Heads up: even among older people the brain can form new pathways

    Heads up: even among older people the brain can form new pathways

    Get your balance back

    9 May 2015

    I don’t remember with any clarity the first time I fell, just a sudden awareness that rather than being perpendicular to the floor, I was lying on it. How strange, I thought to myself. I picked myself up and dusted myself off, prodding joints as I did to see if anything was broken. It all appeared to be in order and nothing hurt. I put it down to it being early morning and the fact I was probably still half asleep.

    The second time it happened I realised something wasn’t right and although I was keen to brush it off as a coincidence, by the third time I began to worry.

    Eventually I was referred to a neurologist, who dutifully did a scan, which showed I’d had very small strokes. I’d been lucky and they had affected parts of the brain that I could do without, although I noticed that my balance was not always good. The neurologist explained that this was probably down to a combination of damage to the parts of my brain involved in fine motor control as well as a bit of a knock to my confidence from the previous falls, which had left me questioning how steady on my feet I was. There was no doubt that balance — something I’d entirely taken for granted my entire life — suddenly seemed remarkably precious. It felt as though, at the age of 68, I had been catapulted back to the vertical uncertainty of a toddler. And then, in a cruel twist of fate, I developed labyrinthitis. This is an infection of the inner ear which affects the delicate organs involved in balance. It was very unpredictable.

    My ability to balance seemed now to be, well, hanging in the balance. One minute the room would be upright and static, the next, without warning, it seemed to swirl and spin, just like I’d stepped on a merry-go-round. This did soon pass, but by then, my confidence had taken a real knock. A cataract meant that I started using a stick temporarily and, once the cataract was operated on, I found I didn’t want to give up the stick. I found myself walking more tentatively.

    All this was compounded by arthritis in the knee. Apparently this is common; people with poor balance often have multiple minor problems which on their own do not cause much impairment but which, when combined, mean that the complex set of information required to maintain balance doesn’t always get processed in the right way.

    I soon learnt that the balancing process was far more complicated than I had appreciated. The inner ear comprises bony chambers known as the labyrinth. This is divided into three parts. The first, the cochlea, is involved in hearing. It’s the other two that contain the organs of balance. These are known as the vestibular apparatus.

    The first of these concerns itself with the position of the head. It contains two fluid-filled sacs called the utricle and the saccule. Within these sacs are sensory hairs known as maculae. When the head is tilted, gravity causes the hairs to move and this creates electrical impulses which travel via the vestibular nerve to the brain.

    Spa partner: Clinique La Prairie in Switzerland is a nice place to find your feet
    Spa partner: Clinique La Prairie in Switzerland is a nice place to find your feet

    The second is concerned with the rotation of the head. It is made up of three fluid-filled loops that sit at right angles to each other, known as the semicircular canals. They are also lined with tiny hairs. When the head moves, the fluid in the canals also moves, and this is detected by the tiny hairs which also send electrical impulses to the brain. Here all this information is processed and the impulses from the different hairs in different planes allow the brain to work out the exact position of the head in space.

    In addition to the vestibular apparatus, the brain assessed balance by obtaining information from other body parts such as your eyes and specialised nerve sensors known as proprioreceptors which detect how much tension your muscles are under. With such a complicated system relying on so many sources of input, it’s easy to see how things can be disrupted.

    So, what to do? I did aqua-aerobics at a local sports centre and found that this helped. Overall, though, I was pessimistic. However, my neurologist explained that, even at my quite advanced age, the brain can change. This ‘plasticity’ means that the brain, even if damaged, can form new pathways. This gave me a sense of hope that I’d not experienced for some time. He suggested I start practising how to balance, relearning to stand and walk. He seemed to think that if I could feel more confident on my feet, then this would help my balance.

    Physiotherapy has been shown to help in people with poor balance, but it’s very limited on the NHS. As I was not acutely unwell, there was nothing available for me. I would only qualify for input if I had a fall and damaged a joint. It seemed counterintuitive — surely prevention was better and, in the long term, cheaper for the NHS?

    The real breakthrough came when I heard about a new programme to improve people’s balance and mobility at Clinique La Prairie, a private medical clinic in Switzerland. It’s located about an hour’s drive from Geneva, next to a lake and with the Alps in the near distance. I had been once before to recover from an illness, and had been bowled over by the facility. The clinic was founded in the 1930s and its guests have included Winston Churchill and Marlene Dietrich. I was interested in their programme called ‘Better Mobility’. This programme is a six-night, full-board package that offers intensive medical, physio and fitness input. In one week, they promised me, they’d improve my balance.


    An evaluation with a rheumatologist and physiotherapist at the beginning and end of the programme means they are able to see what the problems are and tailor the package accordingly, and also show you how you’ve improved and areas that still need work. My initial tests provided stark evidence for what I had suspected all along — my balance and mobility were severely impaired. Stability tests which detected small movements in my muscles and thus how stable I was when standing or walking showed that, to my horror, I was barely able to stand upright — my muscles were having to work overtime continually to correct my balance.

    While I hadn’t even been aware of the tiny adjustments I was having to make to keep myself upright, it went some way to explaining why I felt so much more confident with a stick and why I struggled to recover my balance from even the smallest trip. When I closed my eyes, the readings showed that things were even worse, and I wondered how I’d ever managed with my cataracts.

    Over the next few days I was put through my paces, undergoing rigorous testing and exercise regimes to strengthen my muscles and help me gain confidence. A timetable was devised, based upon my own specific needs. Each day I went to the impressive gym and was guided by my own fitness trainer, who was firm and gave me challenging tasks, but was infinitely patient and encouraging, never giving me an easy time, but also pushing me to achieve more than I would have deemed possible. I received physiotherapy from Malcolm each morning, which again required maximum effort from me, but I was never uncomfortable, just aware of the benefits. This is not for the fainthearted. It’s hard work. But I live on my own and before coming my poor mobility had meant I had lost the motivation to go out sometimes, and I didn’t want to return to that.

    The approach is holistic, so food requirements and any dietary restrictions are also fully considered and advice is given. The day was rounded off with a massage — again it was specific to my requirements. The medical assessment had revealed that I have a sluggish lymphatic system, so I had a lymphatic drainage massage. By the end of the week, my ankles had emerged! My legs felt lighter and more comfortable. Then I had the final medical examination with both the physiotherapist and the doctor. Every joint had improved in terms of how much I could turn it. I was delighted to touch my toes, and my neck had become positively owl-like.

    My knee, often stiff following my operation, showed a vast improvement and I appeared to have grown two centimetres. In fact I had simply improved my posture so that at last I was standing correctly, instead of slouching. The graphs showed the improvement I had made, and when I looked at them and realised how much I had progressed in such a short space of time I could not believe it. The staff were so pleased, and nothing can describe how jubilant I felt. To feel so good, and to have achieved this while breathing the pure mountain air in glorious surroundings and with smiling people at every turn. Wonderful!

    More than anything, though, it showed me that the brain is an amazing organ and that along with the body, even in older age, it can still change and adapt. To remind me of this, every morning I touch my toes, just because I now can.