Three systems determine balance. The eyes lock onto objects to help maintain balance. The fluid in the ear's semicircular canal plays a role. And tension in the muscles adjust balance. They all work together to keep you upright and, if one area is weak, Browning says, the others can help compensate.

"The brain has great elastic ability to retrain itself," he adds, "from the time we're born to the time we die," although it slows down. Sometimes medications will trick the brain into thinking there's no problem. Exercises can also retrain the brain to forget there's an issue.

Benign proximinal positional vertigo occurs when little crystals in the ears become dislodged and move out of place, to float in the semicircular canal, which is supposed to contain only fluid. There, they bump into sensory cells, which exaggerates the sensation of movement. Someone can become terribly dizzy lying down or bending to tie a shoelace.

The solution is like playing one of those tiny marble games where you shift the board around to get the marble through a maze. Physical therapists or audiologists may perform the maneuver, a series of prescribed motions that take about five minutes, watching the eyes to guide the process. The tricky part for the patient is staying upright for 28 to 48 hours afterwards (you sleep in your chair) so the crystals will re-embed themselves where they belong.

Another vestibular, or inner ear, problem is weakness. That, too, is common and is treated using warm and cold water or air as a convection current in the semicircle inside the ear.

Menier's disease can be implicated in imbalance. There are four components: vertigo, fluctuating hearing loss, tinnitus and a feeling of fullness in the ears. It's the result of an overproduction of fluids in the ear canal. Treatment may include reducing salt, taking medications and using hearing aids to compensate for hearing loss.

The ENG and VNG tests can also identify some eye problems that contribute to imbalance.

For central nervous system issues of imbalance, the only solution is exercises designed to retrain — and you have to treat them like medication. You wouldn't skip your insulin with diabetes. You can't skip the exercises, either.

Lovell has retaught many people how to walk and know where their body is in space. Therapists work over and over on getting someone to stand successfully on one leg. The average person, eyes open, should be able to balance at least 20 seconds (5-10 with eyes closed). For the elderly, the time drops a little, but they still use that goal.

They sometimes have to convince people to use assistive devices like walkers and canes and teach them how.

Curing balance problems "is like anything," Lovell says. "In wrestling, it's said you do the move 2,000 times to really learn it. That's what you have to do, especially with balance. Some therapy is strength, some re-education. Repetition is important to develop a new pattern. Most people have very odd walking patterns and start to develop weaknesses and imbalances over time that make them more vulnerable to certain injuries or problems."

---

E-mail: lois@desnews.com