An exploration of the systems controlling balance, which offers insights into the interplay between vestibular, proprioceptive, and visual inputs, essential for clinicians dealing with balance perception issues.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
An editable Microsoft PowerPoint version of the resource.
Balance is a complex system in humans managed by the integration of inputs from the vestibular, proprioceptive, and visual systems. Any alteration in these inputs due to factors like illness or injury can lead to changes in balance perception, which may result in distress. This tool provides a concise visual explanation of how these systems contribute to our experience of balance, equipping therapists with essential knowledge for diagnosis and discussion.
This handout can help therapists working with clients experiencing balance-related issues:
Conditions such as persistent postural-perceptual dizziness.
Balance concerns linked with anxiety disorders, particularly where balance cues are misinterpreted.
Clients with conditions affecting the inner ear and vestibular system.
Symptoms presenting without a clear medical cause, affecting balance.
Use the resource to explain the components of balance to clients.
Engage clients in conversations about their personal experiences with balance.
Evaluate clients' perceptions of balance changes and potential causes.
Human balance is a multisensory process that depends on the continuous integration of inputs from three main systems: the vestibular system, the proprioceptive system, and the visual system. Each system provides the central nervous system with essential information about body position and movement, and disruptions in any of these channels can lead to sensations of unsteadiness, dizziness, or disorientation.
The vestibular system, located in the inner ear, detects angular and linear head movements through structures such as the semicircular canals and otolith organs. This system is essential for coordinating eye movements and postural control, particularly during motion (Cullen, 2012).
The proprioceptive system collects data from muscles, tendons, and joints to inform the brain about the position and movement of the limbs and trunk. It plays a key role in maintaining balance when visual cues are limited—for example, when navigating in darkness or on uneven terrain (Proske & Gandevia, 2012).
The visual system contributes by providing information about the external environment and one’s orientation within it. Visual cues are particularly important when other systems are unreliable, but over-reliance on vision (a phenomenon known as visual dependence) can contribute to balance difficulties in some people (Bronstein, 1995).
Balance is achieved by the central integration of these sensory inputs in the brainstem and cerebellum. The brain constantly compares incoming signals and adjusts motor output to maintain stability. When one input is degraded—due to illness, injury, or aging—the brain compensates by increasing reliance on the other systems. However, this compensation is not always adaptive. In certain conditions, such as persistent postural-perceptual dizziness (PPPD), individuals may continue to feel off-balance despite no ongoing physiological impairment. Cognitive factors such as hypervigilance to bodily sensations, misinterpretations of normal postural sway, and avoidance behaviors are believe to contribute to symptom persistence (Staab et al., 2017; Whalley & Cane, 2017).
This handout can be used to help clients understand how balance works, validate their experience of symptoms, and begin to explore maladaptive beliefs or patterns that may be maintaining distress. It supports psychoeducation and can be integrated into CBT approaches that address anxiety-related misinterpretations of sensory input.
