Balance Impairment (Adult Inpatient)

Clinical Description

Care of the hospitalized patient experiencing an inability to safely or comfortably maintain upright control of the body’s center of gravity relative to the base of support in the given environment.

Key Information

Balance is a complex process involving interactions between multiple body systems, including musculoskeletal, neurologic and sensory systems, such as vestibular, visual and somatosensory systems. Assessment and treatment should address the multifactorial components of balance.

Poor balance confidence may lead to reduced participation in functional activities. This reduced participation and sedentary behavior may lead to decreased strength, range of motion and endurance, which can further impair balance. It is important to address limitations in balance confidence.

Deficits in attention, judgment, memory and cognition directly influence balance abilities, as well as hinder motor learning processes needed to relearn balance skills.

High-risk medications related to balance problems include antidepressant, antianxiety, antihistamine, antiepileptic, narcotic, sedative, insulin or oral hypoglycemic, hypnotic and cardiovascular agents, as well as polypharmacy.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:

Improved Balance and Postural Control

B. Patient, family or significant other will teach back or demonstrate education topics and points:

Education: Overview
Education: Self-Management
Education: When to Seek Medical Attention

Correlate Health Status

Correlate health status to:
- history, comorbidity
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care

Balance Impairment

Signs/Symptoms/Presentation

dizziness
fear of falling
hearing impairment
history of fall
postural control impaired
reliance on arms and hands for support
restricts movement to avoid threats to balance
unsteady gait
vertigo
visual impairment
wide base of support

Problem Intervention

Optimize Balance and Safe Activity

Evaluate balance skills using a validated tool.
Screen for, and address, underlying impairments, such as muscle weakness, sensorimotor, cognitive and postural control deficits.
Promote participation in regular daily and physical activity to minimize decline associated with inactivity; provide adaptations as needed.
Recommend and facilitate environmental modifications to promote independence and safety, such as grab bars or bath seat; consider a home assessment.
Facilitate safe surroundings; keep needed items within reach, such as call light and personal belongings.
Provide a safe, barrier-free, uncluttered environment that promotes optimal level of function; ensure adequate lighting, especially at night.
Train in and reinforce use of appropriate orthoses, adaptive equipment or assistive devices (e.g., ankle foot orthosis, rolling walker, long-handled adaptive equipment).
Facilitate therapeutic interventions, such as balance training, muscle strengthening, trunk training, virtual reality and tai chi, yoga or Pilates exercise.
Address sitting balance impairments with interventions, such as supportive seating, positioning devices and therapeutic exercise.

Associated Documentation

Activity Management
Adaptive Equipment Use
Safety Promotion/Fall Prevention
Self-Care Promotion

Education

CPG-Specific Education Topics

Overview

description
signs/symptoms

Self-Management

activity
assistive/adaptive devices
home safety
medication management
provider follow-up
rehabilitation therapy

When to Seek Medical Attention

unresolved/worsening symptoms

General Education Topics

General Education

admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan

Safety Education

call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support

Population-Specific Considerations

Geriatric

Balance disorders are a common cause of falls in older adults and can lead to injury, as well as loss of function, independence and quality of life.
Gradual decline of vestibular and sensory function with normal aging, sarcopenia and slowing of motor responses contribute to balance impairments. Treatment to improve balance in older adults is imperative to address these declines.

References

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Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.