By Lixin Zhang M.D., Ph.D. and Karen M. Stephenson, B.S., Research Assistant

At Dent Dizziness and Balance Center, we see many patients without vertigo who experience imbalance or frequent falls. They may feel dizzy when they get out bed, step from a car, or get up from bending. Their imbalance is often more noticeable while showering, in the dark, or when walking on uneven surfaces, such as while gardening. Many patients sustain bruises and fractures due to frequent falls. Our clinical observation and research show that imbalance and frequent falls in patients ages 60 or older may be related to peripheral neuropathy, peripheral vestibulopathy (inner ear problems), or brain abnormalities.

Neuropathy patients may experience stabbing, burning, or tingling foot or leg pain, but 73 percent of our patients with balance problems due to neuropathy had no symptoms in their feet. Examining these patients using a turning fork on their big toes, revealed a lack of vibration sensation, or significantly decreased sensation, compared to their hands.

When we stand or walk, our feet unconsciously, but constantly, communicate with our brain to determine where we are in the space. With decreased foot sensation, the brain can’t get enough information it needs, resulting in loss of balance, especially in the absence of visual cues, such as closed eyes in the shower or waking at night to go to the bathroom in the dark.

Conducting a brain MRI, extensive vestibular testing, and examining for peripheral neuropathy can help determine a patient’s problems. Thereafter, we can educate patients and develop specific strategies or treatments based on their specific diagnosis. Unfortunately, patients with any brain abnormalities rarely respond to any treatment. Those with Inner ear balance nerve problems normally respond to vestibular therapy or advanced vestibular therapy available at Dent. Patients with peripheral neuropathy do better using a cane or walker, and most are willing to use them once they understand that peripheral neuropathy is the major reason for their imbalance.

Balance problems can also be related to true neurological disorders, including Parkinson’s disease, cerebellar atrophy, and Multiple Sclerosis. Some mechanical problems, such as those associated with the hips, knees, spine, or even extreme overweight and obesity, may also contribute to imbalance issues.

Imbalance leads to frequent falls, which are the second leading cause of unintentional injury deaths worldwide. Globally, an estimated 684,000 individuals die yearly from falls. Adults older than 60 years of age suffer the greatest number of fatal falls, and each year 37.3 million falls are severe enough to require medical attention. Learning the underlying reasons for each patient’s imbalance and falls helps us to educate and provide patients with important strategies to prevent them from falling. That’s what we do every day at the Dent Dizziness and Balance Center.

Lixin Zhang, MD, PhD is an attending neurologist and Director of the Dizziness and Balance Center at DENT Neurologic Institute. See To make an appointment, call 716-250-2000.