Balance and Coordination Tests

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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.

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.

— Altha Roberts Edgren

Methods of evaluating the ability to maintain a stable equilibrium. One of the simplest involves testing the subject's ability to stand still on 2 feet with eyes open or closed. This may be combined with an ataxiameter, which quantifies head movements. More elaborate tests include the stick-lengthwise test in which the subject stands with the ball of the foot on a stick measuring 1 × 1 × 12 inches (2.54 × 2.54 × 30.5 cm). Some investigators increase the difficulty of the test by raising the stick above the floor. In addition to these tests, teeter boards are often used to measure static balance. See also blind stork test, posturography.