Bloomington / Normal, IL

Working with the community... for a healthier community.

Treating People, Not Patients


By Alexander Germanis

Physical balance is something that tends to be equated with things like riding a bike, performing gymnastics, or being able to stand steadily on a ladder. The real scope of balance extends to practically everything we do, whether it’s simply standing up or walking down a hallway without stumbling into the wall.

Without a proper sense of balance, the entire world becomes an amusement park ride from which one can never get off. Dizziness and nausea are commonplace, and leading any semblance of a normal life becomes a dream.

At the Central Illinois Institute of Balance, Poonam McAllister leads a team of physical therapists and audiologists dedicated to making that dream become a reality, bringing a literal balance back to the life of each person who steps through her door.

People not patients
Although therapists in name, Poonam and her team at the Central Illinois Institute of Balance are not your usual physical therapists; they are experts on the human vestibular system — the system involved with balance and spatial orientation.

“We’re specialized in the area of treating people with various balance and dizziness disorders,” Poonam says. “The misconception is that only old people have these problems, and that’s not true. These types of problems affect people of all ages. We see people in high school with concussions, for example, all the way to 98-year-olds.”

While medication may sometimes help and some balance issues can be resolved with time, most people still don’t realize there is an entire medical field that can help them, complete with rehabilitation to get them back to playing sports, back to driving, or just back to life in general.

Poonam brings a lifelong history of personally dealing with some of these disorders to her work. “I was diagnosed in college with ophthalmoplegic migraines,” Poonam shares. “So, I’ve experienced a lot of vomiting, dizziness, and headaches — the common symptoms most of our patients experience.”

Furthermore, in her final year of PT school, an inflamed vein in her leg went misdiagnosed, putting her on a course of strong treatments, antibiotics, and months of bed rest — actions that could have been life threatening. “I have experienced people not listening, missing the diagnosis, or writing things off as the ‘usual’ or ‘just an infection.’ In general, just not taking people seriously.”

After working as the Director of Rehabilitation at OSF Saint James Hospital for eight of her 11 years there, Poonam decided her passion was to serve people directly, bringing the value of her own experiences — both good and bad — to the fore in order to help others so they do not have to go through what she did.

“My desire is to be a different provider, a provider who looks at people, not ‘patients,’” she says. “A provider who is not looking at the disease and symptoms, but at what people can’t do, how they’re being affected, what anxiety, depression, or loss of quality of life their disorder creates. The emotional impact of dealing with sickness is huge. I am going to listen and not go in with a preconceived idea of what I’m going to do. Then I’m going to do triage within my scope, make an individualized plan, and involve the patients with their plan. They have a choice.”

The body’s gyroscope
With extensive training at the American Institute of Balance, and having earned Susan Herdman’s Vestibular Rehabilitation Certification, as well as years working in rehab, Poonam understands just how vital balance is to living a normal life.

“Balance is the output of certain systems in your body working together,” she explains. “It is what we see, and what we do, and what gets us from point A to point B without falling. The systems are often missed because they’re in your head — in your inner ear.”

The inner ear acts as a gyroscope, stabilizing the entire system of the body, detecting movement on the full body scale down to the movement of just the eyes. That movement is detected and sends signals to the brain, which in turn sends the appropriate signals to your legs, your eyes, your core, or whatever is necessary in order to maintain proper balance.

One of the most surprising things about this gyroscopic system is it partially runs on crystals. Called otoconia or statoconia, small crystals of calcium carbonate move against hair cells in the ear, detecting movement and sending those messages to the brain.

“The crystals have a real function, but if they dislodge and move to a different part, they’re still doing their job, but in the wrong place,” Poonam says. “So if you’ve moved 20 degrees, the brain thinks you’ve moved 2,000 degrees; then the eyes are trying to catch up with that movement and that leads you to be dizzy, nauseated, and falling backwards.” Dislodged otoconia are the common cause of vertigo.

Unfortunately, balance experts cannot actually just poke a light in the ear and check to make sure everything is in place, and the otoconia do not show up on MRI scans due to their composition. But, like the wind, even though they are not visible, their influence most certainly is. Therapists are forced to make conclusions based on external evidence: balance, eye movement, etc.

While dislodged otoconia are the most common issue and the easiest to treat, it does not mean there are not more complicated inner ear or neurological conditions that can present similar symptoms. “That’s why you need a thorough workup,” Poonam advises. “We need a more comprehensive history, a full evaluation of multiple systems, and then we can treat it correctly.”

That comprehensive history comes, sometimes, from multiple sources. Many of the people who are sent to Poonam in the first place are referred to her by other physicians.

“It can become complex and at that point it involves a multi-disciplinary team,” Poonam admits. “I’m just one piece of the whole puzzle. We need other specialists working with us so it becomes a full-team approach to get that person moving forward. With our testing, we can recognize that and have the person go to the right place and then come for rehab. Rehab is not the end-all for everything; it’s a piece —a critical piece — but you have to have a stable system to work with.”

The future of balance
Poonam is looking at expanding the Central Institute of Balance in the near future to better accommodate the needs of her staff and, more importantly, the people who come to see her.

“We want to create an environment where they can rehab a little farther,” she says. “You get to a point where you can only simulate so much in the clinic and then have to say, ‘Just go do life.’” So, for starters, Poonam is working with ISU on researching the benefits virtual reality may have for her practice.

“I would also like to have a support group for people who have recurrent vestibular issues,” Poonam shares, “so they can be given information from other medical providers: neurologists, a pharmacist to give a talk about medications, a cardiologist to talk about dizziness from their standpoint. Those are my dreams.”

Currently, the institute uses state-of-the-art computerized dynamic posturography (CDP), video-oculography (VOG), Dynamic Visual Acuity (DVA), and videonystagmography (VNG). These tests measure body and eye movement and how that movement translates to signs of unbalance.

Case management
“I’ve had health issues in my life and have been bounced from one doctor to another on what I would call the medical referral tree,” Poonam shares. “From medication up to the point of a surgery without an explanation of what I was going through, what to expect, what my choices were, and what options there were for me.”

“When I bring a patient onboard, that helps me prioritize the outcome,” she continues. “I’m on their team now; I’m working for them. I have felt that connection myself; I have seen the lack of it. We’re trying to fill that gap for families and doctors, so people are not just falling in this black hole.”

Getting your life back in balance may not always be easy, but Poonam and her team at the Central Institute of Balance want everyone to know they are willing to do their part to help.

Success breeds growth, which means CIIB needs to grow. Increasing their
space by 1700 sq.ft., Poonam and her staff will soon have more room for
treatment, comprehensive evaluation and equipment, as well as being able
to offer better availability for scheduling.

For more information on problems with balance or dizziness, you may contact Central Illinois Institute of Balance by calling 309-663-4900 or visiting