapy.

Skalabrin tells patients to put handles in places that are more dangerous, like bathrooms. A night light that lights the way into the bathroom and back can save lives. "One fall, one fractured hip can leave people devastated, so prevention goes a long way."

Some of the patients Lovell sees are just weak and when they try to take longer steps they start to fall over. Others have been injured and developed weaknesses, such as discoordination in one leg. He also sees people who don't have good protective responses, so when they put their foot down and the ankle's not quite flat, they stumble and fall instead of repositioning the foot. He's also seen patients who walk or stand just fine, but tip over when they close their eyes.

Someone with peripheral neuropathy, loss of sensation in the extremities, may not feel his foot on the ground and doesn't place it correctly. Those with the condition should never go barefoot. They need nice, big shoes so they can feel what they're doing.

A thorough evaluation to determine the cause of balance problems will point to the solution, Lovell says. The primary care physician is the first intervention step. Tell your doctor you're dizzy or losing your balance.

Physical therapy can help with re-establishing patterns, helping someone walk or stand by doing it repeatedly until it becomes second nature. But there are limits, depending on cognitive deficits caused by such events as stroke or brain injury. "We don't know how much someone will benefit until we get into it," he said.

"The critical part is the evaluation. If it's not good, the treatment won't be good," says Lovell.

An evaluation by an audiologist typically involves an electronystagmography (ENG) or videostagmography (VNG) test. The audiologist analyzes the patient's eye movements to see how well the inner-ear balance mechanism works. Those tests also help identify other possible causes.