Jayson Jacoby
The Baker City Herald

By Lisa Britton

For the Baker City Herald

The walls are moving.

Or maybe I'm moving.

No - it's definitely the floor, tilting slightly to challenge my position.

Regardless of which sensory system is engaged, the challenge is the same - keep your balance.

Straight ahead, a screen keeps score of how well you maintain your balance. By changing variables - such as eyes open and eyes closed - physical therapists can figure out what is affecting a patient's balance and then design a treatment plan.

This machine is called the SMART Balance Master, and was installed Feb. 5 at St. Alphonsus Rehabilitation Services (STARS) in Baker City. It was purchased with funds from the Leo Adler Endowment Fund through the St. Alphonsus Foundation-Baker City.

There are two components. to the SMART Balance Master. One is a large, three-sided stall with a dynamic (moving) plate that can move to test balance. When a patient steps into this, vision is restricted to the machine's walls, which are brightly decorated with clouds and mountains. (The walls can also move, which tests the vision part of balance.)

The second machine has a static (nonmoving) foot plate.

Both are connected to a computer that evaluates the ability to balance.

And balance is not something to take for granted - the American Institute of Balance reports that dizziness or loss of balance is the second most common complaint heard in doctors' offices, and the National Institute of Health statistics indicate that dizziness will occur in 70 percent of the nation's population at some time in their lives. Also, balance-related falls account for half of the accidental deaths in the population over 65.

The NIH also notes that nearly 300,000 hip fractures and $3 billion dollars in medical expenses result from balance-related falls every year.

Installation of the Balance Master is part of the hospital's vision "to create a balance center to help those in our community lessen their risk of falling and return to the activities they enjoy," said Kim Zinn, a physicial therapist at STARS.

A Complex Process

Balance is a complex process that depends on three components: sensory systems for information about the body's position, the brain's ability to process that information, and muscles and joints for coordinating movements required to maintain balance.

In a healthy person, the sense of touch (feet, ankles and joints), sense of sight and inner ear motion sensors work in harmony with the brain.

But if there is a problem with any of these systems, a person might have a problem with balance.

If a patient comes in with balance problems, the SMART Balance Master can help determine which system is impaired.

For instance, a person might be able to balance fine with their eyes open, but lose their balance with eyes closed.

The machine is outfitted with safety harnesses in case patients lose their balance during the testing and evaluation.

Zinn and Diana Downing, PTA, named the following conditions that can cause balance issues and could benefit from testing and treatment with the new machine:

andbull; unsteady gait

andbull; balance impairment

andbull; knee and hip replacements

andbull; Any lower body orthopedic injury, such as ankle sprain, broken toes or calf/hamstring strains

andbull; dizziness

andbull; vertigo

andbull; neurological causes of dizziness/imbalance (stroke, Parkinson's, multiple sclerosis)

andbull; Vestibular (inner ear) Disorders (Meniere's Disease, Labrynthitis)

andbull; concussion (evaluating balance helps to determine if it's safe for an athlete to return to play)

Zinn estimates that the new machine will be used to evaluate and/or treat six to eight patients a week, but that it could increase to as many as 20. It can be used for patients as young as 4.

Using the SMART Balance Master will change a patient's evaluation process.

"It will help us more specifically determine what their primary impairment is and will give us objective data to set better functional goals," Zinn said.

Another part of the machine's system almost looks like a game: the therapist places boxes around the screen, and the patient must move a stick figure to the one box that shows yellow.

Using foot pressure and balance, the patient moves the figure from box to box - when they hit the goal, there is a beep and another box turns yellow. The path is traced throughout the exercise, creating a map of the patient's assessment.

Depending on the difficulty (advanced patients get more boxes placed a greater distance apart), the result can resemble a toddler's scribble. But the therapist can see how long the patient maintains control by seeing where the straight line starts to squiggle.

"The biofeedback piece is having a visual target to aim for or an audio beep to listen for so they know they have attained their goal," Zinn said. "The hope is that they will gain conscious control over a task that they have not been able to master otherwise."

She said patients can ask their primary care provider if they could benefit from an assessment with this new system.