ABSTRACT
This chapter reviews the psychosocial factors and psychological therapies which are relevant to two groups of people with balance disorders. The first consists of people with dizziness and imbalance caused by vestibular dysfunction. In this clinical population psychosocial factors often play a key role in handicap and recovery. Whereas Chapter 15 addresses psychosomatic processes in this population (i.e. the way in which psychological factors contribute to complaints of dizziness or imbalance), this chapter discusses somatopsychic processes – the way in which psychological factors can aggravate or alleviate the course of an organic disorder. The second group comprises people whose balance and gait problems are caused by central neurological disorders. Balance and gait impairment can be associated with hemiparesis following stroke and are features of the middle to late stages of disorders such as Parkinson’s disease, Huntington’s disease, cerebellar disease, multiple sclerosis and motor neuron disease. Postural instability and falls occur early in the course of progressive supranuclear palsy and can help to differentiate this disorder from other parkinsonian syndromes where these symptoms occur somewhat later such as multiple system atrophy and cortico-basal-degeneration and from idiopathic Parkinson’s disease where recurrent falls appear much later.1-3 In these patients psychosocial problems are typically less central to the symptomatology and progression of the disorder, but can still have an important impact on quality of life.
