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Balance Testing and the Neurological Exam

One of the key elements of the neurological exam is posturography, or a balance assessment. Balance can give us loads of information on brain function, and confirm or reinforce diagnostic hunches that your practitioner may have.

What Can Posturography Tell Us?

As we've talked about in previous posts, balance is comprised of three main systems: proprioceptive (body awareness), vestibular (inner ear gravity awareness), and the visual systems. All three systems need to be working in synchrony in order for us to have optimal balance and stability. Teasing out each individual system is crucial to gaining a deeper diagnostic picture on which system(s) is/are not working as they should.

How Do We Determine the Cause of Our Balance Problems?

So, you're concerned about your balance and are looking to improve it. Now, what can we do about it? First and foremost we need to determine the underlying cause of your balance problems, and which of these three systems aren't working the way they should. The way we do this is through computerized posturography using a calibrated force plate to determine your sway pattern and amplitude. We test your balance in a variety of different scenarios.

These scenarios include standing with your eyes open on a flat surface, eyes closed on the flat surface, eyes open and closed on a foam/perturbed surface, and then challenging you with your eyes closed on the foam surface with your head in different positions or asking you to perform a mental task. It's important to keep in mind that we will only do this on patients who are able to complete these tasks. If a task is unsafe for the patient, we will not perform it. It is diagnostic in and of itself if you are unable to perform it, so we do not need to put you through the stress.

Testing with eyes open on a flat surface is our first task. In this scenario, all three systems are in play. We want to get a baseline for how well your balance is doing with all three in play, which may prove better or worse for you depending on how these three systems are being processed.

We then ask you to close your eyes on the flat surface. This excludes the visual system from the equation, so we can gather a better idea of how you do without visual fixation, and when you're only reliant on your proprioceptive and vestibular inputs. Many patients become over-reliant on their visual systems following head or neck injuries, as well as those with vestibular issues.

From here, we make things a little more challenging by introducing a perturbed or foam surface to have you stand on. We begin with eyes open, and then eyes closed. By adding the perturbed surface, we can alter the proprioceptive input of the brain, making the patient more reliant on the visual and vestibular, and then the vestibular. Granted you cannot truly take away one of these systems; however, we can reduce their input enough to gather enough of a clinical picture into the workings of your balance centers.

Next, while on the foam surface and your eyes are closed, we'll put your head in different positions. This is to test the different vestibular and cervical input to your brain. Some positions may make your balance dramatically worse, and some may make it dramatically better. Either way, this is valuable diagnostic information that gives us a window into what interventions we might be able to use to help.

Lastly, we take a look at your balance given a simple cognitive task. We want to see if you're using your frontal lobe, or the executive function area of the brain, to keep you upright and balanced. In a perfect world, we should automatically have good balance. In some cases of poor balance, the patient may use their frontal lobe to overcompensate for their balance deficits. This is good and bad. For one, keeping yourself upright and balanced is a top priority for the brain, so it's good to have this backup system. It's bad because this takes up valuable resources from the frontal lobe, meaning that you may not be able to perform executive function tasks (like those needed for work, school, etc.) as effectively.


Balance is vital to a high quality of life and functioning at our best. At Delta Neuro Health, we take balance very seriously and do all we can to restore optimal balance. If you or someone you love is experiencing balance issues and wants to take a deeper look into what may be causing those issues, give us a call at (614)-706-2093, or check out our website: Delta Neuro Health

balance beam, balance issues, posture, posturography, functional neurology


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