REFERENCE · RECOVERY TECHNIQUE

Practising Balance and Walking With Appropriate Support

When this may fit: When assessed unsteadiness affects standing, turning or walking and practice needs to account for fall risk. [Clinical rehabilitation; adjacent balance evidence and limited PPPD component evidence]

For the Person With FND
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For the Person With FND

Feeling unsteady can make a short walk demand your full attention. Balance practice should give you a safer way to explore movement. It should not put you in a position where falling is the price of trying.

What makes a balance task harder?

Balance uses visual, inner-ear and body-position information together. A narrow stance, an uneven surface, turning the head or carrying an object can change the demand. Removing vision changes it again. These are things a therapist may assess; they are not a checklist to attempt alone. [1]

Gait simply means the way someone walks. In PPPD, the useful target may be turning safely in the kitchen or reaching a doorway with less difficulty. A separate functional gait disorder, neuropathy, joint problem or vestibular loss may need additional assessment. [3]

Bring the practice into a real task

Ask the therapist to choose one stance, transfer or walking task and assess the help it needs.
Use a clear level area, suitable footwear and the prescribed aid. Arrange trained assistance if the plan requires it.
Practise the agreed version—for example, reaching a nearby chair along an uncluttered route—and stop before the task becomes unsafe.
Review the response before changing direction, surface, distance or another demand. A route can become useful without becoming difficult.

Do not close your eyes, stand on a cushion, walk backwards or add stairs because those appear on a generic balance sheet. Those changes require selection and supervision appropriate to your risk. No challenging manoeuvre is required to prove that your dizziness is functional. [1][2]

Aids can stay

A walking aid or wheelchair can make participation possible while rehabilitation continues. Equipment should be fitted and reviewed for its job, not removed as a test of confidence. Falls and near-falls are reasons to review the task, environment and diagnosis.

During a familiar flare

Use the safer route or additional support already agreed. Transfers and essential journeys may need help; practice can wait if balance is unsafe. A fall with injury or a new inability to walk needs assessment.

When to stop and seek assessment

Stop unsafe activity. Sudden or distinctly different dizziness with new weakness, double vision, speech trouble, inability to walk, severe headache, fainting or chest pain needs urgent assessment. Sudden hearing loss, head injury or persistent vomiting also needs prompt medical attention. Increasing falls or progressive loss of function warrants reassessment. Existing PPPD does not explain every new symptom. See the diagnostic and differential-assessment page.

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For Family, Friends, and Other Supporters

Ask what help is wanted and learn safe assistance from a professional. Pulling an arm or surprising someone with a balance challenge can make things worse. Clear obstacles and keep the chosen aid within reach.

During a familiar flare, follow the agreed support and safety plan. Ask before taking over. New or substantially different symptoms need their own assessment; an exercise should never delay that care.

For the Person With FND
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For Clinicians and the Care Team
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For Clinicians and the Care Team

Assess actual balance performance, falls, transfers and sensory, motor and musculoskeletal contributors. A strong subjective sense of instability does not quantify fall risk; neither does a normal brief test exclude problems in daily settings. Specify guarding and assistive equipment. Track safe participation, confidence and burden without treating confidence as the sole cause.

Agree an accessible next step and review point. Consider meaningful activity, safety, access, effort and delayed effects alongside dizziness severity. Limited improvement is not grounds to withdraw assistance or infer lack of effort.

For the Person With FND
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For Clinicians and the Care Team
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Research and Sources

This page expands original entry 6, Balance and gait practice. Examples and practical prompts are educational adaptations, not patient quotations or a reproduced treatment protocol. Original-entry numbering does not imply thirteen independently validated treatments.

Balance and gait work are components of rehabilitation rather than separately proven PPPD treatments. Hypofunction evidence supports adjacent principles; PPPD packages and real-world goals need individual interpretation.

Citation	Source	What it supports and its limits	Figure
1	FND-CIT-0193 — Hall CD, Herdman SJ, Whitney SL, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy. 2022;46(2):118–177. DOI.	Guideline for peripheral vestibular hypofunction; adjacent evidence, not a PPPD exercise prescription.	—
2	FND-CIT-0192 — Herdman D, Norton S, Murdin L, Frost K, Pavlou M, Moss-Morris R. The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness. Journal of Neurology. 2022;269:4753–4763. DOI.	Small feasibility comparison of treatment packages; does not establish component efficacy or ACT benefit.	—
3	FND-CIT-0027 — Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research. 2017;27(4):191–208. DOI.	Diagnostic consensus; defines PPPD and differential assessment, not treatment efficacy.	—

Sources checked: September 22, 2026 · Vestibular, neurological, lived-experience and accessibility review pending

For the Person With FND
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For Clinicians and the Care Team
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