This resource is for patients living with brain metastases (cancer that has spread to the brain). The information can help you if you are having problems with balance and coordination such as:

• feeling dizzy, faint, or unsteady
• stumbling or falling when you walk

What are balance and coordination?

Balance means that you are able to stay upright. Our body depends on balance to stand, sit and walk without falling over.

Coordination means that you are able to use different parts of your body together. An example of coordination is the finger to nose test. See the images on the right on how to do the test.

Finger to nose test

How does the body maintain balance and coordination?

Many parts of the body are involved in balance and coordination. One example is the cerebellum. The cerebellum is a small part of the brain that plays an important role in balance and coordination.

The cerebellum receives information about where and how your body is moving. The cerebellum gets this information from your:

• ears
• eyes
• arms
• legs

The cerebellum then tells your muscles to work together. When your muscles work together, you stay balanced and coordinated.

Other parts of the body that are involved in balance and coordination are the inner ear and spinal cord.

How does cancer cause balance and coordination problems?

Balance problems

Balance problems may cause you to feel unsteady or dizzy. You may notice this more when you stand or walk. If you have balance problems, you may:

• fall or feel as if you are going to fall
• stumble when you walk
• feel light-headed or faint
• feel as if the room is spinning
• become confused

Coordination problems

Coordination problems mean it is hard for you to move the way you want. Some doctors might call this “cerebellar ataxia”. If you have coordination problems, you may:

• Stumble when you try to walk
• Have trouble with tasks such as writing or buttoning a shirt
• Have trouble with eating or swallowing
• Slur your speech

How do brain metastases affect the balance and coordination?

Brain metastases can affect balance and coordination if they damage the cerebellum. The damage may be caused by:

• the brain metastases themselves. For example, tumours may press upon the cerebellum.
• cancer treatments, such as chemotherapy or radiation.

Other causes of balance and coordination problems in cancer patients include:

• dizziness as a side effect from some medicines.
• becoming dehydrated from vomiting (throwing up) and diarrhea (loose poo). Being dehydrated means that your body loses more water than it takes in. Being dehydrated can cause you to feel dizzy and unbalanced.
• anemia (a low number of red blood cells).
• low blood pressure.

Why is it important to manage balance and coordination problems?

The biggest concern for patients with balance problems is that they may trip or fall. Falling can lead to serious injuries, such as bone fractures.

Balance and coordination problems may also make it hard to perform everyday activities such as:

• walking
• eating
• picking up objects

Patients may simply dislike feeling dizzy or unsteady.

What can I do to manage balance and coordination problems?

There are many steps that you can take to manage balance and coordination problems:

1. Move slowly

Stand up slowly. This includes when you get up from a chair, couch, or bed. If you move too quickly, you can become dizzy.

2. Make changes to your home to prevent falls

Below are things you can do to prevent falls in your home:

• Wear proper footwear. The best footwear is non-skid, rubber-soled shoes. Avoid wearing only socks on smooth surfaces such as wood floors or tile.
• Remove clutter from the ground. If you have an area rug, remove it or tape down the edges.
• Use the handrails when climbing stairs.
• Install grab bars by the toilet and bathtub. Grab bars will help you sit and stand safely.
• Make sure there is good lighting in your home.
• Keep supplies in places that are easy to reach. Reaching for objects may cause you to fall.
• Ask for help with tasks that are not easy for you to complete. For example, ask for help when changing lightbulbs.

3. Review your medicine list with your doctor or pharmacist

Some medicines can cause you to feel dizzy. You should review your current medicines with your doctor.

Your doctor may be able to make changes to make you feel less dizzy. For example, your doctor may change the dose or change the medicine itself.

4. Drink lots of liquids

Drink at least 6 cups of liquid each day. The best liquid to drink is water. If you need to, you can drink:

• milk
• fruit juice
• vegetable juice
• soft drinks
• broth and soups
• sports drinks
• tea
• coffee

Avoid too many drinks with caffeine (coffee, tea, or energy drinks). Drinking liquids will prevent you from being dehydrated. Being dehydrated can cause you to feel dizzy.

Drinking liquids is more important if you have diarrhea or vomiting. This is because diarrhea and vomiting cause you to become dehydrated.

5. Limit how much alcohol you drink

Limit the amount of alcohol you drink. Alcohol causes dehydration. Alcohol can also make balance and coordination worse.

Alcohol affects the cerebellum and can increase the side effects of your medicines.

6. Check your vision and hearing often

Make sure your glasses and hearing aids are up-to-date. You are less likely to fall when you can see and hear well.

7. Do exercises to improve balance

Perform exercises that make your stomach, back and pelvic muscles stronger. These exercises will improve balance and are simple enough to do in your home.

While doing these exercises, make sure that you keep a steady support nearby like a counter top or chair. Wear proper footwear.

Meet with a physiotherapist before you try the exercises listed below. A physiotherapist is someone who uses physical methods (massage, heat, or exercise) to treat health problems.

A physiotherapist can plan the best exercises for you. This plan may include resistance training, such as weight lifting, to improve muscle and bone strength.

Other activities, such as yoga and tai chi, have also been shown to improve balance. You can ask your doctor for a referral to a physiotherapist.

Calf raises

1. Stand in place and slowly raise both heels up. You should be on your tiptoes.
2. Lower your heels.
3. Repeat.

 

Tandem stand

1. Put the heel of one foot in front of the toes of the other foot. This should look like you are walking on a tight rope.
2. Hold for 10 seconds.

 

Single leg stand

1. Stand on one foot for 5 to 10 seconds.
Switch legs and repeat.

 

Pelvic tilt

1. Lie on your back with your knees bent. Your feet should be flat on the floor.
2. Tighten the muscles in your stomach so that your back becomes flat. This will tilt your pelvis up slightly.
3. Hold for 10 seconds.

 

Bird-dog

1. Start with your hands and knees on the floor. You should look like you’re crawling.
2. Place your knees hip-width apart and your hands under your shoulders.
3. Extend one leg with both hands on the floor.
4. Once balanced, slowly extend the arm on the opposite side.
5. Hold for 10 seconds.

 

8. Use a mobility aid

A mobility aid is a device designed to help you walk or move around such as a cane, walker, or crutches. Mobility aids provide a wider support base to help you stay stable and balanced.

A physiotherapist or occupational therapist can help you choose the right mobility aid and learn how to use it. An occupational therapist is someone who helps you perform daily activities.

When you purchase a mobility aid, make sure that it is the correct height. When you are standing up straight, your walker hand grip should line up with the crease in your wrist . The mobility aid should also have a rubber tip to prevent slipping.

9. Eat a healthy diet

Ensure that you are eating three healthy meals each day. Include foods that contain calcium and vitamin D. Foods with calcium and vitamin D include:

• cheese
• milk
• yogurt
• eggs
• leafy green vegetables
• fatty fish (tuna, mackerel and salmon)

Foods that contain calcium and vitamin D help keep your bones strong. Strong bones prevent fractures in case you fall.

Avoid skipping meals. If you skip meals, your blood sugar level may become low, leading to dizziness and falls.

10. Take medicines to reduce dizziness

Your doctor may be able to suggest medicines to reduce dizziness. Some medicines will require a prescription (doctor’s order) and some will not.

Talk to your doctor before you begin to take a new medicine, even if it does not need a prescription.

When should I talk to my health care team?

If you notice any of the symptoms (signs) below in between your clinic visits, call the Brain Metastases Clinic at 416 946 4501 extension 6325:

• Severe (very bad) headaches that do not go away with medicines
• Changes to your vision or eyesight (such as seeing double or blurry vision)
• Increased confusion (you cannot think as clearly or quickly as normal)
• Weakness in your arms or legs

Where can I find more information?

• Managing Physical Side Effects on Cancer.Net
• Problems with Balance and Coordination on BC Cancer