Exercises for Balance

Working on balance isn’t just for “old folks”

There is a lot of emphasis these days on cardiovascular fitness and strength training.  However, exercising to maintain orimprove balance is just as important.  Just as strength and endurance decline with age, balance can decline as well.

Balance involves not only the strength of our leg and trunk muscles and flexibility, but also three sensory systems. 

·      Vision helps us with balance by telling us where we are in relation to other objects.

·      Proprioception (position sense) in our feet and legs tells us if we’re leaning one way or the other, or on what kind of surface we are walking, such as thick carpet for a firm floor, or if our weight is more on one aspect of our foot than the other. 

·      Inner ear, known as the vestibular system, gives us information about how we are moving, whether we are turning, tilting or changing speed.

Our brain receives input from each system, integrates the information, and forms a response.  For example, when we walk in the dark, we aren’t using our vision as much to help us balance.  Our brains have to know to use the vestibular (inner ear) system and proprioception (position sense) in our feet and legs to stay balanced.  If we walk on uneven surfaces, we have to rely more on our vision and vestibular (inner ear) system.  A more complex task is walking on an uneven surface at night where input from both vision and proprioception (position sense) is impaired.  Our brain then has to rely mostly on information from the vestibular (inner ear) system.

If we are not challenging our balance as we age, it can decline, just like muscle strength and flexibility.  As we age, if we begin to feel off balance or fall, we lose confidence in doing the things we enjoy and we may limit or stop doing certain activities.  This leads to further imbalance and debilitation, and ultimately a decreased quality of life.

Similar to strengthening our muscles, there are exercises we can do to “strengthen” ourbalance.  Many fitness and social centers are now incorporating balance exercises into their classes and/or offering classes specifically to help with balance.  Tai Chi is a popular exercise that has been scientifically proven to improve balance.  Activities to improve balance include standing with your eyes closed, standing with one foot in front of the other or standing on one leg.

Physical Therapists who are trained in Vestibular Rehabilitation are excellent resources for improving balance.  If you or a loved one is beginning to feel off balance with their normal activities, or experiencing falls, please seek help from a physical therapist who has training and experience in this area.  An exercise program can be developed specifically for your needs based on the difficulties you are having with balance.  Often, only a few visits are needed to make significant progress, improving your balance to prevent falling.

Hearing Loss Hurts!

Hearing Loss Hurts:  Side Effects of Hearing Loss May Shock You!

Hearing loss is often associated with aging, which all of us are trying to avoid.  But leaving your hearing loss at the bottom of the “to do” list could be hurting you more than you think.

By the time most individuals with hearing loss are ready to ask for help, they have already suffered social, psychological, cognitive, and other health effects related to their hearing loss.   Early hearing loss identification and treatment are essential in preventing such an undesired outcome.

Two-thirds of adults aged 70 and older have hearing loss.  But did you know 65 percent of people with hearing loss are below the age of 65?  Shockingly, nearly half of all people with hearing loss are below the age of 55.  A recent publication in the Journal of the American Medical Association stats that 1 in 5 teens/adolescents have hearing loss.  With increased noise exposure in the younger generations, we are seeing these numbers increase at an alarming rate.

Untreated hearing loss has consequences:

Relationships:  Untreated hearing loss can be harmful to relationships.  The inability to communicate effectively with others leads to isolation and alienation.  People with hearing loss start moving into their own world, rather than a shared one.

Fatigue and Depression:  The sheer effort it requires to communicate with an untreated hearing loss causes fatigue, irritability, anger, tension, stress and depression.   This increased mental exertion needed to communicate with others can lead individuals to avoidance or withdrawal from social situations, social rejection and loneliness.

Dementia:  Some studies have suggested an association between hearing loss and decline in cognitive function and dementia.

“The brain has a limited amount of capacity to work; if hearing loss causes the brain to spend additional resources to understand speech, then it has fewer resources to do such things as store information in memory, analyze what is being said, or think about what to say in a conversation.” Edwards, B. (2009). Cognitive and Psycho-social Consequences of Hearing Loss. ENT News. 1-3.

The aging brain can lead to problems such as poor memory and the inability to learn new tasks.  Research shows that the ability to think and multitask is diminished when the brain is working overtime to communicate.  We need to acknowledge that memory loss could in fact be a symptom of hearing loss.

Vestibular Rehabilitation Therapy

The Vestibular System has to do with our sense of balance and is for maintaining equilibrium. Vestibular Rehabilitation Therapy (VRT) is a special form of Physical Therapy designed to decrease dizzy symptoms and improve balance. This is accomplished by stimulating the brain to adjust to abnormalities of the vestibular system.

What is involved with Vestibular Rehabilitation Therapy (VRT)?

• Exercises to help your eyes remain steady during head movements
• Exercises to help you tolerate head movement or position changes which cause dizziness Exercises to help your balance and walking to decrease your risk of falls
• Correcting your posture and help strengthen weak muscles to improve balance Education for prevention, maintenance and self-care of symptoms after discharge

What should I expect with VRT?

• An initial evaluation will be performed to get a baseline of your symptoms and function and will last approximately 45 minutes to one hour.
• You will be seen once a week (twice weekly for more severe problems) for 45 minutes. Treatment can last 4-12 weeks depending on the severity of the problem.
• You will be prescribed a specific Home Exercise Program (HEP) for you based on the results of the evaluation and your improvement over time. The HEP is designed to help your brain adapt to your vestibular system problem. It is important to consistently and regularly perform the exercises at home, in between appointments.
• Some exercises may initially make your symptoms worse, but symptoms will steadily improve as you perform them consistently.
• Many different factors contribute to your final level of recovery including: initial severity and type of injury to the vestibular system, consistency with performing the exercises at home, medical and physical condition prior to this problem, level of anxiety or depression, and headaches.
• Medications such as meclizine, Antivert, phenergan, or valium can slow your recovery by preventing your brain from adjusting to your vestibular system abnormality. Please consult your doctor regarding weaning off of these medications as soon as you can.
• Once VRT is complete, it will be important to continue with the HEP designed for you. Relapse of symptoms, known as “decompensation”, can occur in times of stress, fatigue or illness. By performing the exercises regularly, you can avoid this. 

Hearing Aids Aren't Enough

Hearing Aids Aren’t Enough without Good Communication Habits

If you’ve taken the first step toward better hearing by investing in hearing aids, you deserve to be congratulated. But your satisfaction is not guaranteed by a simple purchase.  You have a responsibility to develop good communication habits designed to maximize the benefits you receive from wearing hearing aids.

To achieve the desired results, remember hearing is not passive.  To understand and communicate effectively, you must learn to be a good listener and to control your environment to help compensate for your hearing loss…even while wearing hearing aids. To maximize the benefit you receive from your hearing aids:

·       Commit to wearing your hearing aids! If you’ve ever worn contact lenses, you know it takes some time to get used to wearing them.  The same is true with hearing aids.  You must become accustomed to how they feel your ear and to hearing sounds you may not have heard for a very long time.  For example, if it’s been awhile since you’ve heard a bird sing or a clock ticking, you may initially find these sounds irritating. But give it some time.  Your brain will adjust to hearing these sounds and soon they will become normal. Do not stop wearing your hearing aids during this adjustment period.  Be patient and focus on the commitment you have made to your hearing health.

·       Show off your hearing aids. Don’t  hide them. It is your responsibility to inform those with whom you communicate that you have difficulty hearing and are wearing hearing aids. Become a partner with the person to whom you are speaking.  Give them guidance to allow you to communicate effectively. You must face the listener when you talk, tell him or her to speak louder or move the conversation to another room if the environment is too noisy.

·       Control your environment.  If you know you are going to be in a situation where background noise will interfere with your ability to communicate effectively, formulate a plan to minimize it.  For example, arrive at a restaurant early so you can choose seating away from the source of background noise.  Prepare in advance by looking online for restaurants that post their menus. By familiarizing yourself with the menu ahead of time, you will eliminate your need to ask the waiter or waitress to repeat menu choices.

·       Make eye contact.  You will discover communication improves when you can evaluate and interpret body language and facial expressions.

·       Practice your listening skills.  You can do this by listening to the radio or an audio book. There is even an auditory rehabilitative software program you can buy for your computer that will allow you to practice listening in background noise.

·       Be patient and “keep your eyes on the prize.” In time, listening with hearing aids will become second nature and you will be rewarded with the joy of hearing all the sounds of life.

Maintaining Balance Throughout Life

Working on balance isn’t just for “old folks”

There is a lot of emphasis these days on cardiovascular fitness and strength training, to help us age well.  However, just as important is our balance.  Just as our strength and endurance decline with age, our balance can as well, especially if we are not challenging it.

Balance involves not only the strength of our leg and trunk muscles and flexibility, but also 3 sensory systems.  Our vision helps us with balance by telling us where we are in relation to other objects.  If I see a door frame is vertical, I know I’m vertical.  The sensation of proprioception in our feet and legs tells us if we’re leaning one way or the other, or what kind of surface we’re on, such as thick carpet for a firm floor, or if we have weight more on one aspect of our foot than the other.  The inner ear system, known as the vestibular system gives us information on where we are in space, and if we are moving, turning, tilting or changing speed.  During every activity we do, our brain takes input from each system, integrates the information and forms the needed response to move in a specific environment.  For example, when we walk in the dark, either outside at night or when turning out a light and walking across a room to go to bed, we can’t use our vision as much to help us balance.  Our brains have to know how to use the vestibular system and the sensation and proprioception in our feet and legs to walk safely.  If we walk on uneven surfaces, the brain has a harder time using the sensation in our feet for information, we have to rely more on our vision and vestibular system.  A more complex task is walking on uneven surfaces at night when both vision and sensation inputs are not 100%.  Our brain then has to rely the most on information from the vestibular system.

If we’re not challenging our balance as we age, it can decline, just like muscle strength and flexibility.  If our brain never has to use the vestibular system, it will in a sense “forget” how to use it when it needs to.  Our proprioception can decline with age so we may rely too heavily on vision for balance and ignore the other systems.  Once people start to feel a little off balance or even fall, they lose confidence in doing the things they enjoy and may limit themselves or stop the activity altogether.  This can lead to further imbalance or debilitation if they end up limiting a lot of activities.  Obviously, that can lead to further medical issues and decreased quality of life.

Just like strengthening our muscles, there are exercises and activities we can do to “strengthen” the balance system.  A lot of fitness centers and social centers are incorporating balance into their exercise classes and/or offering classes specifically to help with balance.  Tai Chi is a popular exercise which has been proven through research to help with balance.  Activities to help improve balance can include standing with your eyes closed,  standing with one foot in front of the other or on one leg, using a chair beside you to hold on to for safety if needed.  These activities can help your balance now, to help keep you active as you age.

Physical Therapists who are trained in Vestibular Rehabilitation are also good resources for improving balance.  If you or a loved one is beginning to feel off balance with their normal activities, or beginning to fall, seek help from a therapist trained in this area.  They can design an exercise program specifically for your needs based on the difficulties you are having with balance.  Often, only a few visits are needed to make some significant progress balance to prevent falls as people age.

Maximize the Benefits of Hearing Aids

Follow these Guidelines to Maximize the Benefits You Receive from your Hearing Aids

Your hearing aids may be the most technologically advanced devices you own, but technology alone cannot guarantee long-term satisfaction.  To maximize the benefits you receive from wearing hearing aids, it is important to follow these hearing health and maintenance guidelines.

Maintaining Your Hearing Health

1.     We recommend you have an audiogram every two years. By comparing the results of a new audiogram with an older one, we can determine if your hearing loss has worsened.  If it has, your hearing aids can be reprogrammed to compensate for the additional loss.

2.     Wear your hearing aids daily to allow your brain time to relearn sounds you may have been missing.

3.     Do not miss a regularly-scheduled check up.  We need your consistent feedback to keep your hearing aids performing as they should, as well as the opportunity to clean them or to replace plastic tubing.

4.     Do not wear someone else’s hearing aids.  They have not been programmed for your listening lifestyle.

Taking Care of Your Hearing Devices

1.     Clean your earmolds daily with an audiowipe (an FDA approved antimicrobial cleaning wipe) to remove any buildup of earwax.

2.     Hearing aids should not be submerged in water so be sure to remove them before taking a shower or going swimming.

3.     Do not expose your hearing aids to hair spray.

4.     Do not expose your hearing aids to radiation from x-rays, so remove them when going through security at the airport or while at the dentist office.

5.     Do not try to repair your own hearing aid.

6.     Do not use alcohol or cleaning fluid on any parts.

7.     Regularly check the plastic tubing on your hearing aid. Remove debris per the instructions provided by your Audiologist.

Battery Care

1.     Replace batteries routinely. Battery life is determined by the type of hearing aid and how long it is worn each day.  The average battery life is 7-10 days.

2.     Memorize the battery size your hearing aid requires.  It is also helpful to know the tab color of the package your batteries come in, as battery sizes are color-coded across all brands. A #10 battery can be identified by a yellow tab; a #13 battery by an orange tab; a #312 by a brown tab; a #675 by a blue tab and a #5 by a red tab.

3.     Extend battery life by turning off your hearing aids at bedtime.  Keep the battery compartment door open to allow any moisture that has accumulated inside to evaporate.

4.     Store batteries at room temperature.

5.     Do not carry loose batteries in your pocket or purse. Contact with metal objects like coins or keys can short-circuit the battery.

6.     When newly purchased, hearing aid batteries are sealed with a tab to ensure freshness.  Do not remove this tab until you are ready to use the battery.  Once the tab is removed, allow the battery to charge for 30-60 seconds prior to placing it into the hearing aid.

Vestibular Neuritis and Labyrinthitis

Vestibular Neuritis and Labyrinthitis are often attributed to a viral infection affecting the vestibular (balance) nerve, as many affected with these conditions report a preceding illness. The vestibular nerve carries information from the inner ear to the brain about head movement and when one of the two vestibular nerves are affected, this creates an imbalance, and vertigo (false sense of motion or “spinning” sensation) occurs. If hearing loss occurs along with vertigo, we use the term Labyrinthitis.

Symptoms
Vestibular neuritis and labyrinthitis (vestibular neuritis with hearing loss) usually cause the sudden onset of vertigo, disequilibrium or imbalance, and nausea or vomiting. Initially, dizziness or vertigo is constant and may last a few hours to a few days. After several days, vertigo will disappear, but dizziness remains. After weeks to months, dizziness is only noted with certain activities, such as turning the head.

Diagnosis
The ears, brain and eyes work closely together to maintain balance. Head movement or other stimulation of the inner ear sends signals to the muscles of the eyes via the brain. Our ability to diagnose Vestibular Neuritis/Labyrinthitis is enhanced by infrared video goggles that easily visualize and record eye movements. The Videonystagmogram (VNG) is a series of tests that look for signs of vestibular system dysfunction by measuring nystagmus (an involuntary movement of the eyes). Additional testing includes Rotary Chair in which the eyes movements are evaluated while sitting in a chair that rotates at various speeds. The vestibular evoked myogenic potential (VEMP) provides information about the lower portion of the vestibular (balance) nerve, which is not evaluated by the VNG and rotary chair. With vestibular neuritis, we will be able to see what is called a right- or left-beating nystagmus with a caloric (air blown in the ears) weakness, a VOR asymmetry on RotaryChair and an abnormal VEMP if the inferior portion of the vestibular nerve is involved. An audiogram (hearing test) will tell us if you have suffered from vestibular neuritis or labyrinthitis.

Treatment
Acutely, vestibular neuritis or labyrinthitis is usually treated with vestibular suppressant medications, such as Antivert (meclizine), Ativan (lorazepam), Phenergan (promethazine), Compazine (prochlorperazine), or Valium (diazepam), in addition to prednisone. The vestibular suppressant medications are not meant to be a long-term solution to controlling the dizziness and should only be used for 3-7 days. Long-term, such medications will inhibit recovery. Recovery from vestibular neuritis/labyrinthitis occurs by the brain adapting to the vestibular imbalance in a process known as central (brain) compensation. Some will recover on their own over time, but for the majority of those affected, Vestibular Rehabilitation Therapy (VRT) is necessary. VRT is a specialized form of physical therapy that helps dizziness and balance disorders. In the hands of a physical therapist (PT) with specialized training in this area, it is highly effective in alleviating any remaining dizzy symptoms from vestibular neuritis/labyrinthitis.