TO STUDY THE ASSESSMENT AND EXAMINATION OF

PATIENTS HAVING BALANCE DEFICIT AND HEARING LOSS

SUBMITTED BY :- SHREYA THAKUR

ENROLMENT NUMBER :- A1106616117
INTERNAL GUIDE :- Dr. JASMINE KAUR CHAWLA (PT)
EXTERNAL GUIDE :-
• AIM :- TO STUDY THE TESTS WHICH ARE USED
FOR ASSESSMENT OF PATIENTS HAVING
BALANCE DIFICIT AND HEARING LOSS
• HEARING :- HEARING IS THE ABILITY TO
PERCIVE SOUNDS BY DETECTING VIBRATIONS
THORUGH A SPACIAL ORGAN SUCH AS EAR.
• BALANCE :- THE ABILITY TO MAINTAIN THE
LINE OF GRAVITY WITH IN THE BASE OF
SUPPORT OF AN INDIVIDUAL IS CALLED AS
BALANCE.
 WHAT IS HEARING IMPAIRMENT AND WHAT ARE THE CAUSES OF
HEARING IMPAIRMENT ???

• HEARING IMPAIRMENT :- hearting impairment , deafness or hearing loss

alludes to the comprehensive loss or partial inability to hear sounds .
• In more simplified language hearing loss also means total or partial
inability to hear.
• CAUSES OF HEARING LOSS :- There are various causes of hearing loss
• A)disease
• B) infection :- LABYRINTHITIS(it is the infection/inflammation of labyrinth
which occurs via haematogenous ,tympanogenic and meningeal route.
• Trauma , Due to occupational exposure
• AGING
• OTOTOXIC DRUGS :- these are the drugs that damage inner ear.
ANATOMY OF EAR
HUMAN EAR CONSISTS OF
THREE PARTS :-
a) The outer ear
• 1) auricle
• 2) external acoustic
meatus
• 3) tympanic membrane
a) The middle ear(3 small
bones)
• 1) malleus
• 2) incus
• 3) stapes
a) The inner ear
• 1) bony labyrinth
• 2)membranous
labyrinth
• PHYSIOLOGY OF HUMAN HEARING
• It is the process by which the ear transforms sound vibrations in the
external environment into nerve impulses that are conveyed to the brain ,
they are interpreted as sounds.

• BALANCE
• There are 3 systems that are involved in maintenance of
balance
• SOMATOSENSORY SYSTEM
• VESTIBULAR SYSTEM
• VISUAL SYSTEM
• BALANCE DEFICIT :- It is the disorder that causes an individual
to feel unsteady , which is accompanied by a feeling of
giddiness ,spinning while performing activities of daily living.
 TESTS FOR BALANCE AND HEARING

• TESTS FOR THE ASSESSMENT OF BALANCE

• There are various tests for the assessment of balance few of
them are as follows :-
• BERG BALANCE SCALE
FUNCTIONAL REACH TEST
This test is used to assess the dynamic
stability of the individual .
FUNCTIONAL REACH = it is the maximal
FOUR SQUARE STEP TEST
distance one can reach forward beyond arms This test is used to assess the
length.
dynamic stability and the ability of
GIVEN BY :- PAMELA DUCAN AND CO-
WORKERS IN 1990. the patient to walk side ways,
forward and backward.
• SOMAI (SENSORY ORIENTED MOBILITY
ASSESSMENT INSTRUMENT)
• TESTS FOR VESTIBULAR FUNCTION
• A) ROMBERGS SIGN

• B) BARAYN’S CALORIC TEST

 HEARING TESTS

• PURE TONE TEST

• Pure tone audiometry is a key test for assessment of patients complaining
of hearing deficit
• This tests enables the determination of the degree, type and configuration
of hearing loss.
 RINNE AND WEBER TEST

• The weber and rinne test are performed together, the resuls of which
indicates location and nature of any hearing losses detected.
 CASE STUDY

DATE:-
• NAME: - Raman Sharma AGE/GENDER :- 62M
• OCCUPATION: - Commercial airline pilot
• CHEIF COMPLAINT:- Patient is unable maintain balance and have a feeling
that he might fall anytime since past few months .
• CASE HISTORY: - The patient is having a history of Parkinson’s disease since
5 years.
• MEDICAL HISTORY: - the patient is taking SINEMET (a combination of L-
dopa/ carbidopa).
• SURGICAL HISTORY: - no surgical history
• ENVIRONMENTAL HISTORY :- the patient lives in a one level sub-urban
home.
• VISUAL ANALOGUE SCALE/ PAIN RATING SCALE :- 5 for knees and
• OBSERVATION:- Resting tremors are present
• GAIT :- The patient is having t typical Parkinson gait with short steps.
• Patient is having difficulty to initiate and stop walking.
• Patient is unable to stand up from the chair and is unable to roll from
prone to supine.
• Patient is having difficulty in changing directions.
• POSTURE:- Patient stands with a flexed and stoop posture ,body is
positioned at the forward limits of the base of support.
• GONIOMETRY :-
• KNEE JOINT
• RIGHT KNEE (PASSIVE) LEFT KNEE(PASSIVE)
• FLEXION: - 0- 110 DEGREE FLEXION: - 0-110DEGREE
• EXTENTION: - 0-110 DEGREE EXTENSION:-110-0
• BALANCE TESTS:-
• BERG BALANCE SCALE TEST :- SCORE is less 30 this means that there is a
risk of fall
• TIME UP AND GO TEST :- time taken is about 45 seconds this means that
the patient is prone to fall
• FOUR SQUARE STEP TEST
• SENSORY SYSTEM EXAMINATION:-
• REFLEXES:- BABINSKI SIGN is positive.
• DIAGNOSIS :- PARKINSON’S DISEASE
• The patient is having balance deficit
• TREATMENT :-
• SHORT TERM GOALS :- to reduce rigidity in the upper extremity and lower
extremity.
• LONG TERM GOALS:- to maintain patients ability to walk stand and perform
activities of daily living.
• MANAGEMENT :-
• HOT PACK before exercises for about 10- 15 minutes.
• Stretching techniques:- hamstring and quadriceps(PASSIVE FOR 15 SECONDS)
• MIRROR THERAPY the patient is asked to walk in front of the mirror looking at his
posture with the help of parallel bars.
• Static cycling:- to help develop rhythmic movement in the body as it helps in
initiation of movement in the body(15mins.)
• Side walking
• Self assisted exercises for activities of daily living
• Frenkel exercises:-
• Peg board exercises
• Finger to nose
• Finger to therapist finger
• Heel to shin exercise
• For 10 to 15 times
CONCLUSION
The tests enlisted in the project are used in wide number of cases for
the assessment of the patients having balance problems following
hearing loss.

REFERANCES
• ARTICLE :- Validity of multi directional reach test and practical
measures for limits of stability in older adults by Robert A. Newton ,
DOPT temple university , Philadelphia
• http://ijahsp.nova.edu/ for article on correlation between 2 clinical
balance measures in older adults; functional mobility and sensory
organization test.
• www.researchgate.net /publication/14700825
• B.D.CHAURISIA :- anatomy of human ear
• PHYSIOLOGY BY GYTAN AND HALL:- Physiology of human ear