neurological conditions and balance

Balance is one of those things everyone takes for granted, but as we age, balance often tends to be compromised. In fact, more than 30 percent of people between the ages of 60 and 97 have problems with balance, says Frasat Chaudhry, MD (pictured above), a neurologist at Phelps Hospital/Northwell Health, and the percentage climbs even higher with advancing age. Balance issues can occur for many reasons; once diagnosed, therapy is available to help people regain their balance and get back to their former lives.

According to Dr. Chaudhry, one of the most common neurological conditions affecting balance is Parkinson’s disease. “This is a movement disorder and we don’t know the exact cause, but one of the things we see is a tremor or progressive difficulty with walking, which leads to problems with balance.” She explains, “Parkinson’s – in and of itself – affects your balance. The lack of dopamine in the brain can lead to problems with the balance center of the brain.”

Alzheimer’s is another disease that can impact balance. “Alzheimer’s involves problems with memory, so as it progresses, you have problems with people forgetting to do things and one of the things is forgetting how to walk,” says Chaudhry.

Neuropathy or nerve damage, potentially a result of diabetes or a vitamin B12 deficiency, is a leading cause of balance problems as people age. Chaudhry explains, “With neuropathy, you lose sensation in your feet, and you are not feeling where you are in space at a given time, and this leads to problems with balance.”

A stroke, depending upon where it occurs in the body, also may disrupt balance. “For example, if the stroke causes weakness on one side of the body and leads to one side [of the body] being stronger than the other, you will have problems with balance – since the body is meant to be symmetrical,” states Dr. Chaudhry.

When an individual is experiencing balance problems and, possibly, recurring falls, the primary care physician is usually the first medical expert seen. The patient may then be referred to a neurologist, at which time an appropriate workup is ordered. “The neurologist may do neuroimaging and then they may refer the person to an ear, nose and throat specialist,” Dr. Chaudhry explains.


Falls are the leading cause of emergency room visits among older adults for injury, notes Lori Ginsberg, RN, MA, who teaches the Stepping On fall prevention program at Phelps Hospital/Northwell Health in Sleepy Hollow. She is also the program director for Community Health Initiatives at the Katz Institute for Women’s Health at the Center for Equity of Care in Lake Success, NY, and warns that more than one in four adults over 65 fall each year.

“In our workshops, we take a comprehensive approach,” explains Ginsberg. “We do balance and strengthening exercises, and we talk about home safety, community safety, as well as how the medications you take and your vision can affect your risk of falling.”

The program is designed to empower people to recognize their fall risk and take steps on their own to reduce it.

In addition to slowing down – don’t rush to answer that phone, and exercising regularly, here are some of her recommendations:

— Improve the lighting in your home and strategically place night lights everywhere you might walk at night.

— Falls usually happen at home because people feel comfortable in their homes and pay less attention to the environment. But clutter at home can impede safety so clear it up. For instance, when you come in from shopping, never put grocery bags on the floor. Place them on the kitchen counter or a table.

— Don’t wear backless shoes like mules or clogs. “When you walk, backless shoes cause you to grip with your toes and cause you to walk incorrectly,” says Ginsberg. “When you wear a shoe without a back, your foot also slips side to side since there is nothing to hold it in place.” Additionally, she says, a backless shoe can slip off your foot without warning. Another tip: avoid long robes and nightgowns that can be a tripping hazard.

— Pay attention to your gait, advises Ginsberg. “Many older people have a tendency to shuffle or plant their feet flat when they should be walking heel-toe, heel-toe.” Place your heel down first and roll onto your toe with each step, always scanning with your eyes to see what’s ahead. Just don’t do this in snow and ice, warns Ginsberg. “In snow, it’s better to walk like a penguin!”

Some of the conditions an ENT physician may diagnose include benign paroxysmal positional vertigo (BPPV), which causes a person to experience short but intense episodes of a spinning sensation; vestibular neuritis, in which the vestibular nerve becomes inflamed or infected and causes severe dizziness for up to several days; labyrinthitis, another infection or inflammation of the inner ear; and Meniere’s Disease, which has symptoms like vertigo, hearing loss, and a roaring or buzzing in the ear.

Once there’s a diagnosis, treatment can be recommended. “They would then be referred for balance therapy since this is really key to improving their balance,” says Chaudhry. “I refer patients to the Balance Center at Phelps. At the Center, they work with people to help them regain their equilibrium. There is a lot that can be done to help you improve your balance. And if you don’t work on it actively, you are going to decline.”


The Balance Center at Phelps Hospital serves two main functions: to diagnose and to aid rehabilitation. Puja Agarwal, PT, DPT, oversees the rehabilitation component and Cameron Budenz, MD, a neurotologist and the medical director of the Balance Center, is in charge of the diagnostic component. Referrals to the Center typically come from primary care physicians, neurologists, and otolaryngologists.

Some patients come to the Balance Center for age-related decline in balance, explains Agarwal. “People become more sedentary as they age, and their vision and hearing are not as sharp,” she says. “We also get patients who have Parkinson’s disease, multiple sclerosis, stroke, or concussions. All are at risk for a fall and so need to work on their balance.”

A fall in an older person can mean the loss of function and independence, Agarwal says. Bones tend to fracture more easily as we age and that can precipitate medical admissions, surgery, and increased dependence on caregivers, she explains.

At the Center, patients typically attend sessions twice weekly, although Parkinson’s patients attend more often. Positioning maneuvers to reduce the symptoms of dizziness and imbalance may be incorporated into therapy sessions, which also may include a variety of exercises for coordinating eye and head movements and stabilizing one’s gait to improve both balance and walking.

The Balance Center is located on the Phelps campus in Sleepy Hollow and can be reached at 914-366-1170.

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