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The effects of age in vestibular dysfunction and how this could affect results in the bodymap protocol
The subject of this dissertation has been born out of differing results in age groups who have been tested using these body map drills. Often Slightly older test members have shown greater results in all parts of the bodymap test hierarchy, however not in all cases. Rather than researching all of the hierarchy I have concentrated on vestibular dysfunction and reduction in balance of older test subjects. The practical assessments I conduct are primarily on the female gym members and PT clients of varying ages.
It’s common for elderly ladies and gents to have reduced balance and function due to in part Sarcopenia(reduction in lean muscle and reduction in bone density). The elderly are also prone to a variety of diseases that affect these systems, including cataracts, glaucoma, diabetic retinopathy, and macular degeneration, which all affect vision; diabetic peripheral neuropathy, which affects position sense in the feet and legs; and degeneration of the vestibular system. Balance is also dependent on good muscle strength and joint mobility. A sedentary lifestyle and arthritis or diseases of bones and muscles can compromise strength and mobility.
With a better understanding of threat, I now realize a lack of practice and using the balance part of the brain can add threat, So in theory a continual vestibular use and practice should take the body out of threat, and improve balance in all groups.
Some of the ways vestibular dysfunction manifests itself are:
· A issue with general balance
Poor balance is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness or wooziness, or having a sensation of movement, spinning, or floating. Balance is the result of several body systems working together: the visual system (eyes), vestibular system (ears) and proprioception (the body's sense of where it is in space).
As an ex soldier I have spent endless cool downs balancing on one leg conducting leg stretching exercises, to be honest in my 20 years of balancing on one leg I don’t believe I have got much better at this, however this is a vestibular, eye and proprioceptive training method. I have seen a number of individuals conducting this one leg stretch, some are great and some simply cannot do it. There are little tricks that seem to work: for example fixing your eyes at a point a few meters ahead or pinching your ear as you balance. Whichever way we look at this the constant standing on one leg must be a form of rehabilitation to the poor function, however in my case it hasn’t really helped.
It's a scene often seen in movies. There's a nervous guy trying to impress a pretty girl. He gets up the courage to walk up to her, and suddenly everything goes wrong. He trips, or he knocks over things, or he accidentally drops all of his books/papers; he becomes extremely clumsy, and the subsequent embarrassment causes him to run away from his bravery. Often clumsiness could just be a lack of coordination or your vestibular system not working effectively. The example of the nervous guy above is described as being caused by anxiety or nervousness, however thinking back to what we know about our two sympathetic systems its more likely that he feels relaxed and confident and his body is fixed in the Para sympathetic system calming him down and then the threat of being knocked back and all of the subsequent embarrassment has placed him into his sympathetic system which in turn has locked up his body into a “freeze” and inhibited functions making him much less coordinated. Clumsiness can also be linked to a huge number of other medical conditions and ailments.
· Motion sickness
One common understanding for the cause of motion sickness is that it functions as a defense mechanism against neurotoxins. The area postremain the brain is responsible for inducing vomiting when poisons are detected, and for resolving conflicts between vision and balance. When feeling motion but not seeing it (for example, in a car or ship), the inner eartransmits to the brain that it senses motion, but the eyes tell the brain that everything is still. As a result of the discordance, the brain will come to the conclusion that one of them is hallucinating and further conclude that the hallucination is due to poison ingestion. The brain responds by inducing vomiting, to clear the supposed toxin.
This does make some sense as often car motion sickness seems to effect small children much more than adults or children who are large enough to have a full 360 vision of their surroundings.
· Ortho static intolerance
Orthostatic intolerance can occurs in humans because standing upright is a fundamental stressor and requires rapid and effective circulatory and neurologic compensations to maintain blood pressure, cerebral blood flow, and consciousness. When a human stands, approximately 750 mL of thoracic blood is abruptly translocated downward. People who suffer from OI lack the basic mechanisms to compensate for this deficit. Changes in heart rate, blood pressure, and cerebral blood flow that produce OI may be caused by abnormalities in the interactions between blood volume control, the cardiovascular system, the nervous system and circulation control systems. Women are 4 times more likely to suffer from this, I have experienced this often in my previous job within the Army, however at the time I had no idea it was called OI. Soldiers can spend a large amount of time stood still on parade and often individuals will collapse, generally it’s a hot day and sometimes alcohol will have a part to play. Looking back and recalling the individuals who have collapsed on these long duration parades nearly all of them were either females or individuals with a low percentage of lean muscle or adipose tissue. I have personally experienced the dizziness and lack of coordination during one of these parades, it’s not a pleasant experience and you feel helpless. OI can sometimes be manifested by the feeling of dizziness after getting to your feet too quickly, the same principles apply.
Without testing we can’t tell how the vestibular system is doing or if we are actually improving it with training or bodymap drills. In the words of D Moy “if you are not assessing you are guessing”
I wont go into them all here, however they are all listed below, the interesting thing is some of these vestibular tests/drills are used as bodymap re-alignment drills to reduce inhibitions. Other ones could be:
1. Sharpened Rombergs test
2. Dix-Hallpike Maneuver
3. Head Shake Nystagmus
4. Head Thrust Test
5. Dynamic Visual Acuity
6. Eye movements
7. Fukuda Stepping Test
8. Tandem Gait Testing
9. Voluntary Hyperventilation
11.Rotational Chair Testing
Testing balance issues and deterioration in the elderly is key to understanding why or if deterioration really occurs. From nearly all of the information researched the frequency of retraining the vestibular system and balance is hugely important for good function, therefore basically “use it or lose it applies”.
The ageing vestibular system
Most people are familiar with the problems associated with the aging of senses such as vision and hearing. However, the vestibular system is another sensory system that can also begin to function poorly with age, leading to a diminished quality of life.
The vestibular system is a complex structure of fluid-filled tubes and chambers that constitutes part of the inner ear. Specialised nerve endings inside these structures detect the position and movement of the head and also detect the direction of gravity. The signals sent from the nerves of the vestibular system are critically important to the brain’s ability to control balance in standing and walking and also to control certain types of reflexive eye movements that make it possible to see clearly while walking or running.
Anatomical studies have shown that the number of nerve cells in the vestibular system decreases from about age 55. Blood flow to the inner ear also decreases with age. Idiopathic bilateral (occurring on both sides) vestibular loss becomes more severe as age progresses. When the vestibular system is damaged by any cause, an individual may experience dizziness and balance problems. However, the gradual, age-related loss of vestibular nerve endings can result in severe balance problems without any associated dizziness. This type of slow loss of vestibular function may be first noticed as difficulty walking or standing, especially in the dark while on soft or uneven surfaces (such as thick carpet or a forest path).
Improvements with age
Luckily as an exercise professional this is my bag and actually my field of expertise (weight loss and improved health for ladies over 30 years of age). So there are a number of exercises which I conduct with my lady clients to reduce the signs of sarcopenia and ageing. However there are certain exercises which are specifically designed to improve balance, coordination and motor skills.
Simple One-Leg Balancing
Lift one knee up until your hip is bent at a 90-degree angle. Hold it there for as long as possible. Time how long you can keep your balance. Take care not to let your legs touch each other. If you prefer, hold onto the back of a chair while you lift your leg and then remove your hand slowly to see how long you can hold the position. This has a similar effect to the Army balance exercise I mentioned earlier.
Balancing on Hands and Knees
Go down on hands and knees on a gym mat or folded blanket. Stretch one hand out in front of you and stretch the opposite leg out in the air behind you. Keep your core muscles contracted to help you balance. Now repeat on the other side.
Starting from a standing position, jump in place and turn 90 degrees to land neatly without losing your balance. Increase the degree of turning to 180 degrees or 360 degrees without losing your balance on landing. This exercise replicates body functions used in sports such as skiing, snowboarding, gymnastics and cheer leading which would explain why the ladies I tested who conducted these sports mostly had an effective vestibular and special system.
Balance Beam Exercises
A low balance beam can be made out of a row of bricks or a sturdy plank laid between two bricks. Start by walking forward and backward along the beam. Increase the demands by balancing a beanbag on your head as you do so or by bending to pick up objects as you walk.
Set up an obstacle course that has a balance beam, a stretch of space for running and markers for changing direction. Include a space for a forward roll or somersault. Time yourself as you complete the obstacle course and try to improve your time without losing your balance. Do the obstacle course from a different direction to add interest.
Draw a hopscotch grid on the ground, making it as long or as complex as you wish. Try different combinations of jumping and hopping through the various squares without touching any of the lines. Toss a beanbag into a square or two and avoid those squares as you jump.
Ball Exercises A
Simple toss-catch games can become more challenging if your feet have to remain within a certain space. Try standing on a pillow to throw a ball in the air or against the wall and then catch it again without moving off the pillow.
Ball Exercises B
Sit on an exercise ball on an exercise mat and put your arms out to the side for balance. Gently lift one foot off the ground while keeping your balance. Lower and repeat with the other foot.
Walk heel-to-toe along a line marked on the ground or along a stretch of rope. Keeping your feet in the heel-to-toe position, catch a ball thrown to you by a friend, or toss a ball against a wall and catch it again. Bending the knees may help to keep your balance as you catch the ball. Also try lifting one foot to stretch out and pick up objects to the side and then return to the heel-to-toe position
I tested a number of ladies using all of the bodymap drills, usually the higher they appear in the threat hierarchy the better the results. However not always, and I will cover this later in the conclusion. As previously stated I specialise in female weight management and lifestyle coaching, I also run an all female gym so finding test subjects was simple. Ladies all seem to love trying the new thing and within a gym there are a large number of ladies who actually could use some help with balance or other inhibitions.
I tested around 50 ladies using the recently acquired bodymap techniques and nearly all of them showed improvements either in flexibility, strength or pain reduction. As expected the drills that provided the greatest average results were drills at the top of the hierarchy like breathing and eye drills. As a rule of thumb the individuals with the poorest initial functions displayed the greatest end results and this makes perfect sense. Another expected finding was that ladies who had a particularly bad system, for example vestibular system then often displayed the greater improvements after some retraining.
Some test subjects just found it too difficult to get the technique for diaphragm breathing and this would effect the later drills negatively, potentially the fact that they felt bad for not being able to achieve belly breathing could fix them firmly in the threat environment therefore having a inhibitory effect on the drills. Certainly of the ladies tested the ones that couldn’t get the hang of diaphragm breathing tested poorly and never really believed in the positive effect of the bodymap process. With more time and more patience from the ladies I could have helped them achieve better breathing.
One test subject in her 60s displayed poor spinal ROM and even after going through the full hierarchy of threats in slow time showed absolutely no improvement. I don’t know the percentages in terms of positive effect, however as the nervous system is a dominant system I would have thought it would help everyone with a functioning nervous system. I am still not 100% sure if she was being honest with her body movements.
Another lady in her 30s showed little to no results, however I know with some certainty she has recently had a nervous episode and is currently being medicated for depression. I am wondering if the effects of the medication downgrading her emotional response will also downgrade any nervous system (bodymap) results.
Most of the test subjects with limited or poor vestibular response had an improved function result from the VOR drills and other balance drills. In some cases even better than the initial bodmap drills such as breathing. Generally the ladies with the worse vestibular system (balance) were the older ones, however there were some exceptions. Individuals who currently play a lot of sport or in the past, regardless of age often had better balance and vestibular system. This in turn ensured little to no improvement during the vestibular and often spacial drills.
In summary, the older the test subjects the worse the initial function in most of the assessments and generally the bigger improvements after all of the bodymap drills, somewhat as expected. Due to the factors mentioned earlier in the dissertation, age reduces the function of the vestibular system a great deal some of which cannot be improved. However with continual training the system can function well which will reduce threat therefore reducing the inhibition. Some young test subjects were so flexible initially the results often never seemed as impressive, not in all cases though. Thinking in terms of keeping mature ladies healthier for longer with better balance, our ladies should continue to practice balancing and reduce the effects of sarcopenia and other function loss by weight training. That’s why even the government who are in my opinion normally 3-5 years behind the rest of us in health ideas recommending resistance training and cardiovascular fitness to the over 50s.
The bodymap system and the vestibular drill amongst it work very well at reducing threat and improving performance. There will always be anomalies and differing results however the greater the dysfunction or inhibition generally the greater the improvement regardless of age or experience.
Ladies at Leisure Gym & St Cuthbert’s’ Catholic Social Club
Chester Le Street, Co Durham
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