Definition

Balance is the ability to maintain a position. Coordination is the capacity to move through a complex set of movements. Balance and coordination depend on the interaction of multiple body organs and systems including the eyes, ears, brain and nervous system, cardiovascular system, and muscles. Tests or examination of any or all of these organs or systems may be necessary to determine the causes of loss of balance, dizziness, or the inability to coordinate movement or activities.

  Purpose

Tests of balance and coordination, and the examination of the organs and systems that influence balance and coordination, can help to identify causes of dizziness, fainting, falling, or incoordination.

  Precautions

Tests for balance and coordination should be conducted in a safe and controlled area where patients will not experience injury if they become dizzy or fall.

  Description

Assessment of balance and coordination can include discussion of the patient's medical history and a complete physical examination including evaluation of the heart, head, eyes, and ears. A slow pulse or heart rate, or very low blood pressure may indicate a circulatory system problem, which can cause dizziness or fainting. During the examination, the patient may be asked to rotate the head from side to side while sitting up or while lying down with the head and neck extended over the edge of the examination table. If these tests produce dizziness or a rapid twitching of the eyeballs (nystagmus), the patient may have a disorder of the inner ear, which is responsible for maintaining balance.

An examination of the eyes and ears may also give clues to episodes of dizziness or incoordination. The patient may be asked to focus on a light or on a distant point or object, and to look up, down, left, and right moving only the eyes while the eyes are examined. Problems with vision may, in themselves, contribute to balance and coordination disturbances, or may indicate more serious problems of the nervous system or brain function. Hearing loss, fluid in the inner ear, or ear infection might indicate the cause of balance and coordination problems.

Various physical tests may also be used. A patient may be asked to walk a straight line, stand on one foot, or touch a finger to the nose to help assess balance. The patient may be asked to squeeze or push against the doctor's hands, to squat down, to bend over, stand on tiptoes or stand on their heels. Important aspects of these tests include holding positions for a certain number of seconds, successfully repeating movements a certain number of times, and repeating the test accurately with eyes closed. The patient's reflexes may also be tested. For example, the doctor may tap on the knees, ankles, and elbows with a small rubber mallet to test nervous system functioning. These tests may reveal muscle weakness or nervous system problems that could contribute to incoordination.

  Preparation

No special preparation is required prior to administration of balance and coordination tests. The patient may be asked to disrobe and put on an examination gown to make it easier for the doctor to observe muscles and reflex responses.

  Aftercare

No special aftercare is generally required, however, some of the tests may cause episodes of dizziness or incoordination. Patients may need to use caution in returning to normal activities if they are experiencing any symptoms of dizziness, lightheadedness, or weakness.

  Risks

These simple tests of balance and coordination are generally harmless.

Normal results

Under normal conditions, these test will not cause dizziness, loss of balance, or incoordination.

Abnormal results

The presence of dizziness, lightheadedness, loss of coordination, unusual eye movements, muscle weakness, or impaired reflexes are abnormal results and may indicate the problem causing the loss of balance or incoordination. In some cases, additional testing may be needed to diagnose the cause of balance or coordination problems.

   Key Terms:

Meniere's disease An abnormality of the inner ear that causes dizziness, ringing in the ears, and hearing loss.

   Resources:

Books

• Blakley, B. W., and M. E. Siegel. "Finding the Cause of Dizziness and Vertigo." In Feeling Dizzy: Understanding and Treating Dizziness, Vertigo, and Other Balancing Disorders. New York: Macmillan Publishing, 1995.
• "Clinical Evaluation of Complaints Referable to the Ears." In The Merck Manual. 16th ed. Ed. Robert Berkow. Rahway, NJ: Merck & Co., Inc., 1992.
• Shaw, Michael, ed. Everything You Need to Know About Diseases. Springhouse, PA: Springhouse Corporation, 1996.

Periodicals

• Bowen, J. "Dizziness: A Diagnostic Puzzle." Hospital Medicine 34, no. 1 (1998): 39-44.

Organizations

• American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince St., Alexandria VA 22314-3357. (703) 836-4444. http://www.entnet.org
• Ear Foundation. 1817 Patterson St., Nashville, TN 37203. (800) 545-4327. http://www.earfoundation.org
• Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428 or (503) 229-7705 (phone); (503) 229-8064 (FAX).