Gait: sometimes it is about the ear (sort of).

We have talked on several occasions about the aging population and the high morbidity and mortality rates with falls in this population. We have discussed the eyes, dual tasking, changes in environment and many other factors that play seamlessly into normal gait, things we all take for granted. But the aging population has yet another challenge, declining function of the vestibular apparatus. We often hear about balance, and we tend to treat it without truly thinking that this is a integration of the eyes, ears and proprioceptive systems together. If you have clients with multiple falls for unknown reasons, it is time to send them for a check up of the mechanical components of the vestibular system (and visual check up as well) you should be able to do the functional vestibular assessments in your office for the most part.

Recent studies are showing significant declines in semicircular canal function in each of the canal planes as well as otolith function within the aging population. “These findings suggest that age-related slowing of gait speed is in part mediated by the decreased magnitude of saccular response associated with age. ” -Ferrucci study

While the Agrawal study suggested “an overall decline in semicircular canal as well as otolith function associated with aging, although the magnitude of impairment was greater for the semicircular canals than the otoliths in this elderly population. A better understanding of the specific vestibular deficits that occur with aging can inform the development of rational screening, vestibular rehabilitation, and fall risk reduction strategies in older individuals.”

Dr. Shawn Allen, the gait guys


Otol Neurotol. 2015 Jan 7. [Epub ahead of print]
Association Between Saccular Function and Gait Speed: Data From the Baltimore Longitudinal Study of Aging. Layman AJ1, Li C, Simonsick E, Ferrucci L, Carey JP, Agrawal Y.

Otol Neurotol. 2012 Jul;33(5):832-9. doi: 10.1097/MAO.0b013e3182545061.
Decline in semicircular canal and otolith function with age.
Agrawal Y1, Zuniga MG, Davalos-Bichara M, Schubert MC, Walston JD, Hughes J, Carey JP.