Balance control relies on the interdependence and cooperative actions of multiple systems. Due to the complex nature of the Balance System, patients with chronic balance and mobility disorders often have multiple sensory and motor system problems. For example, problems in the vestibular system can lead to changes in the use of visual information, and to changes in head and body movement strategies, which in turn can lead to mobility problems. Without access to information relative to each of the contributing components, it is not possible to assess effectively the full impact of a balance disorder.
Problems in different systems are not independent of one another, and effective resolution of a chronic balance problem often requires treatment across specialties. In non-specific balance patients, where there is no conclusive diagnosis or specific pathology, treatment must be focused on the underlying impairments. Identification of the impairments most likely to respond to retraining often times requires a medical evaluation of the relevant components.
The most effective approach to managing these patients, therefore, is through a multidisciplinary team that focuses on the pathology, impairments, functional limitations and resultant disability. As the following graphic illustrates, team members from different specialties work together, sharing common information regarding the contributing factors underlying a patient’s balance problem. Diagnostic testing, assessments and treatment planning are managed in a coordinated effort, resulting in better patient outcomes.
All team members should have training and expertise in the assessment and treatment of patients with balance deficits. Core teams may also have consulting relationships with pharmacy, podiatry and nursing.
The multidisciplinary team approach represents a significant shift in the way care has traditionally been delivered to patients with balance problems. Under acute intervention approaches, patients with chronic balance and/or dizziness disorders may see multiple physicians before being diagnosed and effectively managed, if ever. For example, many mild head-injured patients with persistent occult visual-vestibular problems never receive specialized evaluation or treatment, particularly when the MRI is normal. Elderly patients with long-standing records of instability suffer injurious falls, but are rarely treated for imbalance, only the consequences of the fall. With a diagnosis as a label, patients with different diagnoses who share many balance impairments in common are sent to divergent medical specialties. Subsequently, care is often fragmented.
To solve these problems, team members take a comprehensive, integrated approach, focusing on all aspects of the patient’s problem from the underlying pathology through the resultant disability. Thus, for each individual patient, service delivery is faster, more comprehensive and more cost-effective.
It should be noted that the multidisciplinary team can, and often does, include medical professionals from separate clinical practices and/or facilities. The effectiveness of the team comes through a cooperative approach to patient management that relies on the sharing of information. This can certainly be accomplished without all team members residing under one roof. Examples of this are further discussed under Balance Program Models.