The problem of falling

Falling  can occur due to vestibular disease, but also happens in normal people.  Humans stand on two feet, which is much less stable than the four-footed mobility of most animals.  To master this, we had to develop a tight system of reflexes and feedback to our balance system.   There are three critical areas:

1) The vestibular system of the inner ears and brain.  This keeps your brain informed about any head movements that occur and sends out appropriate reflexes to the eyes and body.

2) Vision, including 3-D vision and visual tracking.  Vision overlaps with the inner ear in keeping track of head movements. It also gives feedback if vision is blurred by movement that helps fine-tune the reflexes.

3) Sensation, strength and mobility in the legs and feet.  The arms, hands and neck are also part of this system.  These body parts need to be able to respond smoothly and quickly to the reflex information being sent to the balance system and give feedback about the ground or environment that is conveyed by touch and position sensors.

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How are imbalance and dizziness connected?

When a person has a dizziness disorder, they will often feel off balance when on their feet.  Imbalance  or unsteadiness can be as simple as  just feeling “off”, or slightly uncertain of your balance.  As imbalance worsens, you might begin to fear that you will fall, and you may bump into doorways or have to touch counters in the house to steady yourself.  A more severe imbalance can cause you to stagger from side to side when walking or have to walk with your feet wide apart to maintain balance.  Most people will start using support aids like a cane or walker when this stage is reached.  In the most severe cases, you might be unable to walk unless someone is physically holding you up.   People with this very severe imbalance will be confined to a wheelchair or their bed.

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Dizziness: Video camera vision

The inner ears are busy sensors.  We depend on them for hearing, they let us feel motion sensations, and they help control balance.  One of the most important things they do is something most people aren’t aware of:  they keep the eyes focused while we are in motion.

Imagine playing a game of ping pong.  You have to keep your eyes on the moving ball while at the same time you jump back and forth to intersect it for your shot.  This requires two major systems that control eye movements to be perfectly coordinated.

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