The effects of aging on the proprioceptive system

When the nervous system breaks down, there are predictable patterns that we can see. Aging isn't that much different in the grand scale of things than some neurological disorders. Here is a brief video of a gentleman that presented to us with neck discomfort and limited range of motion. Step through it several times before proceeding.

Hopefully, you noted the following:

  • Increased arm swing on the right (or, decreased on Left)

  • Pelvic shift to the left on Left stance phase

  • Decreased step length on the left

  • Hip hike on Left during Right stance phase


The patient DOES NOT have a leg length deficiency.

We remember that there are 3 systems that keep us upright in the gravitational plane:

1. vision
2. vestibular system

3. proprioceptive system

We also remember that as one of these systems become impaired, the others will usually increase their function to help maintain homeostasis. All these systems are known to decline in function with aging. So we have 3 systems breaking down simultaneously.

Did you also note the head forward posture, to move the center of gravity forward? How about the subtle head tilt to the right and “bobble” right and left? Motions which have to do with the head are functions of the vestibular system. He is attempting to increase the input to these areas (by exaggerating movements) to increase input.

How about the glasses? Presbyopia (hardening of the lens) makes it more difficult to focus. Movement (detected largely by rods in the eyes have a much higher density than cones, which are for visual acuity). By moving the head, he provides more input to the visual (and thus nervous system)

Amplified extremity movements provide greater input to the proprioceptive system (muscle spindles and golgi tendon organs (GTO’s), as well as joint mechanoreceptors).

Think of the cortical implications (and effects on the cerebellum, the queen of motor activity and important component for learning). You are witnessing the cognitive effects of aging playing out on the ability to ambulate and its effect on gait.


So what do we do?

  • Improve quality of joint motion, whether that is mobilization or manual methods to improve motion where motion is lost. Perhaps acupuncture to help establish homeostasis and improve muscular function. There are many options.

  • Postural advice and exercises

  • Core work

  • Proprioceptive exercises (like head repositioning accuracy, heel to toe and heel to shin)

  • Gait retraining


You get the idea. Providing some of that increased input for him and helping the system to better process the information will be the key to improving his function and helping to counteract and maybe slow the effects of aging on the locomotor system.

We are the Gait Guys; giving you the info so we can all make a difference, every day


We will be talking about some principals of proprioceptive rehabilitation along with 2 cases of neurological disorders Wednesday evening for our "3rd Wednesdays" talk on online.com: Biomechanics 321. 5 PST, 6MST, 7CST, 8EST

Special thanks to RM, who allowed us to use this video for this discussion.

Better gait = better cognition = Better gait

use it or lose it....

"This study demonstrates that cognitive flexibility is associated with walking, in particular under challenging walking conditions, in a cohort of older adults without relevant motor and cognitive deficits. We also demonstrated that older individuals with poor cognitive flexibility use a pattern in variability-related gait parameters across walking conditions that differs from individuals with good cognitive flexibility. This difference might indicate a lower capability of the former population to adapt to challenging walking situations with different demands. Our findings add relevant information to our understanding of gait and balance deficits in older adults with poor cognitive flexibility and may give a basis for interventional studies."

 

FREE full text available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442228/

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

References:

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.

Proprioceptive effects of aging: It’s all in the details

Here is a brief video of a gentleman that presented to us with neck discomfort and limited range of motion. Step through it several times before proceeding.

Hopefully, you noted the following:

Increased arm swing on the right (or, decreased on Left)

Pelvic shift to the left on Left stance phase

Decreased step length on the left

Hip hike on Left during Right stance phase

The patient does not have a leg length deficiency.

We remember that there are 3 systems that keep us upright in the gravitational plane:

1. vision

2. vestibular system

3. proprioceptive system

We also remember that as one of these systems become impaired, the others will usually increase their function to help maintain homeostasis. All these systems are known to decline in function with aging. So we have 3 systems breaking down simultaneously.

Did you also note the head forward posture, to move the center of gravity forward? How about the subtle head tilt to the right and “bobble” right and left? Motions which have to do with the head are functions of the vestibular system. He is attempting to increase the input to these areas (by exaggerating movements) to increase input.

How about the glasses? Presbyopia (hardening of the lens) makes it more difficult to focus. Movement (detected largely by rods in the eyes have a much higher density than cones, which are for visual acuity). By moving the head, he provides more input to the visual (and thus nervous system)

Amplified extremity movements provide greater input to the proprioceptive system (muscle spindles and golgi tendon organs (GTO’s), as well as joint mechanoreceptors).

Think of the cortical implications (and effects on the cerebellum, the queen of motor activity and important component for learning).  You are witnessing the cognitive effects of aging playing out on the ability to ambulate and its effect on gait.

 So what do we do?

Improve quality of joint motion, whether that is mobilization or manual methods to improve motion where motion is lost. Perhaps acupuncture to help establish homeostasis and improve muscular function. There are many options.

Postural advice and exercises

Core work

Proprioceptive exercises (like head repositioning accuracy, heel to toe and heel to shin)

Gait retraining

 You get the idea. Providing some of that increased input for him and helping the system to better process the information will be the key to improving his function and helping to counteract and maybe slow the effects of aging on the locomotor system.

We are the Gait Guys. Two geeks, giving you the info so we can all make a difference, every day

Special thanks to RM, who allowed us to use this video for this discussion.


Copyright 2012 , The Gait Guys/Homunculus Group

Materials and content cannot be used, copied or distributed without proper author credit /reference or without prior written consent.