Aging is not a Disease!

Have you ever had to care for someone who is elderly, or maybe you are in your golden years and you see this in your friends, and they seem to have lived beyond years’ worth living?  I am talking about a  person who is alive, but so disabled that they no longer enjoy life.   These are the people who have lost their dignity, no longer in control their lives or their safety, due to frailty and increased fall risk.

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As a therapist devoted to neurology and the vestibular system, my aim is to restore function to this population, regaining a life worth living.  “We need to focus on adding life to years, and less on adding years to life.”1   Wouldn’t this be easier done if more preventative measures were taken, instead of reactionary ones?  I mean, I would much rather prevent an injury than rehabilitate someone from injury, doesn’t that seem logical?

With the proportion of people over the age of 60 growing exponentially in almost every country1, it is imperative that we keep them active so that they can continue to be a part of society and not a burden to care for.  Active Ageing is the term that WHO developed that refers to “continuing participation in social, economic, cultural, spiritual, and civic affairs.  Active ageing aims to extend healthy life expectancy and quality of life for all people as they age.”2   But in America, the tendency is for our elderly is to retire and become sedentary, which leads to a path of weakness and poor balance, raising the risk of falls significantly.  “Globally, falls are a major public health problem.”3 With approximately 424,000 fatal falls each year2,   reducing fall risk is a big goal of mine, especially ”since the deaths rates are highest among adults over the age of 60 years.”

elderly man falling

 Impaired balance (without any other diagnosis) is not a progressive disease, but rather a weakening and discoordination of the systems of balance.  If you want more information about those systems, check out this previous blog post here.  With vestibular and sensorimotor rehabilitation, these systems can certainly be improved! By reducing risk of falls, we can essentially lower unnecessary disabilities and deaths that are the result of a fall.  If you are a loved one is having difficulty maintaining balance, it is certainly worth a consultation with a therapist trained in vestibular rehabilitation.  Maybe you’re wondering what a balance impairment looks like, or how to detect a problem at the earliest onset? Good question! If you’re answering YES to these questions, then getting evaluated is probably a really good idea!

  1. Do you have difficulty getting up from a chair or out of bed? For instance, it takes more than one try to get up
  2. Do you experience a numbness or loss of sensation in your legs?
  3. Do you have trouble walking up or down inclined surfaces?
  4. Do you ever lose your balance when standing still?
  5. Do you feel the need to look for support or grab on to something when you are moving around?
  6. Do you have problems transitioning to different floor surfaces or heights? For example, is it difficult for you to move from carpet to hardwood? Is it hard for you to step off a curb?
  7. Do you use an assistive device (cane, walker) to walk around?
  8. Have you fallen more than once in the last year?
  9. Do you ever feel unsteady or lose your balance when walking? Try walking and looking to the left or right, do you step to the side?
  10. Do you ever get dizzy?


With a comprehensive treatment plan to rehab all systems of balance to their highest potential, returning to a life that is active and enjoyable, and not full of fear from falling, is an achievable goal!

couple on bicycle

As always, if you have questions and want more information, please feel free to contact me!

– Mari

  1. Holtz, C. Global Health Care. Sudbury, Massachusetts:  Jones and Bartlett Publishers; 2008
  2. What is active ageing?. Available at:  Accessed February 16, 2011.
  3. Falls Fact Sheet. Available at: Accessed Feb 18, 2011

Can I give you an ear full?

Did you know that your ears are responsible for more than hearing?  Well, they are! In fact, the inner ear houses a very important system responsible for balance, the vestibular system.  Not many people understand how different systems in our body work together to create balance, and I will attempt to explain it in the simplest terms possible.  Understanding how the systems work together, and some common problems associated with the vestibular system, may help you to understand how or why your balance can be impaired.  First, we need to understand what it means when we talk about balance.

Stability is present when our body can resist both linear and angular acceleration, or resist a force that may disrupt our equilibrium.  The ability to control our equilibrium and maintain our stability is known as BALANCE.

The 4 main systems of balance are: (click on the terms for more info)


All 4 systems send information to the brain, and the brain then filters and regulates the information to form a motor plan for

  • Postural Control
  • Coordination of eye movements


The vestibular system provides:

  1. Sensory information about head movement and position as it relates to gravity
  2. Gaze Stabilization (control of eye movements when the head moves)
  3. Postural adjustments
  4. Effects of autonomic function and consciousness

Now, I’m going to teach you a bit of anatomy.  Don’t be scared of the funny names; I have provided a detailed diagram of where these obscure organs sit.  Just try not to get bogged down in the anatomy!

There are receptors that convert the head’s position and motion into neural signals that are sent to the brain.  These receptors are in the inner ear and are located in the semicircular canals and the otolithic organs which are titled the Saccule and Utricle.

inner ear

The otolithic organs (Utricle and Saccule) are very sensitive to gravity and linear acceleration by using the mass of the otoconia (little crystals or “rocks”) into the otolithic membrane.  The otoconia are like fine particles of sand that shift as we move our head, giving the brain information about where our body is in space.


Also giving feedback to the brain is the fluid (endolymph) moving through the semicircular canals. As the fluid moves through the canals, hairs inside the canals bend, and change the frequency of signals sent to the brain.  As these hairs bend, the brain is receiving more communication about the body’s position in space through a person’s head position.  This system, working with the other 3 systems of balance, are how our brain knows if we are standing up, laying down, bending over, ect….

Seems like a pretty efficient system, what could go wrong??

Plenty….but in this blog post let’s talk about a common inner ear issue; BPPV.

Occasionally, otoconia will get displaced (you know, the “rocks”).  When one or some get displaced, they will float inside the Semicircular canals and cause the most common cause of vertigo, BPPV, or benign paroxysmal positional vertigo.  This diagnosis presents itself by episodes of vertigo with common changes in positions, such as, sitting up, bending over, or looking up.   Basically, the rocks are bouncing around and bending hairs, which sends a message to the brain which is inconsistent with your body’s actual position.  Your muscles, feet and eyes are giving your brain correct information on your body’s position, such as your standing up.  However, the vestibular system is giving false information, such as, you’re laying down.  These conflicting messages really confuses the brain, and the result is



Left alone, the body is fairly amazing, and finds a way to shut out the confusing signals that are being sent, therefore, reducing the amount of vertigo over about 10 days.  As time goes on, your body learns to compensate to a new normal of impaired balance, and bouts of vertigo will probably be one of your consistent complaints.  Luckily, there are repositioning techniques that can put those pesky rocks back where they are supposed to be, which gets rid of the vertigo.  Some doctors and physical therapists are specially trained to know which canal the “rocks” are in and which positions you need to be put in to get them back where they are supposed to be.

If you are looking for a doctor or vestibular therapist that can perform these test, and the repositioning techniques, I have listed some of my favorites below


Dix Hallpike

Roll Test





Horizontal liberatory Maneuver

If your suffering from vertigo, and feel like BPPV may be your problem, make sure the clinician you seek help from is fully trained in clearing BPPV.  There are a lot of variations in symptoms that tell a trained clinician which canal the BPPV is in, as well as, if the otoconia are free floating in the canal or possibly stuck in one spot.  With the help of a doctor or therapist trained to treat BPPV, you can clear the BPPV quickly (1-2 visits), and begin your rehabilitation to regain your balance to its prior level of function.

I love to hear from my readers.  Please let me know if you have any questions or comments!



It’s important to do a comprehensive evaluation

One of the pit falls that I see therapists fall into is focusing immediately on a patient’s area of pain.  A comprehensive evaluation, which is performed on every new patient, is crucial to making sure you come to the right conclusions about why your patient is having a problem.  Their daily routine will be a large contributor, and if their day is sedentary with little head movement, they may have musculoskeletal pain coupled with vestibular impairment.  This is a great article Published on 2/18/2015 by Dr. Lee Burton in FMS Screening reminding us to look at the big picture!  I encourage every clinician to create a standard evaluation for every patient that is comprehensive (you can add the individual details case by case); that way you never miss information and your patient’s progress with thank you for it!


Vestibular Disorders Reference Chart

Vestibular Disorders (print PDF here)

Vestibular Disorders

adapted from Vestibular Rehabilitation, by Susan Herdman, PT, PhD, FAPTA

Disorder                                Tempo                                    Symptoms                              Circumstances

Vestibular neuritis Acute dizziness vertigo, disequilibrium, nausea and vomiting, oscillopsia Spontaneous, exacerbated by head movements
Labyrinthitis Acute dizziness vertigo, disequilibrium, nausea and vomiting, oscillopsia, hearing loss and tinnitus Spontaneous, exacerbated by head movements
Wallenberg’s infarct Acute dizziness vertigo, disequilibrium, nausea and vomiting, tilt, lateropulsion, ataxia, crossed sensory loss, oscillopsia Spontaneous, exacerbated by head movements
Bilateral vestibular deficit or > 7 days from a unilateral vestibular defect Chronic dizziness Dizziness, disequilibrium, occasional oscillopsia Induced by head movements, walking. Exacerbated when walking in the dark or on uneven surfaces
Mal de débarqument Chronic dizziness Rocking or swaying as if on a boat Spontaneous while lying or sitting, rarely occurs while in motion
Oscillopsia Chronic dizziness Subjective illusion of visual motion Spontaneous with eyes open
Anxiety/depression Chronic dizziness Lightheadedness, floating, or rocking Induced by eye movements with head still
Benign paroxysmal positional vertigo (BPPV) Spells: seconds Vertigo, lightheadedness, nausea Positional: lying down, sitting up, or turning over in bed, bending forward
Orthostatic hypotension Spells: seconds Lightheadedness Positional: standing up
Transient ischemic attack (TIA) Spells: minutes Vertigo, lightheadedness, disequilibrium Spontaneous
Migraine Spells: minutes Vertigo, dizziness, motion sickness Movement induced, usually visuo-vestibular mismatch
Panic attack Spells: minutes Dizziness, nausea, diaphoresis, fear, palpitations, paresthesias Spontaneous or situation
Motion sickness Spells: hours Nausea, diaphoresis, dizziness Movement induced, usually visuo-vestibular mismatch
Ménière’s disease Spells: hours Vertigo, disequilibrium, ear fullness from hearing loss and tinnitus Spontaneous, exacerbated by head movements

Where did all the fun go?

Remember the days with your arms stretched wide, spinning in circles until you fell down in the grass giggling? Remember the days when hanging upside down on the monkey bars was a preferable way to spend your time? Remember a time when an amusement park was the perfect way to spend an afternoon?

boy spinning hanging upside down on monkey bars roller coaster

All these things used to spark emotions of excitement and happiness, so why do they now spark emotions of dread? Why does life seem to become a boring routine as we age? Why are we now avoiding activities that used to be so much fun? Well, many systems in our bodies tend to be neglected as we age, but none are more ignored than our vestibular system.

What’s our vestibular system?  I am glad you asked! The Vestibular system is the sensory system, in the inner ear, that provides the majority of information to the brain about our body’s orientation in space.  It is also responsible for coordinating eye movement with head movement.  If our body is moving faster than our vestibular system can communicate, the brain gets really confused on our bodies position.  When the brain gets one set of information from our eyes, muscles and somatosensory system (that’s the feeling of the floor coming up through your feet!), but conflicting information from the vestibular system, a host of symptoms can appear.  People complain of nausea, seasickness, a floating feeling, loss of coordination, falls and vertigo.

In the beginning of my physical therapy career, I assumed that my patients with balance impairments had them because they were not moving, resulting in muscle atrophy and weakness.  As I have evolved, I realized that I was right about the immobility, but I was missing a large piece to their balance impairment.  Their immobility may have affected their strength, but it created a greater problem within their vestibular system.  Without the normal head movements achieved when you are mobile, the vestibular system’s function begins declining, and eventually your balance becomes impaired.

Now, there are many different insults that can cause vestibular impairment.  However, what this blog post is discussing is vestibular hypofunction as a result of immobility.  You would be amazed at how many people suffer from this, and it is easy to see why! We stopped spinning in the grass, and hanging upside down on the monkey bars.  Instead, we drive to work

drive to work

stare at a computer

stare at computer

drive home from work, read, watch TV, and never move our heads from side to side or up and down. Even during exercise at the gym we tend to stare straight ahead reading or watching TV.

Bottom line, the vestibular system is fed by head movements, and the majority of us over the age of 20 are starving it!

If you’re battling with vertigo, or just a lack of balance, a hypofunctioning vestibular system may be your problem.  If it is – don’t worry! The vestibular system can be rehabilitated, and it’s a superfast learner!  How do you do it? Find a physical therapist that knows their stuff, and they will hook you straight up for how to tackle the rehab. Not sure if this is your problem?  A physical therapist can help you there too.  It’s our job to know when we can help, and when you are better off sticking with your doctor.

Check back with holdfastpt as we continue to build on just why the vestibular system might be causing us havoc.