The Vestibular System’s Effect on Falls in Parkinson’s Disease

Written by Katelyn Trane SPT

Without therapy interventions, 70% of people with Parkinson Disease (PD) experience a fall each year.  There can be many reasons for this high fall rate.  Many of the principal signs of  PD; including postural imbalances and slowness of movement, can be large factors of what cause falls. In addition to these, recent studies have shown that a malfunction in your vestibular system (your inner ear) could also be contributing to falls.

What is my vestibular system?

The role of the vestibular system is to tell your brain the position of your head in space, and to measure the speed of movement of your head with all movements.  Our vestibular system makes up one third of the systems that contribute to our overall balance.  The other two systems being our vision, and our sensory system.  You may already be experiencing trouble with your balance due to effects of PD.  Therefore, when our vestibular system is not working properly , you may notice increased balance impairments.  Our vestibular system is divided into two parts, the peripheral vestibular system and the central vestibular system.   Our peripheral vestibular system is made up of a small group of structures within the inner ear on both sides of our head.  There are many dysfunctions that can occur in the peripheral vestibular system.  One common condition is called vertigo, or a feeling of spinning upon certain head movements.  Our central vestibular system is comprised of two areas of our brain that make sense of the informatvestibular 1ion that is received and then send signals to our trunk and our legs to keep us upright.

 

Your vestibular system in your inner ear is about the size of a dime and responsible for letting your body know which way is up. 

 

 

If I have Parkinson’s, does that mean I have dysfunction in my vestibular system?

As you may know, PD affects the area of the brain called the basal ganglia. Therefore, PD is not directly affecting your vestibular system.  However, due to postural instability that occurs as a result of the disease, the balance system is even further at risk with even slight vestibular abnormalities.  Due to the common posture displayed by patient’s with Parkinson Disease including, leaning forward of the trunk when standing and walking, studies have shown that signals within the vestibular system can get diminished on one side.  Often times, the vestibular system is affected on the same side of the symptoms from the PD.  Vestibular dysfunction can often be overlooked in patients with PD.  However, vestibular dysfunction can occur following the use of a strong antibiotic, after a flu/cold, or following a fall,as in the case where the head hits the ground.

 

How do I know I have this and what can be done to help?

Your vestibular system may be at risk if you experience dizziness with head turns including looking right, left, up and down. The good news is that we can re-train, or up-train, the diminished portion of the vestibular system.  A physical therapist trained in vestibular rehabilitation can work with you to improve your symptoms with specific exercises and training strategies.  Examples of such exercises include vestibular ocular reflex training x1 and remembered targets, both listed below.  Prior to trying these exercises, make sure you are in a safe space where you will be supported if you lose your balance.  These exercises may cause or increase dizziness.

Exercises

Exercise 1: VOR x1 Viewing

Instructions: Tape a card with a single letter (example: A, X, or O) or symbol (example: star) onto the wall at eye level.  (Keep your glasses on if you wear them)

Begin: Sitting

  • Sit 6 to 10 feet away. The further away you sit, the easier it will be for your eyes to focus on the object.
  • Move your head side to side from left to right at a speed so that the object is in focus with your vision. An occasional blurriness is okay, but you do not want to be seeing double. If you are, slow down your speed.
    • Do this for 1 minute without stopping. Rest 1 minute or until symptoms subside. Repeat 1 more time.
  • Next, repeat looking up and down instead of left to right
    • Do this for 1 minute without stopping. Rest 1 minute or until symptoms subside. Repeat 1 more time.Vestibular 2Progression 1: Sit with the card in front of a busy background (wrapping paper, newspaper). Putting the object in front of a busy background will further challenge your vestibular system.
      • Sit 6 to 10 feet away. The further away you sit, the easier it will be for your eyes to focus on the object.
      • Move your head side to side from left to right at a speed so that the object is in focus with your vision. An occasional blurriness is okay, but you do not want to be seeing double. If you are, slow down your speed.
        • Do this for 1 minute without stopping. Rest 1 minute or until symptoms subside. Repeat 1 more time.
      • Next, repeat looking up and down instead of left to right
        • Do this for 1 minute without stopping. Rest 1 minute or until symptoms subside. Repeat 1 more time.

      Once you have mastered this, try both of these exercises in standing.  Stand in a corner with a support surface behind you in case a loss of balance occurs.

      If you want to challenge yourself more, try standing on a pillow or a cushion to challenge your balance.

       

      Exercise 2: Remembered Targets

      Instructions: Tape a target onto the wall. Sit in front of the object.  Again the closer you are to the target, the more challenging it will be.  Look at the target.  Close your eyes and turn your head slightly to the right, imagining that you are still looking at the target.  Open your eyes and see if you were able to keep your eyes on the target.  Move your head back to the middle and repeat to the left.

      • First advance this exercise by moving your head at a quicker speed. After each turn, make sure to open your eyes to look at the target and then re-center your head.
      • Next, perform this exercise with head motions up and down and diagonals (example: up and to the right, down and to the left)
      • Vestibular 3

      For more information, contact the rehab department at the UF Center for Movement Disorders and Neurorestoration and/or talk to you physician about vestibular rehabilitation.

 

References:

Bassetto, J., Jurkiewicz, A., Klagenberg, K.,  Zeigelboim, B.  Neurotological Findings in Individuals with Parkinson’s Disease. Sci Flo. Vol. 74, No. 3. June 2008. Web.  Retrieved from: http://www.scielo.br/scielo.php?pid=S0034-72992008000300007&script=sci_arttext&tlng=en

Vitale et. al. Vestibular Impairment and Adaptive Postural Imbalance in Parkinsonian Patients with Lateral Trunk Flexion.  Movement Disorders. Volume 26, Issue 8 pages 1458-1463.  July 2011. Web. Retrieved from: http://onlinelibrary.wiley.com/doi/10.1002/mds.23657/abstract

 

 

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Alison Kraus

Alison Kraus (DeCirce) graduated with a B.S. in Clinical Health Studies from Ithaca College in 2011. Following her Bachelor’s degree, Alison received a Doctorate in…

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