John is a 66-year-old grandfather and successful businessman from Asheville, NC who plays tennis and counts flying among his favorite hobbies. But he is concerned that his memory is starting to slip. There’s no family history of Alzheimer’s disease or dementia.
John, however, did have a car accident and subsequent skiing accident in which the fall he suffered was so serious that his helmet broke. He also admits that he is often dizzy, fatigued, easily angered, and frustrated over his physical and mental limitations.
Intervention for balance and cognitive decline
John underwent comprehensive Brain Training at a frequency of three times per day over the course of five days. His brain function was carefully monitored throughout the training process with measurement of EEG brainwaves, vital signs, eye movements, balance, mental and physical timing, and more to ensure he was receiving the proper amount of therapy without exceeding fatigue limits that might promote worsening of his symptoms as is often the case in more conventional rehabilitation programs.
Understanding the relationship between physical functions such as balance, timing and eye movements and higher cognitive functions like memory (both major challenges in his case), we implemented the following Brain Training procedures: EEG neurofeedback, Interactive Metronome, vestibular rehabilitation, metabolic/nutritional therapies, eye movement and neurological rehabilitation, electrical stimulation, breathing exercises, lifestyle changes and home care therapies.
Outcomes with Brain Training
John reported midway through his five-day training program that he had “one of his best games of tennis.” He also said he felt less dizzy and improvements in his mood and memory were noticeable to him and others. “I walk better, talk better and feel better,” he said.
Actual measurable, objective improvements recorded with post-intensive diagnostic testing included:
- Interactive Metronome (Timing): 14% improvement in timing accuracy and normalization of hyper-anticipatory timing tendency with motor tasks (i.e. becoming more ‘in-sync’ with a specified reference tone).
- Videonystagmography (Eye movements): Significant improvements in numerous aspects of oculomotor functionality including: gaze holding, slow and fast eye movements, optokinetic responses, and spontaneous/involuntary eye movements.
- Computerized Assessment of Postural Stability (Balance): 24% improvement in balance under the most challenging circumstances (eyes closed on an unstable surface – noted as PSEC on charts below below). Near complete normalization of a hazardous posterior center of pressure (tendency to carry his body or sway to the rear):
Implications Following Treatment
After his treatment was completed, John says he was able to recapture the moments of joy and sense of accomplishment he experienced through playing tennis and flying his aircraft, his two favorite hobbies; as well as being more engaged with his family.
He reports his memory has improved, he has fewer symptoms of dizziness and fatigue, and most important – he is now a safer, happier pilot following his specific Brain Training program.
At the time of presentation to APEX Brain Centers, Roger was a 70-year-old male struggling with severe balance problems, clumsiness, fatigue, and a general disinterest in life. He used to enjoy life as a family man, successful entrepreneur and golfer. Just over 10 years prior he had undergone radiation therapy for cancer that damaged his 8th cranial nerve (the balance and hearing nerve). He had also undergone prism therapies and surgery for eye position abnormalities, which have caused further insult to his ability to maintain good balance and to learn effectively. Although not listed as a primary complaint, he also suffered from significant cognitive decline in several areas as evidenced by very low to low average scores on standardized cognitive testing.
Roger sought care at APEX Brain Centers in Asheville, NC in May of 2015 and underwent an intensive course of Brain Training. He was admitted into in an individualized program directed by extensive diagnostic testing, and led by clinicians highly experienced in functional neurology. What follows is a sampling of some of the cutting-edge clinical interventions and amazing functional gains Roger experienced during his time at APEX.
Intervention for balance and cognitive decline
Roger underwent comprehensive Brain Training at a frequency of 3 times per day over the course of 15 days (with 2 days off between each for much needed rest and recovery). His brain function was carefully monitored throughout the training process with measurement of EEG brainwaves, vital signs, eye movements, balance, mental and physical timing, and more to ensure he was receiving the proper amount therapy to be effective, but not too much so as to be counter-productive. Modalities implemented included, but were not limited to: neurofeedback (NFB), Interactive Metronome, vestibular rehabilitation, metabolic/nutritional therapies, eye movement and neurological rehabilitation, whole body vibration, electrical stimulation, breathing exercises and home care recommendations.
Outcomes after Brain Training
Subsequent to his Brain Training program, Roger reported subjective improvements in the vast majority of his pre-intensive complaints. More profound than that; his wife was quoted as saying, “it’s like I have my old husband back”. She noted that he used to be the life of the party and had been slowly deteriorating over time to the point of sitting in his chair all day and sleeping more and more often. He was finally plugging back into life, putting an end to his isolation and apathy. As is demonstrated by his balance testing, he is also experiencing a renewed ability to maintain balance, allowing him to be safer and more efficient in navigating his physical environment.
Actual, measurable objective improvements recorded with post-intensive diagnostic testing include:
- Cognitive Testing: Increase in his Neurocognition Index of 48%. This is a standardized overall score of cognitive performance. Increases in various aspects of memory, attention, processing speed and more as great as 21%.
- Interactive Metronome: 56% improvement in task average with motor timing, and normalization of hyper-anticipatory timing tendency with motor tasks (i.e. responding prematurely to a pre-set reference tone).
- Computerized Assessment of Postural Stability (CAPS): 20.5% improvement in balance on an unstable surface with eyes closed – bringing him from severe to mild reduction in balance compared to his peers. Elimination of a posterior center of pressure (CoP); significantly reducing his risk of falling backwards.
- Videonystagmography (VNG): Significant improvements in numerous aspects of oculomotor (eye movement) functionality including: gaze holding, slow and fast eye movements, optokinetic responses, and spontaneous/involuntary eye movements.
With an alarming increase in the number of baby boomers and seniors experiencing balance issues and cognitive decline (that are in fact related), it is important to recognize the symptoms of these potentially debilitating disorders and, more importantly, that something can be done about them. Early intervention is key, as the longer one waits and the more function is lost, the more difficult it is to recover and have full engagement with life!
Every breath you take, every move you make (enter the distinct guitar sounds of The Police’s wildly popular 1983 hit) is controlled by your brain’s innate timing system. Whether physical movements or production of thoughts, your brain’s ability to time these magical feats appropriately is the difference between unnoticed normal everyday functioning and disastrous consequences.
Most can relate to the impact timing has on the way we move. We’ve all seen someone with Parkinson’s disease or brain injury, or simply decline in function with aging, struggle with what most of us take for granted (i.e. walking, tying shoes, speaking, etc.). Our ability to effortlessly time movement is taken for granted… Until that ability is lost.
On the other hand, it might be a bit more difficult for one to consider that the disorganized thoughts of those with schizophrenia or similar conditions has anything to do with timing. This is in fact a growing area of research where disorganized or uncoordinated thoughts are being related to uncoordinated motor activity such as walking and speech. When movements are improved through various types of physical training, individuals experience more efficient thought processing and communication of these thoughts. Through this lens it is quite easy to see how our thoughts, and even emotions, can be impaired by improper mental timing.
Can I improve my brain’s timing???
Musicians, dancers and other athletes would tell you… Absolutely! Simply involving yourself in activities that revolve around a regular beat or rhythm (cadence) will help to strengthen your mental timing ability. The obvious here would include activities such as music and dance.
But what if there are problems with my brain???
Previously mentioned brain injury and Parkinson’s disease would be natural barriers to improving timing in the brain. Studies also show that key physical abilities (bio-markers) such as balance and eye movements are impaired in those experiencing cognitive decline with aging. Challenges in these and other abilities will undoubtedly have an impact on our ability to improve timing. Addressing the physical and metabolic aspects of these conditions would be the logical first step in improving mental timing in any situation. For those with severe impairment, and for those looking to be the best they can be, there are other options.
Can my mental timing be measured and improved???
Fortunately, yes! With sophisticated measurement and training tools such as the Interactive Metronome, those with neurological conditions and peak performers alike can have their brain’s timing measured quite accurately. This particular program utilizes auditory (sound) cues to first measure and then train one’s mental timing capacities. Through matching body movements to a standardized metronome beat, the computer software can determine (down to the millisecond) how accurately one is timing. Numerous aspects of timing can be measured including early and late timing tendencies, left vs. right side of body differences, upper vs. lower body timing differences, consistency in timing from one beat to the next, and much more. Armed with this information, experienced clinicians such as those at APEX Brain Centers in Asheville, NC can design and deliver specific Brain Training programs to repair the deficient timing issues to the highest degree possible.
What does this all mean for me???
With intact and efficient mental timing our risk of injury due to falling decreases… Thought processing and problem solving become more efficient… Attention and focus get sharper… Memory formation and retrieval becomes much easier… Certain unwanted behavioral traits improve… Academics and test taking require less effort and produce less anxiety… Our limits of physical performance can skyrocket…
I believe you get the point. There are few aspects of humanism that are not positively impacted by an improvement in our brain’s innate timing abilities. Go exercise that rhythm – your brain will thank you!
You may often ask yourself, “Does my ability to maintain healthy balance have anything to do with how well I think, remember, and solve problems?” Well, maybe that exact thought (or anything close to it) has never actually crossed your mind, but it very well should. Assessment and treatment of impaired balance is being looked at as the “Holy Grail” for higher level thinking by many experts in the brain world!
The Benefits (and Consequences) of Bipedalism
Our ability to stand on two legs is nothing short of remarkable. Becoming bipedal is possibly our greatest feat as human beings. Balancing on the stilts we call legs requires a tremendous amount of brainpower. And walking, that’s an even greater accomplishment! Then why isn’t everyone talking about this? While standing, and even more so while walking, we are constantly in a state of falling. Think about this, when someone’s brain is “offline” due to alcohol consumption, disease, or simply waking up from a deep sleep, they have a dramatic increase in their likelihood of falling.
Our brain requires constant and precise input from the many sensory receptors located in our eyes, inner ears (vestibular system), and muscles and joints (proprioceptive system). Any damage to these systems, or changes in our brain’s control over these systems, will lead to measurable changes in our ability to balance and walk. It works both ways.
The Connection Between Balance and Cognition
Now that you understand the very basic connections between the brain and our ability to maintain balance, you can begin to see why it is essential to maintain healthy balance. Bipedal locomotion (walking on two legs) has long been associated with our larger and more complex human brains. From our early ancestors’ rudimentary tool making abilities to our descendants’ possibilities of inhabiting other planets in the future (for better or for worse), only humans are capable of generating the cognitive power to do such things. As much as I love my dogs, I cannot see them ever being able to sit and type an article as I sit to type this one (that is, at least while they remain on four legs)!
Over the past several decades, the research has been accumulating to support the fact that our ability to move through our environment (spatial navigation) is directly related to our ability to learn and remember. A groundbreaking paper published in the Journal of Vestibular Research, Does Vestibular Damage Cause Cognitive Dysfunction in Humans, demonstrates that the degree of damage to the vestibular system is directly correlated to changes in the hippocampus, which is a key component of memory and higher cognitive function.
A more recent paper published in the journal Stroke entitled Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline discusses the irrefutable link between poor balance, cognitive decline, and small blood vessel disease in the brain. Subjects that had a reduced ability to stand on one leg were clearly shown to have lower cognitive functions of memory and spatial awareness. The lead author of this study urged that those with postural instability (impaired balance) should receive special attention as they may be at greater risk of cognitive decline.
Noted in an article entitled Poor Balance Tied to Small-Vessel Disease, Cognitive Decline by Pauline Anderson on Medscape referencing the above-mentioned paper was the simple neurological observation of people’s ability to “rise, stand and walk” as “the single most important part of entire neurologic examination.” This was quoted from Dr. Jose Biller from Loyola University’s Department of Neurology. As with any general observation test, if someone is unable to “rise, stand and walk” they are clearly in moderate to advanced stages of balance impairment, and, very likely, moderate to advanced stages of associated cognitive decline. More sophisticated testing of balance is required to pick up abnormalities long before they are visible.
Dynamic posturography, or computerized assessment of postural systems, is the gold standard for measuring such abnormalities. Testing of eye movements with videonystagmography (VNG) and neurological evaluation of muscles and joints will help determine if the associated systems of balance are impaired.
Please read my blog The Importance of Early Screening for Alzheimer’s, Dementia, and Cognitive Decline to find a more comprehensive list of physical tests that can be performed.
What to Do if You Are Having Balance Problems
With early detection of balance problems, you are in the driver’s seat and have the full ability to act on repairing these abnormalities to the highest degree possible. As with anything else in your body, (or your house, your car, etc.) the longer you wait to act, the less likely you will be able to fully recover much needed function and perform at your highest ability. If you have been having problems standing or walking, make an appointment with a practitioner who specializes in balance issues for further screening as soon as possible. The better your ability to balance, the better your ability to think, so do not hesitate to get checked out!