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Improving Balance and Preventing Falls for Patients with Brain Tumors

Published on January 17, 2024 in Educational Resources

A woman uses a wheeled walker. Patients with brain tumors may experience balance and fall challenges.

For patients like Linda Long, persistent dizziness and balance issues were some of the first symptoms that ultimately led to a brain tumor diagnosis. 

Common symptoms caused by brain tumors can include weakness, numbness, or loss of movement on one part or one side of the body, as well as difficulty with balance or dizziness. These challenges largely depend on the tumor’s location within the brain, its size, and how quickly it grows.

According to an article in the Neuro-Oncology Practice, “More than 70% of patients with malignant glioma report motor dysfunction as a problem at some time during the disease course.”

Patients with brain tumors may also experience balance difficulties because of vision challenges, sensory problems, cognitive changes, or generalized weakness. When a patient faces imbalance, they may experience more falls. Balance challenges can impact quality of life and limit the ability to work or participate in activities frequently enjoyed before diagnosis. 

A man sits in his scooter, crutches hanging off the back, in front of a University of Michigan stormtrooper.
Dr. Eric Galvez

By assessing a patient’s fall risk, patients and care partners can work together to help mitigate the risk of falls with the help of appropriate health care professionals.

“Falls in the survivor population are typically overlooked in lieu of more pressing oncology/medical issues,” said Dr. Eric Galvez, a former therapist turned patient and advocate. “However, falls can be devastating to oncology patients with unexpected emergency room visits, fractures, or even [long-term] hospital admissions.”

What are key signs to help assess a patient’s balance?

Monitoring and promptly addressing balance issues can significantly contribute to the safety and well-being of patients with brain tumors. One’s risk of falling can increase depending on their intrinsic (internal) and extrinsic (external) risk factors. 

Does the patient have any intrinsic (internal) fall risk factors?

Intrinsic risk factors refer to the potential risks that originate within the individual rather than something in their environment. Consider the following key questions to determine whether the patient has any internal difficulties that may impact their balance:

  • Have there been any changes in the patient’s ability to perform daily activities, such as getting in and out of bed, walking to the bathroom, or standing up from a chair?
  • Has the patient experienced any falls or near falls recently? (Even one fall can make a patient more likely to fall again.)
  • Are there instances where the patient feels unsteady on their feet, even if they haven’t fallen? (They may be using their hands on the furniture more to keep steady.) 
  • Have there been noticeable changes in the patient’s walking pattern or gait (e.g., a foot drop or hip weakness)?
  • Does the patient frequently experience dizziness or lightheadedness, especially when changing positions (e.g., standing up from sitting or lying down)? 
  • Has there been any decline in cognitive function, such as difficulty with concentration, memory, or decision-making, which could impact the patient’s awareness of their surroundings and increase the risk of falls?
  • Have there been any changes in the patient’s vision that may impact their spatial awareness or depth perception?
  • Do they report that they feel like they are on a boat? 
  • Is the patient experiencing sensory issues, such as numbness or tingling in the extremities, which might affect their ability to feel the ground beneath them?
  • Does the patient frequently report feeling fatigued? Does this fatigue impact their ability to maintain balance throughout the day or during/after physical activities?
  • Are there medications being taken that list dizziness, lightheadedness, or imbalance as potential side effects? Have there been recent changes in medication that may be contributing to balance issues? (Even missing one dose of an anti-inflammatory may cause changes.)
  • Is the patient in pain or fearful of moving?

Caregivers may notice some of these risk factors through observation and experience. For example, a care partner may observe that the patient isn’t finding words as quickly as they used to, or perhaps they are more forgetful. The patient may struggle to stay on top of their finances, which they frequently did with ease before their diagnosis, or they may now have difficulty planning. These cognitive difficulties can increase an individual’s risk of falling.

Since care partners are familiar with how a person walks, they are more likely to notice gait changes. A primary brain tumor or treatment for the tumor can cause weakness, so the patient may not pick up their foot as high as they used to, or perhaps they’re slapping it down a little bit more. A caregiver may notice that the patient is holding onto them more when walking at night, which can be a sign that the patient is experiencing vision and perception challenges when it gets dark.

Caregivers may notice that patients may get temporarily dizzy when they change position from lying down to sitting up. Patients with this medical condition, called orthostatic hypotension, experience these symptoms due to changes in blood pressure associated with changes in position. In these instances, patients can benefit from intentionally sitting at the edge of their bed for a minute to allow their bodies to adjust. While sitting, they could do some ankle pumps — moving their ankles up and down — to help get their blood flowing so it’s safer to stand up and walk.

Does the patient have any extrinsic (environmental) fall risk factors?

Making environmental adjustments can reduce the risk of a fall at home. For example, removing rugs and clutter, adding grab bars or ramps, and moving the furniture layout to make it easier to move around can help reduce the risk of falls. Consider the following questions to evaluate whether there are environmental fall risk factors:

  • Does the patient’s home have any steps without a rail?
  • Are there scattered rugs in their home?
  • Are there no grab bars in the shower?
  • Is there poor lighting, particularly by the stairs?
  • Are there uneven surfaces?
  • Do they have pets that might unexpectedly get underfoot?

How can physical therapy help patients with brain tumors?

Rehabilitation may become a crucial component of the journey for patients who are grappling with balance issues. 

“A physical therapist will understand that people going through cancer intervention will have peaks and valleys in how they feel and what they’re going through,” said Earllaine Croarkin, a physical therapist at the Clinical Research Center at the National Institutes of Health (NIH). “Whether they’re coming out of a surgical procedure and need acute physical therapy to get over those recent onset concerns or they’re having radiation fatigue, we understand how various treatments and interventions might affect them.” 

Physical therapy, tailored exercises, and adaptive strategies aim to retrain the brain and body, helping patients regain their footing. 

A patient works with a physical therapist to improve balance and fall prevention.

“Coordination and balance was a huge issue early on for me,” Eric said. “They had me do a lot of balance and coordination exercises, like throwing a ball and catching it. This is recovery from brain surgery — not a total knee or hip surgery — so you’re going to have to relearn a lot of things.”

Physical therapy can help patients improve their fitness level so they can tolerate a surgical procedure or increase a patient’s aerobic conditioning to improve radiation fatigue. 

“We try to not only teach the patient, but we also really focus on the caregiver,” Earllaine said. “We try to help people understand that there are both extrinsic and intrinsic factors that increase the risk of falls.”

If a patient needs assistance from their caregiver, a physical therapist can work with the caregiver to be more proactive — not only helping them understand the environmental factors that they might be able to fix or providing strengthening or balance exercises to do at home but also teaching them how to help the patient with transfers from their bed to the bedside commode, for example. 

Which assistive devices can help minimize falls?

Assistive devices can play a crucial role in enhancing the quality of life for brain tumor patients, especially those facing challenges related to balance, mobility, and coordination.

Mobility aids can help maintain the patient’s stability and reduce the risk of falls for individuals with balance difficulties. Examples of mobility devices include:

  • Single-point cane
  • Quad cane (offers a broader base of support but is heavier than a single-point cane)
  • Hemi walker (an option for patients with weakness on only one side because this type of walker allows them to lean to one side)
  • Wheeled walker (a device that can help a patient who is tripping over their feet at the end of the day or has foot drop but their hands can push the walker)

A physical therapist can help patients and care partners determine which assistive device best suits their situation. Sometimes, a mobility aid is not needed, but a small orthopedic brace can be placed inside a patient’s shoe. An orthopedic device can provide support to the weakened limb. A physical therapist can refer the patient to an orthotist for a customized brace.  They may provide a simple lightweight non-customized option or even suggest a device that holds the toes up through the shoelaces.

Additional tools and modifications can help reduce the risk of falls, like a reacher or grabber tool to help the patient retrieve items without bending or stretching. Installing grab bars and handrails in bathrooms and other areas of the home can also provide additional support. Occupational therapists work with physical therapists and are also skilled in the evaluation of home safety equipment and may provide optimal solutions in the context of the diagnosis.

What are some certifications for patients with brain tumors to consider in a physical therapist?

Physical therapists can receive additional board certification through the American Physical Therapy Association to specialize in a certain area. To search for a specific type of physical therapist, visit the American Physical Therapy Association’s directory.

Board Certified in Oncology

Beginning in 2019, physical therapists could receive oncology certification to provide optimal rehabilitation for patients with cancer. Given the newness of this certification, it is still somewhat rare to find physical therapists with this certification, but they can be found at cancer centers or even lymphedema centers.

Board Certified in Neurology

Physical therapists who are board certified in neurology will also have the background to fully understand the balance issues and neurological impacts of a brain tumor and how tumor location impacts symptoms.

Board Certified in Geriatrics

Physical therapists board certified in geriatrics frequently work with patients on balance and fall prevention, so they would be familiar with exercises to assist patients with brain tumors dealing with imbalance.

How can community programs help patients improve balance?

In addition to physical therapists, there are other resources available in a community setting that can benefit patients with brain tumors. A 2017 study found that when assessed about how they prefer to exercise, patients with high-grade gliomas preferred home exercise programs or working with individuals around them. 

When looking for a community balance program, look for evidence-based programs backed by research. Explore the National Council of Aging’s list of available community balance programs, which details each program in depth. The YMCA also offers an evidence-based 12-week class called Moving for Better Balance, rooted in Tai Chi. 

“Individuals with primary brain tumors, for instance, might not be older individuals,” Earllaine said. “They might be 45-50, and they’re in the prime of their life. They want to be able to not always be in a geriatric setting, so I’ll try to find a local balance class at a community center.”

Tai Chi and yoga are other exercise options that can benefit patients with brain tumors.

As patients and caregivers look for potential community programs, it’s important to know that patients with brain tumors may need to modify these programs. Ideally, they can find a practitioner or program administrator to work with the patient to make any necessary modifications, like putting a chair in front of them during the class, for example, to minimize falls.

Keeping individuals with brain tumors safe throughout their treatment is key to maintaining a good quality of life. Patients and care partners concerned about balance and fall prevention are encouraged to talk with their health care team to see if adding physical therapy would be appropriate and beneficial as an overall part of their care plan.

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