Balance and Mobility Issues

Weakness & Chemotherapy

Related: Balance & Mobility, Managing Incoordination (ataxia), Weakness (asthenia).

Balance and Mobility

What helps us to keep our balance and mobility?

The body's nerves and muscles are highly involved in maintaining balance and mobility. Balance is the ability to keep us stable, on our feet, and perform certain activities. Balance also prevents us from falling down from a standing or sitting position. Mobility allows us to move around and react to our environment in a timely manner. There are certain areas of our body that help us to keep our balance. These include:

• The cerebellum, which is located behind the brain stem and controls functions of movement, balance, mobility and posture. If you have experienced damage to your cerebellum you will experience impaired mobility, imbalance and incoordination.
• The vestibular system of the inner ear also plays an important role in helping to maintain our balance. It sends and interprets signals from the environment to keep us erect, and the body in balance when we move.

Causes of imbalance?

Many medications, treatments, and diseases can effect these areas, which then can cause problems with imbalance and dizziness, which affects our mobility. Examples of conditions or medications that may affect the cerebellum or vestibular system in person's receiving chemotherapy include:

• Chemotherapy drugs that may affect the vestibular system of the inner ear include:
• Cisplatin and carboplatin.
• Chemotherapy drugs that may affect the cerebellum include:
• High dose cytosine arabinoside (Ara-C) and high bolus doses of fluorouracil (5-FU).
• Dehydration: If you are dehydrated, and you change positions, you may feel experience imbalance or dizziness. This is a result of low blood pressure (orthostatic hypotension). Your healthcare provider may check your vital signs (including your blood pressure and heart rate) while lying down, sitting up, and standing, to help in determining this.
• Weakness causes by stress, tiredness, fever, fatigue, anemia, heart problems, or stroke may cause dizziness, and imbalance.
• Infection or inflammation of the inner ear, brain or spinal cord.
• You may notice imbalance after prolonged bed rest, when your muscles weaken. This will also lead to problems with mobility.

What are some symptoms of imbalance and poor mobility to look for?

• Generalized weakness or tiredness, not being able to perform usual activities.
• Dizziness
• Double vision.
• Vertigo (feeling like the room is spinning around you).
• Hearing loss. Weakness of hearing.
• Blurred vision.
• Ringing in the ears.
• Nausea and vomiting
• Difficulty with tasks such as writing your name, changing position from sitting to standing.
• Fever and/or chills (if infection or flu-like syndrome causing dizziness or imbalance)

Dizziness and problems with mobility and balance may be a symptom or sign of a serious problem. Notify your doctor if you experience any of the symptoms of imbalance and poor mobility mentioned here.

Things you can do about imbalance and poor mobility:

• It is important to notify your healthcare provider if you notice any sudden changes with your mobility or balance, if you experience any dizziness, or any change in the pattern of dizziness you are experiencing. Also, notify your healthcare provider if you have any loss of vision, hearing, or if your symptoms become more severe, and do not improve.

Prevent dehydration:

• Drink 2-3 liters of fluid per day to prevent dehydration. This may include fruit juices, water, non-caffeinated sodas and coffee, and non-alcoholic beverages.
• Avoid alcohol and caffeine as these may cause dehydration.
• Always carry a "sipper" cup with you, filled with your favorite drinks.
• Change positions slowly. Allow your body a chance to adapt to the position change. For some people, lying down until the dizzy episode passes may be the best solution.

Safety:

• With moderate imbalance, walk slowly and often. Walk with assistance if you are having severe dizzy episodes, weakness, or imbalance.
• If you are at risk for falling down due to imbalance:
• Remove throw rugs from your usual walking path in your home if you are at risk for falling down. Avoid clutter, if possible.
• Place track lighting, or keep the areas that you spend the most time in, well lit. this will prevent your chance of falling, if you are able to see more clearly.
• If you are at risk for falling down due to weakness and unsteady movements, and you live or spend most of the day alone, try to carry a cordless phone, or another device to notify someone if you fall down.
• Wear well-fitting shoes. Make sure the shoelaces or Velcro straps are tied tightly.
• Do not operate any heavy machinery. It is also important to be careful when taking new medications.
• Use any braces, canes, walker or other supportive devices prescribed by your health care professional.

Other therapies:

• Physical therapy (PT): May be recommended or requested to evaluate for safety concerns, optimize mobility and for assistance with other interventions as appropriate such as exercise for muscle strengthening or assistive devices.
• Occupational therapy (OT): If you are experiencing imbalance or problems with mobility, in general, you may be taught in OT how to do many tasks that you normally do, in a more effective manner.
• If you have vertigo that is causing imbalance and poor mobility, your doctor or a trained therapist may teach you exercises, called "vestibular exercises", to try to decrease the level of your dizziness. These exercises involve sitting down, and changing into different positions. This may increase your imbalance or dizziness at first, while you are performing these movements, but should help to correct the vertigo. You may expect improvement in 2-6 months.

To help prevent problems related to poor mobility:

• Keep your bowels moving. People who move around less may become constipated (see managing side effects - constipation for additional information).
• Take deep breaths. It is necessary to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. This is especially important if you have poor mobility. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• If you smoke, you should quit. If you do not smoke, avoid smoke-filled rooms. Smoking can affect the way your medications work. Discuss with your healthcare provider techniques that can help you quit.
• Change position often (every 2 hours) to relieve pressure points.
• Move legs and arms to help improve mobility. Use "pressing down the gas petal" motion, or make circling motions with your ankles to help prevent blood clots.

Other:

• Depending on the cause of imbalance and poor mobility, your symptoms may last a few days to a few months. It is important to follow all the instructions your healthcare provides.
• Exercise, under the supervision of your healthcare provider such as walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood (oxygenation).
• Make sure to get enough sleep at night. This may help to lessen trouble in the daytime with incoordination, fatigue and weakness. If you have trouble sleeping:
• Do not eat or exercise within 2 hours of bedtime
• Make the room dark
• If you have an electronic clock, or one with an illuminated face, turn the face away from you.
• Use the bed only for sleeping
• Keep a consistent schedule. Make sure you go to bed each night and wake up each morning, at the same time.
• Minimize daytime naps. If you must take a nap, do not sleep for more than an hour at a time. Longer naps will make you feel more tired, and interrupt nighttime sleep.
• If these techniques do not work, consult your healthcare provider.
• If you experience weakness symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Drugs or treatments that may be prescribed by your doctor for imbalance or poor mobility:

Treatment of balance disorders is based upon finding the underlying cause, and treating that condition.

• If your weakness is a result of a medication or treatment, removing that medication may help alleviate weakness.
• Depending on your overall health status, your doctor may recommend certain drugs that may help you. Some of the common drugs that are used to treat your weakness may include:
• Antibiotics - If your doctor or healthcare provider suspects that you have an infection that has caused your imbalance and poor mobility problems, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once asthenia is relieved.
• Meclizine (Antivert^®), Dimenhydrinate (Dramamine^®), or the Scopolamine Patch (Transderm-Scop^®). These medications may help to decrease the symptoms of poor mobility or imbalance, that may accompany dizziness.
• Prochlorperazine (Compazine^®), and Promethazine (Phenergan^®) -Used to treat imbalance as a result of dizziness. These work by preventing a feeling of dizziness, or by preventing nausea and vomiting that may cause dizziness.
• Physical therapy or Occupational therapy assistance may be prescribed.

When to call your doctor or health care provider about weakness:

• If weakness becomes progressively worse.
• If you have a headache, blurred vision, numbness or tingling.
• If there is a change in mental status, such as confusion, disorientation, or increased sleepiness.
• Any sudden changes with your imbalance, dizziness, or any change in the pattern of dizziness you are experiencing.
• Fever of 100.5° F (38° C), and /or chills (possible signs of infection if you are receiving chemotherapy).
• Feeling your heart beat rapidly, or experience palpitations
• Constipation unrelieved by the use of laxatives
• Diarrhea (4-6 episodes in a 24-hour period), especially if it is becoming worse
• Nausea (interferes with ability to eat and unrelieved with prescribed medications).
• Vomiting (vomiting more than 4-5 times in a 24-hour period).
• Any new rashes on your skin

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about weakness and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.