Postural imbalance with head extension: improvement by training as a model for ataxia therapy

Head extension may cause a physiological vertigo and postural imbalance separate and distinct from basilar insufficiency. This physiological imbalance mainly is due to a vestibular sensory deficiency when the utricular otoliths are beyond their working range because of the change in head position. Since the intact visual and somatosensory control hope widely compensate for the vestibular deficiency, head-extension vertigo is of particular concern only in certain stimulus situations or diseases in which the stabilizing input from the eyes or joint receptors is reduced. Balance training on foam rubber with head extension and closed eyes improved postural-sway activity up to 50% within five days. A daily short-term training effect and a long-term training effect together form a typical exponential sawtooth curve of postural stability over time. After termination of training, learned balance skill exponentially returns to the pretraining values within weeks. The percentage of improvement through training depends on the amount of initial instability. Clinicians should treat ataxia by exposing patients to stimulus situations producing increasing body instability in order to activate sensorimotor rearrangement.