The FYZICAL Balance Paradigm
The road to recovery for balance and vestibular issues can be long, arduous, and often frustrating – for a clinician or patient! Physical therapists are seeing the amount of time spent with patients shortening and reimbursements decreasing at the same time. There is a heightened sense of importance to isolate the root cause and get to the point quickly in treatment. FYZICAL has become known for being the balance expert due to its evidence-based approach to treating people who experience vestibular and balance issues. The problem historically is that there hasn’t been much in the way of peer-reviewed literature to guide treatment, and the treatments outlined are more of a ‘one-size fits most’ approach.
It may or may not work, becoming a ‘try-and-see what works’ program. By not knowing what to really focus on random practice can lead to error in treatment, prolonged treatment schedules, overutilization, and increased costs.
Here’s a simple analogy: If you are driving in your car to work, would you prefer the fastest, most efficient route to get there or the scenic route that takes longer and meanders through the backroads, maybe with a detour and/or some stops along the way? Most people would say, “I need to get to work” and prefer the fastest, most effective route. If you have a patient who has balance and vestibular issues and comes to you to guide them on their road to recovery, they are seeking fast, efficient, and effective treatment. That is why the FYZICAL Balance Paradigm was created.
The Theoretical Framework and Sensory Mismatch Theory stem from the idea that not all patients are the same. When a person has balance and vestibular issues, they will over-rely or under-rely on their sensory systems to compensate. Take seniors for instance, who are at the highest risk for falling and experiencing balance issues.
Seniors tend to sit more, are not as active. They may have another medical condition that causes them to be less active. Your balance and vestibular system operate on a use it or lose it policy. The more inactive a senior is, the worse their balance becomes, placing them at higher risk for falling. They tend to compensate with their sense of touch, reaching for things to hold to move and stand.
Let’s compare a senior to a younger, middle-aged person who may also be experiencing balance issues. That younger person may be more active, their body stronger, and does not require the surfaces around them to stabilize. They move but may be more vision-dependent, relying on visual cues to remain stable. They may try to move without moving their head very much in an effort to quell dizziness. Both of these patients are at risk for falling, but for very different reasons. As a result, they require drastically different treatment protocols to effectively rehabilitate.
FYZICAL has developed five different sensory mismatches that cover the spectrum of possible types of sensory dependencies. Some are vision dependent, while others are surface dependent or some combination of the two. There is no assumption that everyone is the same. It is not based upon symptoms a person describes, but on Clinical Tests for Sensory Interaction in Balance (CTSIB), six conditions of progressively harder tests of balance. Through this series of tests, a person’s type of sensory mismatch can be quantifiably measured and diagnosed. Once a sensory mismatch has been identified, treatment can commence using a conceptual and progressive plan of care customized for that type of mismatch. Essentially, it is a roadmap that outlines protocols for each step of the patient’s progress. Each condition and stage are distinct