Bodymap Dissertation
The effects of age in vestibular dysfunction and how this could affect
results in the bodymap protocol
Outline
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.
·
Clumsiness
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 postrema
in 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 ear
transmits 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.
Testing
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
10. Oculomotor tests
11. Rotational Chair
Testing
12. Posturography
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.
Balance exercises
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.
Twist Jumps
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.
Obstacle Course
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.
Hopscotch
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.
Heel-To-Toe Exercises
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
Test
subjects
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.
Conclusion
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.
Locations
Ladies at
Leisure Gym & St Cuthbert’s’ Catholic Social Club
Chester
Le Street, Co Durham
References
1. Ko CW, Hoffman HJ, Sklare DA. Chronic
Imbalance or Dizziness and Falling: Results from the 1994 Disability Supplement
to the National Health Interview Survey and the Second Supplement on Aging
Study. Twenty-ninth MidWinter Meeting of the Association for Research in
Otolaryngology (ARO); National Institute on Deafness and Other Communication
Disorders (NIDCD). Feb. 2006.
- Kroenke, Lucas, Rosenberg et al.
Causes of persistent dizziness: a prospective study of 100 patients in
ambulatory care. Ann Intern Med, 117 (11), 898-905.
-
- Allum, H.J., & Shepard, N. T. (1999),
An overview of the clinical use of dynamic posturography in the differential
diagnosis of balance disorders. J Vestib Res, 9, 223-252
-
- Kaplan, Marais et. al. (2001), Does
High-Frequency Pseudo-random Rotational Chair Testing Increase the Diagnostic
Yield of the ENG Caloric Test in Detecting Bilateral Vestibular Loss in the
Dizzy Patient? Laryngoscope, 111: 959-963
-
- Hain, Timothy, Vestibular Evoked Myogenic
Potential (VEMP) Testing
-
- Hajioff, D et. al. Is
electronystagmography of diagnostic value in the elderly? Clinical
Otolaryngology, 27(1) Feb. 2002 pp 27-31
-
- Desmond, Alan. Vestibular Function:
Evaluation and Treatment. Thieme Medical Publishers, INC New York, NY
2004. pp 65-111.
-
- Stockwell, Charles. Introduction to
ENG. ICS Medical, Schaumburg, Illinois, 2001, multiple pages.
-
- Stockwell, Charles. Catalog of ENG
abnormalities. ICS Medical, Schaumburg, Illinois, 2001, multiple pages.
Glenn Hill
07983570574
.jpg)