Home > NF2 Facts and Information >

Balance Issues and Recovery

Last Updated: 08/31/17


  1. Reasons for Balance Issues
    1. Vestibular Schwannomas Damage
    2. Spinal Tumors
    3. Epilepsy and Seizures
    4. Medication;
      Codeine, Percocet & Tylenol #3
  2. Vestibular Rehabilitation Therapy (VRT)
  3. Basic Balance Recovery Methods

Also See:

People with Neurofibromatosis Type 2 (NF2) tend to develop balance issues as a result of:

  1. Growth of Vestibular Schwannomas (VS) also known as Acoustic Neuroma (AN);
  2. Loss of function of Vestibular Nerves and Vestibular System on one or both sides of the head;
  3. Spinal Tumors;
  4. Peripheral Neuropathy/Nerve Degeneration

Different things can be done to recover and compensate for balance loss. VS tumors and Vestibular damage are not always the result of the condition NF2. Regardless of the reason of the damage, this damage always requires Vestibular Rehabilitation Therapy (VRT), since VS damage from NF2 makes less than five percent (5%) of the population who develop these tumors, proper physical therapy for this should be easily accessible.

Sometimes balance issue is from other issues. Know what is causing your balance issue, it is best to know the reason of balance issue before considering exercises to correct it. Talk to your doctor.

"Current evidence is in support of VRT for treating patients with a variety of vestibular disorders, both central and peripheral. High-level evidence studies support the use of treatment techniques of adaptation and substitution for gaze stabilization, habituation, balance and gait training, and can with repositioning maneuvers. Recent evidence has also examined and found promising results with technological innovations that are targeted at those with bilateral vestibular hypofunction and insufficient gains with a standard exercise-based program. Nevertheless, factors such as anxiety overlay/depression, time when beginning therapy, and adherence may have an impact on how a patient will do with his/her VRT program and should be acknowledged." [Burzynski, 2017]

1. Reasons for Balance Issues

  1. Vestibular Schwannomas Damage
  2. Spinal Tumors
  3. Epilepsy and Seizures
  4. Medication: Codeine, Percocet & Tylenol #3

1. Vestibular Schwannomas Damage

1. List
Cranial Nerve 8
Inner Ear System
Inner Vestibule
Inner Vestibule

Gyroscope: Source Wikipedia

The most common location for tumors to grow for individuals with NF2 is in the brain along the Vestibular Nerves. The tumors are attached to the nerve itself which classifies these tumors as Schwannoma. There are two Vestibular Nerves left and right, one on each side of the brain since there are two cranial nerves for each nerve type, one affecting the left and the other the right side of the body. The Vestibular Nerve is responsible for the function of the Vestibular System which is responsible for balance.

Vestibular Schwannoma (VS) that grow on a Vestibular Nerve will typically also damage the Cochlear Nerve as well. The Cochlear Nerve is responsible for the function of the Cochlea and therefore hearing. Cranial Nerve 8 (CN VIII), the Vestibulocochlear Nerve starts at the brainstem and splits to become the Vestibular Nerve and the Cochlear Nerve.

The three Semicircular Canals of the Vestibular System can be best understood by understanding the workings of a Gyroscope, used by ships and planes.

Since it can be a slow process from the point one nerve starts to become damaged to the point where both nerves are completely broken, individuals with NF2 tend to adjust better and faster than individuals whose nerves are damaged for other reasons. However; since vision is used to compensate for the loss of these nerves, in bad vision situations like night or if vision issues develop, balance issues will continue to be a problem.

2. Vestibular Rehabilitation Therapy (VRT)

Vestibular Rehabilitation Therapy (VRT) is very important following Vestibular Nerve damage. The dizziness, vertigo, balance problems, and other symptoms can lead to unnatural standing and walking methods. This improper compensation can be even harder to correct, lead to worsening of symptoms and often causing headache, muscle tension, and fatigue.

VRT is an exercise program used to treat people of many different ear conditions that result in damaged Vestibular Nerves. Because of the number of people with these issues, people trained to do VRT are not hard to find.

  • some balance may be recovered through exercise and/or therapy
  • your doctor may be able to refer you to a therapy specialist experienced in balance treatment
  • perseverance can help achieve results but it is important that a medical doctor ensure that any regime is safe for the patient

3. Basic Balance Recovery Methods

Balance ideas here should not be done while alone, and should not be done instead of having a Physical Therapist. Review ideas suggested here with your doctor.

While many people are often concerned about an awkward recovery in a facility where other people might be watching and can sometimes make recovery from balance a little more difficult, physical therapists are also available who travel to patients home which some find to be an ideal environment for therapy.

Some Painkillers including; Codeine, Percocet and Tylenol #3 can make a person Lightheaded and Dizzy. Taking these things can make walking after Vestibular Nerve damage is even more difficult.

  1. Visual Cues: Look at a fixed point in the distance to walk towards, not at your feet on the ground. Examples; streetlight, picture on a wall.
  2. Leg Muscles: Exercises that can be done while sitting or standing can be done to build these muscles. The stronger they are the better your balance will be.
  3. Complex Walking: Even if leaning on a wall or person, practice walking sideways or backward can help in fall prevention.
  4. How to Stand: Back straight, chest out, head up looking forward as far as possible.
  5. Core Strength Buildup: Exercises for Core Muscle strength; torso - belly, mid back and lower back (not the shoulders)
  6. Be Prepared - Know Yourself: Speak to a Physical Therapist about the best shoes to wear for better balance. If you find yourself getting better and wish to wear other shoes eventually, make sure shoes to keep better balance shoes on hand for low light situations like nighttime or poor weather.
Walking Straight and Turning Around
Focal Point, Walking Walk Straight - Forget Feet
1. Look At Picture
Not Down
Turn Head, New Focal Point Turning
2. After Reaching Focal Point,
Turn Head Right
Turning Body, Facing New Focal Point 3. After Head Turns
Move Body to Face the New Focal Point
Complete Turn, 180d 4. Turn head Again, Find new Focal Point
Keep Walking

Simple Exercises for Circulation Despite Poor Balance
Knee Lifting Knee Lifting - Focus 1 leg at a time Lift from Ankles Lift from Ankles - Focus 1 leg at a time Lift From Knee Lift From Knee - Focus 1 leg at a time Arm, Back, Movement Arm/Back Movement - Left/Right
Up/Down Up/Down Secure, Balance Support Chair/Wall Support Lifting from Ankles Lifting from Ankles Bending Knees Bending Knees

* Note: Some Pain Killers including; 1) Codeine, 2) Percocet, and 3) Tylenol #3, can cause Lightheadedness and Dizziness. Taking these things can make walking after Vestibular Nerve damage even more difficult.

2. Spinal Tumors

Different locations of the spine, noted by location points at or between each vertebra, affect different areas of the body, controlling different; muscles, movement, and organs. Therefore when Schwannoma tumors grow the location of the tumor will determine what will be damaged.

Regular exercise and movement can help prevent tumors from being symptomatic. These methods can also help aid in the healing after surgery if needed. Tumor damage can be permanent, but it depends on the extent of nerve damage and nerves are more likely to heal along the spine than in the brain.

Healing can take six months assuming the right steps are taken in the healing process; it is important to follow the instructions of your doctor and physical therapist.

3. Source