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Balance - Our Sixth Sense
- When we walk through the supermarket -- up and down aisles, turning our head right, left, up and down -- reading labels -- dodging other shoppers -- spinning around and answering a greeting from a friend at the other end of the aisle -- all without effort -- never once thinking about how we do this and stay upright.
- When we drive on a 4 lane highway at 65 mph, during rush hour, at night -- traffic passing us on both sides -- looking in the rear view mirrors and turning our head to check traffic as we make a lane change -- reading road signs overhead as well as on each side of the road -- all the time talking on a cell phone -- without difficulty -- without paying much attention to how we do this.
- When we dribble a basketball -- spin, jump, aim, and throw all the while avoiding opponents and being aware of where our teammates are moving in relation to where we are moving --, bobbing, weaving, spinning all without paying much attention to balance and how we perform these multiple, complex tasks.
We take for granted the complex processes involved in coordinating our eyes, turning our head, walking forward, and maintaining our balance -- our orientation to space and position. All of these processes are automatic, controlled and monitored by the brain without our having to pay attention to them.
Until we have a problem that affects our balance.
One of the most common balance problems relates to the Vestibular Ocular Reflex (VOR) which is the connection between our balance centers and our eyes -- a major piece of our balance system. Typical complaints referable to this system are a sense of increased dizziness or imbalance when entering or walking through a supermarket -- going up and down the aisles -- in crowded environments or under bright lights (frequently fluorescent lights). These environments create a "visual confusion" if our VOR is not operating correctly.
The purpose of the VOR is to stabilize our vision while our head is in motion. This reflex allows us to look at things while we are moving, easily and without conscious effort. We can move our head back and forth rapidly while focusing on a single object and never lose focus on that object. When our brain (the computer) can make instant, accurate calculations, we then know exactly where we are in relation to things around us - whether they are moving or stationary - especially when we are moving as well. The more visually complicated the environment is that we are in, the more difficult it is for the brain to make quick, accurate calculations. If we have a weakness in the VOR, the brain`s ability to do this is weakened as well, and symptoms of imbalance and disorientation are triggered.
Another good example of abnormal VOR functioning is when you are sitting at a red stoplight in an automobile with another car stopped at the same light to your left. If you are watching that car when the light changes to green and that car moves forward, you would have the confusion as to whether you are moving backward or that car is moving forward. In the abnormal situation, you would quickly apply your brakes because you would feel you were moving backward. In the normal situation (with normal VOR functioning), you would not think that you were moving - would realize that the light had changed and would proceed forward yourself.
We can measure the functioning of the Vestibular Ocular Reflex (VOR) through certain tests, one of which is called the Dynamic Visual Acuity test.
When you go to the ophthalmologist, your static visual acuity is measured for eyeglasses. We measure your Dynamic Visual Acuity which is your ability to lock your eyes onto objects (signs, faces, etc.) while your head and / or body is moving. The Dynamic Visual Acuity is a function of the Vestibular Ocular Reflex (VOR) and is dealt with frequently among sports medicine specialists.
Ted Williams had such highly developed Dynamic Visual Acuity that he claimed he could count the number of stitches on a baseball that was pitched to him traveling at 90 to 100 mph. Tennis, ice hockey, basketball and many other sports require highly developed Dynamic Visual Acuity.
In fact, it is hard to think of anything we do on a daily basis that doesn’t require normal functioning Dynamic Visual Acuity and therefore it is highest priority among many tests that we perform when we evaluate patients with suspected vestibular disorders. These test results are then compared against normal data from people of the same age without vestibular problems. For patients with abnormal test results, we can tailor an appropriate and effective exercise program (part of vestibular therapy) that has been proven to improve Dynamic Visual Acuity and hence Vestibular Ocular Reflex (VOR) function which in turn will reduce symptoms associated with balance and vestibular disorders.
The Vestibular Disorders Association of America (VEDA) has proclaimed the week of September 21st through 27th as the sixth National Balance Awareness Week. During this week, and all through the month of September, we are promoting "Balance as the Sixth Sense".
Most people can list five human senses -- site, hearing, touch, taste and smell -- but do not usually mention Balance.
According to the National Institutes of Health National Institute of Deafness and other Communication Disorders (NIDCD), 40% of all Americans will seek medical attention for dizziness at some time in their lives.
Balance Awareness Week targets the importance of balance as the Sixth Sense.
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