Posted by: seattledizzygroup | December 31, 2018

Choosing Positivity Despite Chronic Illness

Something Good in Every Day quote

Strategies for Having a Positive Outlook While Chronically Ill

Living with chronic illness is a struggle, but focusing on the positive can help lower stress, increase ability to cope with symptoms, and improve overall quality of life.

Every day may not be good, but there is something good in every day! Practice looking for something positive in each day, even if some days you have to look a little harder.

These articles discuss the benefits of choosing positivity and offer strategies for having a positive outlook despite chronic illness:

The Power of Positivity: How to Maintain a Positive Attitude While Dealing with a Chronic Illness

5 Steps to Find the Bright Side When Coping with Illness

Keeping a Positive Outlook When Dealing with Chronic Illness

5 Tips for Staying Positive Despite Chronic Illness

10 Ways to Be Happier Despite Chronic Illness

The Brighter Side of Living with Chronic Illness: 6 Amazing Things You Know Better Than Most

Turning Negatives into Positives When You’re Chronically Ill

Mental Contrasting: A Smart Alternative to Positive Thinking

Seeing with New Eyes: How to Find the Good in Every Day


Post Updated January 2019.

© Copyright 2018, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | November 30, 2018

Advancements in Restoring Balance & Hearing with Prostheses

Cochlear implant

Treating Chronic Vestibular & Hearing Loss with Cutting Edge Implanted Devices

by James Phillips, PhD

Director of the Dizziness & Balance Center at University of Washington Medical Center 

 (Presented to Seattle Dizzy Group on 11/10/18)

This presentation gives an overview of vestibular and auditory prostheses including how the University of Washington Medical Center is currently evaluating these cutting edge implanted devices which will hopefully help to improve the quality of life for many with chronic vestibular and hearing loss.

What is the Vestibular System?

  • The vestibular system includes the structures in the inner ear that contribute to balance and orientation.
  • It includes the nerves that relay balance and orientation information from the inner ear to the brain.
  • It includes the neurons in the brain that make sense of that information, by combining information from a variety of sources:
    • different parts of each inner ear
    • from both ears
    • from the visual system
    • from the muscles and joints

Balance System

What Parts of the Inner Ear are Parts of the Vestibular System?

  • Semicircular canals
    • Posterior canal
    • Lateral canal
    • Anterior canal
      • Detect turning
  • Otolith organs
    • Utricle
    • Saccule
      • Detect front-back, right-left, up-down
      • Detect tilt
  • Vestibular Ganglia

The Internal Ear

What are the Semicircular Canals?

  • 3 canals (posterior, lateral, anterior)
  • Orthogonal
    • Fluid filled
  • Ampula
    • Location of hair cells.  (Our sense of balance starts with hair cells!).
      • Like the hair cells in the cochlea for hearing
    • Neural transduction
      • Convert movement into neural signals

How Do the Semicircular Canals Work?

  • When you turn your head fluid moves in the semicircular canals.
  • Each ampula contains a cupula, which billows when the fluid moves, which in turn bends the hairs of the hair cells.
    • Gelatinous tongue
    • Embedded hair cells
    • Sense rotational acceleration

How Do the Otolith Organs Work?

  • The otolith organs contain a gelatinous cap (otolithic membrane) and otoliths (otoconia, calcium carbonate crystals).  They also contain hair cells.
  • When we slide or tilt, the gelatinous cap deforms, and the hairs of the hair cells bend.
    • Shear
    • Sense of tilt and linear acceleration

Otolith Organs

What Happens When the Inner Ear Vestibular System Fails Bilaterally?

Both ears fail to work:

  • No whirling vertigo
  • Significant Disorientation
    • Swimmy headed feeling
  • Nausea and fatigue
    • Conflicting sensory input
  • Anxiety
  • Cognitive Impairment
  • Oscillopsia
    • Failure to stabilize your eyes when you turn your head
    • The visual world moves when you move
    • Reduces your vision
  • Postural and Gait Instability

Is There Compensation for Inner Ear Vestibular Loss?

  • YES
  • Over time we can compensate well for vestibular loss
    • Especially true of children
    • Our brains are designed to adjust for loss of input
  • Compensation is dependent on learning:
    • not to misinterpret sensory cues from a non-working vestibular system
    • to use contextually appropriate cues
    • to develop a general strategy that is adaptive over a range of situations
    • to substitute useful information from other sensory systems:
      • Somatosensory System
      • Visual System
  • Compensation requires sensory stability
    • Defeated by change of fluctuation

Can We Replace the Inner Ear Vestibular System?

Yes, with a vestibular prosthesis!

Vestibular Prosthesis

Who Could Be Treated with a Vestibular Prosthesis?

  • Not patients with a single acute transient loss of function.
  • Patients with bilateral loss of balance function.
    • Often iatrogenic
      • Exposure to ototoxic drugs
  • Patients with uncompensated unilateral loss of balance function.
    • Large numbers of patients do not adapt to a loss from one ear
  • Patients with fluctuating balance function.
    • Meniere’s Disease
      • Extreme intermittent vertigo
        • Destructive therapy
          • Injected ototoxin, surgical ablation, nerve section
          • These devices would take the place of a labyrinthectomy
  • Usher Syndrome patients:
    • Bilateral loss of balance dysfunction
    • Combined with hearing loss
      • Usher Syndrome patients may already have inner ear implants (cochlear implants for hearing loss).
    • To effectively treat Usher Syndrome vestibular loss requires a combined vestibular and auditory implant.

UWMC Road to Human Trials

  1. Design a device to stimulate vestibular afferent fibers.
    • Leverage a highly developed existing technology
      • Cochlear implant
    • Modify the software and hardware
      • Create a minimally invasive electrode technology
      • Create appropriate stimulation strategies
        • FM not AM
    • Partner with an existing Cochlear Implant manufacturer
  2. Develop a simple surgical approach with the right target.
    • Three semicircular canals
      • Coherent rotational information
  3. Construct prototype devices.
    • Identical to the final production device

UWMC Road to Clinical Trials

  1.   Evaluate the device in animal model.
    • Implanted devices in 14 rhesus monkeys
      • Similar inner ear anatomy to humans
      • Test in intact and lesioned animals
        • Ideal model for unilateral and bilateral loss
      • Evaluate risk
        • Longitudinally evaluate inner ear function
          • Using identical clinical tests to those that are used diagnostically in humans
      • Evaluate efficacy
        • Longitudinally evaluate prosthetically elicited function
          • Using clinically relevant behavioral and physiological measures
  2. Test the device in human patients with vestibular loss.
    • In 4 Meniere’s Disease patients
      • Can the device restore vestibular function lost from the destructive treatment?
  3. Modify our devices to create a combined cochlear and vestibular prosthesis.
  4. Test the new device in rhesus monkeys.
  5. Modify our existing FDA IDE to test patients with hearing and vestibular loss with the new combined implant.
  6. Test the new device in human patients with combined hearing and vestibular loss (2 additional patients, 6 total).

Turning the Implanted Device On

  • Electrical stimulation with biphasic pulse trains
  • Produces:
    • Eye movements – eVOR (Vestibulo-Ocular Reflex)
    • Body sway
    • Sensation of motion
  • Effective vestibular stimulation does not produce:
    • Nausea
    • Pain
    • Sound sensation
    • Facial nerve activation

UWMC Research Team Conclusions

  • We know that a vestibular implant works!
  • We have tested such a device in animals and humans.
  • We have an existing approval to test these devices in patients.
  • We have built a combined vestibular and cochlear implant.
  • We are currently testing it in monkeys.
  • We are working with the FDA to modify our existing human trial to test this new device.
  • We are not the only ones doing this!  (John Hopkins is researching similar implanted devices).

*This material regarding vestibular and auditory prosthetic technology is the intellectual property of the members of the device research team, the University of Washington, and Cochlear Ltd.*

More Information:

Conquering Vertigo article by James Phillips, PhD


James Phillips PhD UWMC

James Phillips, PhD

Director of the Dizziness & Balance Center

University of Washington Medical Center

James Phillips, PhD, joined the faculty at the University of Washington in 1998 and is currently a research associate professor in the Department of Otolaryngology-Head and Neck Surgery. He is also the director of the Dizziness and Balance Center at the UW Medical Center, the Vestibular Diagnostic Laboratory at UWMC, and the Roger Johnson Clinical Oculomotor Laboratory in the Division of Ophthalmology at Seattle Children’s Hospital. Prior to joining UW, he earned a PhD in psychology and in physiology from the University of Washington. Dr. Phillips teaches in the Departments of Otolaryngology-HNS, Ophthalmology, and Speech and Hearing Sciences. He is a faculty research affiliate of the National Primate Research Center, the Virginia Merrill Bloedel Hearing Research Center, the Center on Human Development and Disability, and the Autism Center at the University of Washington. He is also a faculty affiliate of the Center for Navigation and Communication Sciences at the University of Rochester and the Center for Integrative Brain Research at Seattle Children’s Research Institute. He is on the Medical and Scientific Advisory Board of the Vestibular Disorders Association.

More information:


Presentation information is not meant to be taken as medical advice.

Presentations posted online may include discussion notes, links, images, and other information added by Seattle Dizzy Group.


© Copyright 2018, Seattle Dizzy Group. All rights reserved.


Posted by: seattledizzygroup | October 31, 2018

Chronic Illness Dilemmas

Dilemma Question 3.png

Strategies for Making Decisions with Unpredictable Health

It can be challenging to make decisions with unpredictable health.  The uncertainty of fluctuating symptoms and fatigue makes it difficult to plan ahead and keep commitments.  A common dilemma for the chronically ill is when to say “yes” to making plans and when to say “no” to invitations.  It is important to practice self care and pacing, consider the opportunity costs and possible health impact of activities, and try to find a good balance between pushing yourself sometimes and also knowing your limits.

These articles offer suggestions for common chronic illness dilemmas:

“Should I or Shouldn’t I?” The Dilemmas of Chronic Illness

6 Things to Do Before You Say “Yes”

10 Questions to Ask Yourself Before You Say “Yes”

Sometimes Saying “No” Isn’t An Option

How Chronic Illness Fans the Flames of Uncertainty


© Copyright 2018, Seattle Dizzy Group. All rights reserved.
Posted by: seattledizzygroup | September 30, 2018

Take Steps to Prevent Falls


Falls are Preventable!

The vestibular system deteriorates as we age, and as a result many older people begin to feel unsteady.  Dizziness is a common symptom affecting about 30% of adults over the age of 65 and 1/3 of adults over age 65 fall each year.  Falls can take a serious toll on seniors health, quality of life and independence.  However, falls are NOT a normal part of aging and are preventable!

More information:

The first week of Fall each year is Falls Prevention Awareness Week with the goal of raising awareness about how to prevent falls among older adults.

Falls Prevention Steady as You Go VeDA infographic 2018

Falls Prevention Resources:

Balance and Aging VeDA Article

Balance and Falls in the Older Adult VeDA Article

Falls Prevention Fact Sheet

NCOA List of Falls Prevention Articles


© Copyright 2018, Seattle Dizzy Group. All rights reserved.


Posted by: seattledizzygroup | September 25, 2018

Balance Awareness Week Did You Know Facts About Vestibular Disorders

Help Raise Awareness For Vestibular/Balance Disorders Beyond Balance Awareness Week!

Every September, the Vestibular Disorders Association celebrates Balance Awareness Week to raise awareness and increase understanding of vestibular/balance disorders which are debilitating yet may seem “invisible” to others, and help improve the quality of life of millions of people world-wide who are living with chronic dizziness and imbalance.  Find out how you can get involved and help “Defeat Dizziness” at

As a part of Balance Awareness Week 2018, the Vestibular Disorders Association launched a “Did You Know” online campaign with facts about vestibular/balance disorders.  Share this information to help raise awareness beyond Balance Awareness Week!

Did You Know?

  • 35% of adults aged 40 years or older have experienced some form of vestibular dysfunction.
  • Vertigo from a vestibular problem accounts for 1/3 of all dizziness and vertigo symptoms reported to healthcare professionals.
  • 80% of people with vertigo have an inner ear disorder.
  • Vestibular disorders affect more Americans than type II diabetes, asthma, fibromyalgia and celiac disease combined.
  • Dizziness is a common symptoms affecting about 30% of people over the age of 65.
  • On average, a vestibular patient sees 5-7 doctors before being diagnosed.
  • Your body uses your vision, sense of touch and inner ear to help you maintain balance.
  • Just getting out of bed can be difficult when you have an inner ear disorder.
  • Inner ear disorders overload your brain, making it hard to think, speak, or read.
  • Some people with inner ear disorders appear drunk when they walk and slur their speech.
  • Lying back, such as at the dentist or hairdresser, can cause the crystals in your inner ear to fall out of place, causing spinning vertigo.
  • Grocery stores, restaurants, move theaters and large crowds can be difficult environments for someone with a vestibular disorder.
  • Social events can be too loud and busy for vestibular patients.
  • Inner ear problems can lead to social isolation, anxiety and depression.
  • Vestibular disorders can cause or worsen anxiety, depression, migraines and pain.
  • Inner ear problems can trigger the “fight or flight” response, causing a heightened state of anxiety.
  • “But you look fine!” doesn’t mean you are fine.
  • Your pet can have inner ear problems, too.


Click to download PDF: Vestibular Disorders An Overview VeDA Infographic


Click to download PDF: Causes of Dizziness and Vertigo VeDA Infographic

See also:  Vestibular Disorders An Overview Article

To learn more about vestibular and balance disorders, visit:


Balance Awareness Blog Posts:

Raise Balance Awareness

Balance Awareness Facts, Figures & Trivia

Balance and Falls Prevention Awareness

A Balancing Act: Improving Balance and Preventing Falls

Exercise & Tai Chi Moving for Better Balance

*How Seattle Dizzy Group is Making a Difference for Balance Awareness*


© Copyright 2018, Seattle Dizzy Group. All rights reserved.


Posted by: seattledizzygroup | August 31, 2018

How to Respond to Comments about Chronic Illness


Ways to Handle Remarks about Being Chronically Ill

It can be challenging to know how to deal with comments about chronic illness.  Likewise, it can be difficult for friends and family to know what to say and what not to say to a loved one who is chronically ill.

These articles offer suggestions for those living with chronic illness as well as helpful tips for friends and family:

How to Respond to Unkind Remarks When You’re Chronically Ill

4 Tips for Dealing with Unsolicited Health Advice

When Your Friend is Ill The Right Words are a Blessing

12 Comments that Would be Welcomed by the Chronically Ill

What Those with Chronic Illness DO Want to Hear

  10 Things You Should Say to Someone with a Chronic Illness

15 Things Not to Say to Someone with a Chronic Illness

What Those with Chronic Illness DON’T Want to Hear

What the Chronically Ill DON’T Want to Hear (Part 2)


© Copyright 2018, Seattle Dizzy Group. All rights reserved.

Post updated September 2018.

Posted by: seattledizzygroup | July 31, 2018

Strategies to Combat Motion Sickness

Motion Sickness Road

Ways to Prevent & Treat Motion Sickness

Traveling can be a fun adventure, but may unfortunately bring on motion sickness—especially for those living with a chronic vestibular disorder.

Motion sickness occurs when the body systems that make up the vestibular (balance) system, the inner ear, eyes and receptors located throughout the body that can sense movement (proprioception), lose sync with one another. This “sensory mismatch” is often caused by riding in a car, boat, airplane, or riding a novelty ride at the carnival. It can however be caused during any other activity that involves motion.

Dizziness is the main symptom associated with motion sickness and may be accompanied by a variety of other symptoms including  nausea, vomiting, fatigue, cold sweats, headache, etc.

A sensory mismatch also occurs in certain inner ear disorders, producing the same symptoms. For example, in Meniere’s Disease, fluid pressure in the inner ear can give a false cue to the brain that the body (or the room) is spinning, but vision and the pressure on the feet indicate otherwise. The resulting nausea is similar to being sea-sick.  In Benign Paroxysmal Positional Vertigo (BPPV), abnormal particles in a semicircular canal cause currents when the head is tilted, creating a false cue of spinning.  This can result in a loss of balance because of disorientation, and nausea because of the sensory mismatch.

(Sensory Mismatch information from vestibular expert Dr. John Epley’s

Luckily, motion sickness from travel adventures is usually temporary.  However, in rare cases motion sickness may persist long after travels.  Mal de Débarquement Syndrome (MdDs) or Disembark­ment Sickness is a rare neurological disorder (also considered a balance disorder though not resulting from an inner ear disorder) that most often develops following an ocean cruise but may occur after any type of travel or even spontaneously.  The characteristic symptom of MdDs is a persistent sensation of motion (such as rocking, swaying, bobbing, etc.).  MdDs is a life-altering condition which may be quite disabling and may persist for years.

(MdDs information from

Helpful Articles:

Dizziness & Motion Sickness

Motion Sickness

Motion Sickness: Causes, Symptoms, and Treatments (Vision Therapy)

7 Things You Didn’t Know About Motion Sickness

Why You Get Car Sick: Your Brain Thinks It’s Being Poisoned

How to Prevent Motion Sickness + Natural Treatments

Preventing and Treating Motion Sickness

10 Tips to Prevent Motion Sickness

10 Ways to Combat Motion Sickness (from a Life-Long Sufferer)

Natural Remedies for Motion Sickness

Vertigo, Dizziness, Disequilibrium: Battling Chronic Nausea

Mal de Débarquement Syndrome

Summer Survival Strategies

Traveling with Dizziness (Adventures in “Dizzyland”)


© Copyright 2018, Seattle Dizzy Group. All rights reserved.


Posted by: seattledizzygroup | June 30, 2018

Soak Up the Sun for Vitamin D

soak up sun 4

Enjoy the Summer Sunshine for Better Health

Vitamin D is an essential nutrient which we get from food as well as from sun exposure (which is why it is often called the “sunshine vitamin”).

There are many health benefits of Vitamin D and it plays an important role in vestibular disorders and other chronic illnesses.  For example, recent studies have suggested higher Vitamin D levels may decrease the frequency and severity of Benign Paroxysmal Positional Vertigo and migraines.  Vitamin D may also help with reducing chronic fatigue and inflammation as well as managing autoimmune disease.

Just 15 minutes of noontime summer sun exposure on the hands, arms, and face will provide a person the equivalent of 1,000 IU of Vitamin D.  (Skin should turn the lightest shade of pink, but be careful not to get sunburned).  If we soak up enough sunshine in the summertime, the excess Vitamin D is stored and can be used during the gray winter months.  So, get outside and enjoy sunny summer days for better health all year!

Most people have low or less than optimal Vitamin D levels.  Those who are at higher risk of deficiency or insufficiency, including the elderly and those with chronic illness, should have their Vitamin D levels routinely checked and supplement if necessary.

More Information About Vitamin D:

Let There Be Light: The Importance of Sunshine

7 Signs You May Have a Vitamin D Deficiency

How Much Vitamin D  to Take for Optimal Health?

The Relationship Between Vitamin D and Vertigo

Decreased Serum Vitamin D in Idiopathic Benign Paroxysmal Positional Vertigo

New Study Finds Low Vitamin D Levels May Be Related To Migraines

Vitamin D and Autoimmune Disease

See Also:

Summer Survival Strategies


© Copyright 2018, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | May 31, 2018

Gentle Yoga for Improving Balance


Gentle Yoga

Easy Modified Yoga for Those with Chronic Dizziness & Imbalance

by Bev Holstun

Yoga Instructor

 (Presented to Seattle Dizzy Group on 5/12/18)

This presentation discusses how practicing yoga and deep breathing meditation can help increase mindfulness, relieve stress and anxiety, and improve balance and well-being.  Many Gentle Yoga stretches and Restorative Yoga poses are appropriate for those with chronic dizziness and imbalance.  (Try easy, modified exercises which can be done from a seated or supported position to accommodate postural limitations and restricted head movement).


Yoga is a 5,000-year old scientific technique for spiritual development. Yoga is a Sanskrit word meaning “union”, thus its goal is the unification of body, mind, and spirit. Because the science of yoga is so old, it has developed many paths toward obtaining the goal of union. This state of union is called samadhi or enlightenment, where we experience the unity of not just our mind-body-spirit, but experience the whole universe as one interconnected whole.

Yoga is not a religion, but a scientific methodology of the experience and integration of the mind, body, and spirit. Yoga is a toolbox for spiritual, mental, and physical health and well-being.

Hatha Yoga

Hatha Yoga (ha=”sun” tha=”moon”) attains this union though a balanced practice of Astanga, the eight limbs of yoga:

(1) Yama – restraints or ethical practices: Ahimsa (nonharming), satya (truthfulness), asteya (nonstealing), bramacharya (abstaining from sensual indulgence), and aparigraha (nonpossessiveness)

(2) Niyama – observances:  Saucha (purity), santosa (contentment), tapas (discipline), svadhyaya (self-study), and isvara pranidhana (surrender to God)

(3) Asana – the physical postures/exercises

(4) Pranayama – breath awareness and control

(5) Pratyahara – inner focus

(6) Dharana – concentration

(7) Dhyana – meditation

(8) Samadhi – absorption

The integration of these practices helps one to develop self-awareness.

Asana is the foundation for this practice and is often practiced alone as a method of holistic exercise, stress reduction, and/or healing.

Yoga Asanas

Asanas are the yoga postures, the physical poses held in Hatha yoga.  Each asana should be steady and comfortable, firm and engaged yet relaxed. There are thousands of yoga asanas that have been developed over the centuries.


Pranayama are breathing exercises developed by the ancient yogis for purification. Prana translates into “life force energy” and Yama translates into “control or mastery of”. Thus, Pranyama is used to control, cultivate, and modify the Prana in the body. Prana is taken in through the air we breathe, and since the Pranayama exercises increase the amount of air we take in, we increase the intake of Prana.

For most Pranayama, the breath is slow and steady, breathed in and out of the nose and down into the belly. Always sit with a straight spine and a relaxed body. While you are practicing Pranayama, let go of any thoughts by focusing on the breathing involved with the Pranayama.

Deep breathing practice:  Gradually lengthen your exhale breath 1-3 beats longer than your inhale breath to activate the parasympathetic nervous system and promote greater relaxation.

Benefits of Hatha Yoga

Relaxation: yoga exercises: gentle stretching, breathing, meditation and guided relaxation calms the nervous system, emotions and releases body tension.

Concentration: focus, attention and concentration are promoted by a yoga practice of mindful movement and body awareness. The practice of balancing postures especially builds concentration.

Toning: holding yoga postures creates isometric exercise, which tones every part of the body, including the internal organs.

Healing: yoga exercises the glands, organs and endocrine system; massaging toning and increasing circulation to stimulate, heal, and eliminate toxins from the body.

Flexibility: yoga postures gently stretch the muscles in the body, increasing the flexibility and lengthening the muscles, tendons and ligaments.

Nourishing: slow gentle movements with deep breathing energize the body rather than tire it. This, combined with relaxation and yoga’s healing benefits, allows daily renewal and nourishment of the body-mind-spirit.


The sound Om was discovered by the ancient yogis to be the vibrational sound of the universe. By chanting this sound, you can connect with this vibration and hence feel connected to the oneness of the universe.


Namaste is a Sanskrit word that does not have an English equivalent. So we usually translate it something like this: “I honor/acknowledge the divine/spirit/light/god within you”. I like to use the words of Thich Nhat Hanh “I bow to you, a Buddha to be”. Like yoga, it’s more about the feeling of the word rather than the mental “meaning”.

Guidelines for Yoga

  • If possible, don’t eat for at least 2 hours before coming to class.  Practicing on an empty stomach will increase your flexibility, concentration, and strength.
  • Always do yoga barefoot. Your feet will stick better to the mat if your socks and shoes are off.
  • Always seek out a position that feels good!  If you feel awkward in a pose of if you feel pain, you are probably forcing the pose.  While doing yoga stretches, seek out gentle releases.  When you are in a pose that requires strength and stamina, pace yourself by paying attention to your breath.  When the breath shortens or must be taken through the mouth, you need to rest.
  • Remember that your lungs are like muscles: they need to be stretched gradually.  If the breath work makes you dizzy or hurts your chest, return to normal breathing.
  • The flexibility of the muscles and the energy level of our bodies change daily.  Never approach a pose without first checking in to how your body is feeling at that particular point in time.
  • You should always stay away from any sharp physical pain.  Work close to your limit (your edge) without going past it.  Create an awareness and understanding of it, but don’t plow into it.
  • Always feel free to come out of a pose before the rest of the class.  Your body is the first voice you should listen to.  The teacher is the second voice you should listen to.  Try not to listen to your ego at all.
  • Yoga is designed to open up the body so that it stands tall, feels positive, and thinks clearly.  Sometimes negative emotions or discomfort will come up during a practice, needing to be cleared before openings can occur.  Treat yourself kindly.  Work close to, but not in pain.  Work slowly and seek out what feels good.  Clearing out old patterns can work wonders for your body and your life if you work gently.
  • Breathe through the nose.  You will benefit from filtered air and a calmer nervous system by doing so.
  • Always drink lots of water after you practice yoga. You will move your body in ways that it is not used to moving, so you may be sore the next day. A warm bath before bed may also help any soreness.

Gentle Yoga

Gentle Yoga uses easy modified yoga stretches/poses practiced while focusing on breath which helps increase mindfulness, relieve stress and anxiety, and improve balance and well-being.

Yoga neck stretch

Gentle Yoga Exercises to Try:

Belly Breathing and lengthen exhale.  (In yoga we move with the breath).

Circle wrists, circle ankles

Shoulder Rolls

Arms overhead (out to side and up)

Circle arms slowly one at a time, both directions, from shoulder (forward, up, back, down 6X, reverse)

Lift and lower elbows with fingers on shoulders.  Then circle elbows. 

Gentle Eagle arms

Gentle Tricep stretch

With shoes and socks off, lift heal of foot to stretch toes and sole of foot (hold 5 – 10 seconds each side)

With shoes and socks off, turn foot over and stretch top of foot (hold 5 – 10 seconds each side)

Balance poses at the wall with one hand on wall or chair

Figure four stretch in chair

Lift and lower legs from the knees, one leg at a time or both at the same time

Restorative Yoga

Restorative Yoga is a conscious relaxation practice where participants lie over blankets and bolsters on the floor in passive, but comfortable yoga poses and focus on breathing for up to 10-20 minutes in each pose.

Yoga restorative pose


Meditation is a focusing of the mind on a single object, creating the cessation of all thought. As thoughts dissipate, the mind becomes quiet, and we are able to be fully in the present moment. The techniques of meditation are simple and easy to learn, but the ability to keep the mind focused takes time, patience and practice. The benefits of a regular meditation practice include reducing stress, tension, anxiety and frustration as well as improving memory, concentration, inner peace and whole body well-being.

Yoga Meditation Pose

Simple Yogic Meditation

Sit in a comfortable position, either cross-legged on the floor or in a chair. Sit up tall with the spine straight, the shoulders relaxed and the chest open. Rest the hands on the knees with the palms facing up or down. Lightly touch the index finger to the thumb. Relax the face, jaw, and belly. To relax your jaw, swallow a couple of times and then keep a little bit of space between your teeth.  Let your tongue relax away from the roof of your mouth and rest lightly on the floor of your mouth, just behind your lower front teeth. Allow the eyes to lightly close. Or gaze slightly downward at a focal point. Breathe slowly, smoothly and deeply in and out through the nose. On your inhale breathe all the way down into the bottom of your lungs filling your lungs completely with air.  As you exhale, release all the old stale air slowly and completely.   As the breath slows and deepens, let go of any thoughts or distractions and allow the mind to focus on the breath. Feel the breath as it moves in and out of the body, feeling it move through the nose, throat, windpipe and lungs. Feel the body as it rises and falls with each breath. Bring as much of your awareness and attention to your body and breath as possible with each moment. As the thoughts return to the mind, let them go, and return the focus back to the body and breath. Practice this meditation for 10-20 minutes. To end, gently let the eyes blink open, inhale the palms together in front of the heart, exhale and gently bow. Take a moment or two before moving on with the rest of your day.

Exercise Resources:

The Melt Method – Book by Sue Hitzmann

Vestibular Disorders Association (VEDA) Home-Based Exercise Article

Bev Holstun Yoga Instructor

Bev Holstun

Yoga Instructor at YMCA Seattle

Yoga Classes:




Presentation information is not meant to be taken as medical advice.

Presentations posted online may include discussion notes, links, images, and other information added by Seattle Dizzy Group.


© Copyright 2018, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | April 30, 2018

Posture and Balance

The Key To Life Is Balance

Postural Control & Balance

by Morgan Kriz, DPT

Vestibular Physical Therapist

 (Presented to Seattle Dizzy Group on 4/14/18)

This presentation gives an overview of how postural control helps maintain balance including the role of the cervical spine and the somatosensory system (musculoskeletal and joint systems).  It also offers a few strengthening and stretching exercises to practice for maintaining better posture and improving balance.

Balance is the ability to maintain the body’s center of mass over its base of support

Balance/stability is achieved and maintained by a complex set of sensorimotor control systems that include sensory input from 3 main systems:

  1. Vestibular System/Inner Ear (motion, equilibrium, spatial orientation)
  2. Vision (eyes)
  3. Somatosensory/Proprioception (sense of body’s position)

These systems are connected to each other and to the brain to help maintain good balance.

Balance System

Vestibular System

  • Size of a coin

Vestibular System size of coin

  • 5 end organs
    • 3 semicircular canals
      • Angular accelerations of the head
    • 2 otolith organs
      • Linear accelerations
      • Utricle
      • Saccule

The Internal Ear

Semicircular canals — Full of fluid that moves when you move your head around (little “fish bowls”)

Otolith Organs — Where otoliths live on a bed of jello


Vision System

Vision is human’s strongest sense

80% of what we learn is through our eyes

40% of our brain is mapped to connect to vision

Vision System

  • Make sure you have vision exam annually
    • Ensure proper prescription for glasses
  • Bifocal and progressive lenses considerations
  • Eyes and inner ears communicate
    • Via Vestibulo-Ocular Reflex (VOR)
    • Practice gaze stabilization
  • Eyes and the body connect
    • Via Cervico-Ocular Reflex (COR)

Gaze stabilization

Vestibular Dysfunction

People with vestibular disorders often experience problems with vertigo, dizziness, visual disturbances and/or balance.

Other problems also arise that are secondary to vestibular disorders, such as nausea and/or vomiting, headaches, “foggy headedness,” heavy headedness, reduction in one’s ability to focus or concentrate and increase fatigue.  (Cervical spine issues can also cause or exacerbate foggy or heavy headedness).

These impairments can be life-altering.

The Brain Controls It All

The midbrain is like a busy mail room.  Incoming messages need to be sorted and sent on.  Error signals cause system alarms (resulting in symptoms such as nausea, headache, etc.).

Brainstem = Body’s Highway

  • The brainstem controls the flow of messages between the brain and the rest of the body.  Sensory and motor neurons connect through here to the brain.
  • It also controls basic body functions such as:
    • Breathing
    • Swallowing
    • Heart Rate
    • Digestion
    • Blood Pressure
    • Consciousness (whether one is awake or sleepy)
    • Vestibular System
    • Motor Movement (particularly movements of the eye)
    • Auditory and Visual Processing


Posture:  The position in which someone holds their body when standing or sitting.  Other:  An approach or attitude.  (Attitude plays a role in brain function.  It is important to give the brain positive encouragement.  For example, congratulate the brain for milestones achieved in the healing process).  Posture and attitude are interconnected.  (For example, good posture brings confidence).

Somatosensory:  Relating to or denoting a sensation (such as pressure, pain, or warmth) that can occur anywhere in the body, in contrast to one localized sense organ (such as sight, balance, or taste).

Proprioception:  The unconscious perception of movement and spatial orientation arising from stimuli within the body itself.  (Humans use nerves, joints, and semicircular canals of the inner ear).

Human Body Anatomy

  • Muscles = 640
    • Eye muscles = 6
  • Joints = 360
  • Circulation System = 60,000 miles
  • Nerves = 95-100 billion
    • Nerves in Brain = 85 billion (of the 100 billion total nerves in the body)

Nerve function

Nerves are like “cords” of the body’s “entertainment system.”  After an injury or onset of an inner ear or balance disorder, Vestibular Rehabilitation Therapy (VRT) helps to organize the “cords” so that the brain and body can relearn to function properly together.

Body Reflexes for Posture

Maintaining balance is complex.  It is dependent on maturity of the nervous system, mobility of the joints in the spine and limbs and muscle power. 

We have involuntary and voluntary reflexes:
  • Involuntary:  Goosebumps when cold, eyes water when cutting an onion
  • Voluntary:  Walking, slapping someone when someone slaps you

Occur through habit.

We get these in the developmental stages of life (start after being born = gravity must be involved).

Vestibulospinal Reflex (VSR):  Motor output to skeletal muscle below the neck

Neck Reflexes

The neck is the bridge between the brain and the body.

  • Vestibulocollic Reflex (VCR)
    • Reflex for the neck musculature in order to stabilize the head
    • Neck movement counters the movement sensed by the otoliths or semicircular canals
  • Cervicospinal Reflex (SSR), also known as Tonic Neck Reflex (TNR)
    • When neck moves, body stabilizes/changes position
  • Cervicocollic Reflex
    • Stabilizes head on the body (like toothpick with a bowling ball on it)
  • Cervico-ocular Reflex (COR)
    • Eye movements driven by neck proprioceptors

Cervical Spine Anatomy

Atlanto-occipital (AO):  flexion/extension “yes joint”

Atlanto-axial (C1-2):  rotational/lateral “no joint”

Lower cervical spine (C3-C7):  rotation

Cervical Spine Anatomy

Position of the Spine Matters!

Spine positionMuscle tightness can change the position of bones and spine.  This can impact blood flow and bring on symptoms such as headache/migraine.  Try not to associate muscle tightness with pain, but instead use muscle tightness as a signal to change/improve posture.  Practice exercises regularly to relieve muscle tightness, change bad habits and improve posture, and increase efficiency of muscles (move easier).

Muscle Tightness Exercises

Muscle Tightness Exercises 2

Exercise Tips

  • It is important to be proactive to exercise to calm your brain prior to it becoming overwhelmed and triggering symptoms.
  • While exercising, use diaphragmatic (deep) breathing to oxygenate the body.
  • Try using phone apps for postural check reminders and breathing pace/biofeedback exercises (for example, the Calm app).
  • A foam roller or lacrosse/tennis ball or trigger point roller ball (pictured below) may be used to help relieve muscle tightness.

Morgan Kriz Posture and Balance

Base of Support

Foot Ankle

Balance Stance

Try Exercises With Your Eyes Closed

  • If we are 80% visually dominant, consider connecting your brain better with other systems (for example, the somatosensory system)
  • Continue exercises/movement but try to also do so with your eyes closed (be safe!)
  • You may have to make balance stance easier to be successful (try not to grab for walls, instead make balance control internal)
  • Purpose:  To know your boundaries in space and catch yourself (increases confidence and reduces fear of falling)


  • Sitting
    • Move every 15 minutes
    • Neck range of motion
    • Stand up every hour
    • Knees hip width apart
    • Ankle rolls/toe tapping
    • Shoulders down and back
    • Screen/book directly in front
    • Breath from belly
  • Standing/Walking
    • Stand tall
    • Keep big toes down
    • Shoulders down and back
    • Engage core
    • Look at stable object in the distance
    • Swing arms

Walking correct posture

Recommended Books

Migraine Brains and Bodies by C.M. Shifflett

The Brain Always Wins by John Sullivan


Morgan Kriz DPT Puget Sound ENT

Morgan Kriz, DPT

Vestibular Physical Therapist

Morgan has a Doctorate of Physical Therapy that specializes in Balance and Vestibular Rehabilitation. Morgan does have a strong background in Orthopedic Physical Therapy and this provides a foundation for general musculoskeletal conditions that may contribute to balance limitations.

Her focus as a provider is for patients to feel empowered with management of their condition and learn strategies to live a functional life so they can participate in the things they love. The human body is a magnificent. Each body system has a distinguished function however all systems are interdependent with one another. Morgan tries her best to educate patients so they may be proactive in their healthcare and strives to communicate well with other providers to give efficient and quality care through a multidisciplinary approach.

Vestibular Rehabilitation is an exercise based therapy program used to treat balance and dizziness disorders. It is based on the body’s natural ability to compensate for balance problems through optimizing the brain’s connection from your inner ear; eyes and body. Morgan uses evidence based guidelines when creating a patient’s individualized plan of care for Vestibular Rehabilitation. Morgan believes getting the most out of life is to make it fun/play games and tries to incorporate this into her rehabilitation programs so the brain retains the information for long-term management.

More information:


Presentation information is not meant to be taken as medical advice.

Presentations posted online may include discussion notes, links, images, and other information added by Seattle Dizzy Group.


© Copyright 2018, Seattle Dizzy Group. All rights reserved.

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