Posted by: seattledizzygroup | November 30, 2017

Managing Hearing Loss and Tinnitus

Strategies for Improving Communication with Hearing Loss & Tips for Managing Tinnitus

by Mary Henry, AuD

of Swedish Balance Center

 (Presented to Seattle Dizzy Group on 11/4/17)

This presentation discusses hearing loss/impairment and offers strategies for improving communication with others as well as tips for managing tinnitus.

The majority of people with hearing loss have loss in the high pitches of speech (“f, s, th, k”), which tends to cut out the clarity of speech. This is why a common complaint for a person with hearing loss is “I can hear fine – people speak loudly enough, but they mumble!”  However there are many different configurations of hearing loss, particularly for those who experience balance problems.

If you have ever had a hearing test (or plan to have one), feel free to draw your right (O) and left (X) hearing scores on this graph and see which letters you might be missing! The letters you have difficulty hearing are the ones which fall above your scores (as they are softer than the softest sound you can hear). Talk with your audiologist if you have questions about this.

Communication  Strategies for the Individual

Advocate for Your Listening Needs

Hearing loss is “invisible.” This means it is difficult for others to determine when you are having difficulty hearing. Acknowledging your hearing loss and educating others about your listening needs will facilitate successful communication. Many are unaware of strategies that can improve communication. Education and gentle reminders to use strategies are helpful to improve communication.

Strategies to Share for Improving Communication

  • “Please get my attention before speaking to me. It is helpful if you say my name or tap me on the shoulder to ensure you have my attention before beginning to speak.”
  • “Please look at me when speaking. I benefit from seeing your mouth for speechreading cues.”
  • “Please speak slowly and clearly. It is difficult for me to hear some speech sounds when speech is spoken quickly.”
  • “Please reduce the background noise. I will hear you better if the television/radio/dishwasher/fan is turned off.”
  • “Please don’t cover your mouth while speaking to me. I benefit from seeing your mouth for speechreading cues.”
  • If you only hear part of a sentence, repeat the part of speech that you did hear, for the other person to fill it the part you missed. (“You want to go to the movies when?”)
  • “Please let me know if the topic of conversation changes. Please give me a clue such as: Movie. What movie would you like to see?”
  • “May I sit at the center of the table? Sitting in the center allows me to clearly see everyone, which will provide me with visual cues about the conversation.”
  • “May I sit with the noise to my back? It will help my hearing aids reduce those sounds” (if you wear hearing aids with directional microphones).

Communication Strategies for Friends and Family

Hearing loss is “invisible.” The nature of hearing loss makes it difficult for communication partners to realize when a communication breakdown has occurred. People with normal hearing may be unaware of the additional concentration those living with hearing loss exert to communicate. As a communication partner to someone with hearing loss, you can take the following steps to facilitate communication and understanding:

  • Always speak from within the same room.
    • A person with hearing loss will not hear your message when you speak from one room into another.
  • Face the listener when speaking.
    • The listener with hearing loss utilizes visual cues in addition to hearing. Clearly seeing the mouth is essential.
    • Do not cover your mouth with your hand or an object as this muffles your speech and removes visual cues
    • Take advantage of well-lit areas to increase facial visibility.
  • Get the listener’s attention before speaking.
    • Tap the listener on the shoulder before talking, if mutually agreeable by both individuals.
    • Say the listener’s name before talking. This simple step focuses the listener’s attention and a head turn provides acknowledgement to the speaker that the listener is prepared for conversation.
  • Reduce background noise when conversing.
    • Turn off the television, radio or noisy equipment when possible.
    • Select quiet establishments or dine during off-peak hours when visiting restaurants.
    • Conversations in the car may be challenging. Assistive devices may be helpful in reducing these challenges. Talk to your audiologist to determine if these are appropriate.
  • Visit in smaller groups when possible.
    • Many hard of hearing people have difficulty following and participating in rapid conversations between many speakers. Reducing group size to a smaller group of three or four versus a larger group of eight or more speakers can result in easier participation.
    • Cue the listener with hearing loss when the topic of conversation changes.
  • Speak slowly and clearly.
    • Rapid speech is often difficult to understand for those with hearing loss. But don’t slow down too much — that can also reduce understanding!
    • Enunciate clearly.
  • Do not shout.
    • While speaking loudly and clearly are appreciated, shouting is not necessary.
    • Shouting distorts facial features and may hinder lip reading cues.


What is tinnitus?  Tinnitus (pronounced TIN-it-us or tin-NIGHT-us) is the perception of a sound or noise in the ear or head that occurs in the absence of a sound.  Some people perceive tinnitus as a ringing sound while others report it as a clicking, roaring, hissing or static noise.  It is also common for tinnitus to become louder and change in severity from time to time.   The exact cause of tinnitus is unknown, however it is often associated with hearing loss and is sometimes a symptom of it.  It should be noted that tinnitus can occur independently of hearing loss, and sometimes people with normal hearing will also experience it.

What causes tinnitus?  The exact physiological causes of tinnitus are not known.  It may be associated with many factors, including the following:

  • Noise exposure
  • Cerumen (ear wax) impaction
  • Side effects of medications (particularly anti-inflammatory medications and medications in the aspirin family
  • Fatigue
  • Stress
  • Vascular abnormalities
  • Ear conditions, including hearing loss, Meniere’s Disease and ear infections
  • Ear, head and neck traumas and jaw misalignment
  • Other possible factors that are less conclusive include alcohol, caffeine and smoking
  • Other unknown factors

Can it be cured?  Though it is the subject of extensive research, there is currently no known cure for tinnitus.  The nature of tinnitus is unpredictable.  For some it may spontaneously resolve over time.  Others learn to live with tinnitus as a chronic condition.  Coping strategies are recommended to manage tinnitus symptoms.

What can I do to manage my tinnitus?  Different strategies work for different people.  Below are some suggestions:

  • Remain positive. It can be easy to become discouraged by limited tinnitus treatment options.  Tinnitus is an area of extensive research.  We may have insights and answers tomorrow that are not available today.
  • Redirect your attention. Many report that focusing on the tinnitus can exacerbate the symptoms.  Pursuing a hobby or favorite activity can be an effective refocusing tool.  Many report that they are unaware of the tinnitus when reading an interesting story, watching a favorite television program or having a conversation with others.
  • Explore masking noises. Tinnitus is often most noticeable when trying to fall asleep or early in the morning.  Some find that the use of noise machines or a radio playing at a low level mask the noise of tinnitus while falling asleep.
  • Wear hearing aids if appropriate for your hearing. Many report that tinnitus is less noticeable when hearing aids are worn.  Hearing aids do not cure or prevent tinnitus.  The increased volume provided by hearing aids can sometimes mask tinnitus sounds.
  • Avoid loud noises. Always wear hearing protection when operating machinery and lawn equipment and when attending concerts or playing an instrument.
  • Reduce stress. Many report that tinnitus is more prominent during periods of stress.  Consider breathing exercises, yoga or taking a walk to reduce stress.
  • Rest. Get adequate sleep at night.  Fatigue has been associated with increased tinnitus.

Where can I find other tinnitus resources?  Tinnitus information, management strategies and support groups can be found through the following sources:

American Tinnitus Association:

American Academy of Audiology:

American Speech-Language and Hearing Association:

Mayo Clinic:

TM Soft: Downloadable white noise maskers:


Mary Henry, AuD

of Swedish Balance Center





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 2017, Seattle Dizzy Group. All rights reserved.


Posted by: seattledizzygroup | October 31, 2017

Treating Dizziness and Imbalance with Physical Therapy

October is National Physical Therapy Month!

Every October, the American Physical Therapy Association (APTA) celebrates National Physical Therapy Month (NPTM) which is a great opportunity to learn about the many benefits of physical therapy and recognize the impact of physical therapists.

Maximize your movement. Participate in your recovery. Choose physical therapy!  

Find out more:

How Can Physical Therapy Help with Dizziness and Imbalance?

Dizziness is a common problem, especially among older adults. In fact, for people over the age of 65, dizziness is one of the most common reasons for physician visits and hospitalizations. Regardless of the cause of dizziness, the sooner you get help, the better.

The good news: most dizziness and balance disorders can be successfully treated—and they are not an “inevitable” part of aging.

Your physical therapist can perform tests to determine the causes and also to assess your risk of falling. Often, there is more than one reason for dizziness and falls in the same person. Based on your physical therapist’s evaluation and your goals for recovery, the therapist will customize a treatment plan for you. Your therapist’s main focus is to help you get moving again and manage the dizziness at the same time. Exercise and new ways to perform daily activities are the primary treatments.

During your recovery, your physical therapist will teach you strategies to help you cope with your symptoms:

  • Do certain activities or chores around the house cause you to become dizzy? Your therapist will show you how to do those activities in a different way to help reduce the dizziness.
  • Have simple activities become difficult and cause fatigue and more dizziness? Your therapist will help you work through these symptoms right away so you can get moving again and return to your roles at home and at work more quickly.

Physical therapy treatments for dizziness can take many forms. The type of exercise that your therapist designs for you will depend on your unique problems and might include exercises to improve your balance, to improve your ability to focus your eyes and vision, and to “correct” differences between your brain and your inner ears. The inner ears tell the brain how the body is moving in relation to gravity. They also communicate information about head motion, which is used to coordinate eye motion.

In addition to those exercises, your physical therapist might prescribe exercises to improve your strength, your flexibility, and your heart health—with the goal of improving your overall physical health and well-being.

(Information from Move Forward PT)

Evidence has shown that vestibular rehabilitation (a specific type of physical therapy) can be effective in improving symptoms related to many vestibular (inner ear/balance) disorders. People with vestibular disorders often experience problems with vertigo, dizziness, visual disturbance, and/or imbalance. These are the problems that rehabilitation aims to address. Other problems can also arise that are secondary to vestibular disorders, such as nausea and/or vomiting, reduced ability to focus or concentrate, and fatigue.

Symptoms due to vestibular disorders can diminish quality of life and impact all aspects of daily living. They also contribute to emotional problems such as anxiety and depression. Additionally, one of the consequences of having a vestibular disorder is that symptoms frequently cause people to adopt a sedentary lifestyle in order to avoid bringing on, or worsening, dizziness and imbalance. As a result, decreased muscle strength and flexibility, increased joint stiffness, and reduced stamina can occur.

Treatment strategies used in rehabilitation can also be beneficial for these secondary problems.

(Information from Vestibular Disorders Association)


Vestibular Rehabilitation Therapy Promotes Compensation

Vestibular rehabilitation (VR), or vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls.

For most people with a vestibular disorder the deficit is permanent because the amount of restoration of vestibular function is very small. However, after vestibular system damage, people can feel better and function can return through compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e. body sense) to substitute for the deficient vestibular system. The health of particular parts of the nervous system (brainstem and cerebellum, visual, and somatosensory sensations) is important in determining the extent of recovery that can be gained through compensation.

For many, compensation occurs naturally over time, but for people whose symptoms do not reduce and who continue to have difficulty returning to daily activities, VRT can help with recovery by promoting compensation.

The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem(s). Therefore, before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder.

Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.

For patients with Benign Paroxysmal Positional Vertigo (BPPV) the exercise methods described above are not appropriate. First a clinician needs to identify the type of BPPV the patient is suffering from, and then different repositioning exercises can be performed. After BPPV has been successfully treated and spinning symptoms resolved, some patients will continue to report non-specific dizziness (symptoms other than spinning) and/or imbalance. In these cases, treatment using habituation exercise and/or balance training may be indicated.

(Information from Vestibular Disorders Association)


More Information about Vestibular Rehabilitation:

VEDA Article “Vestibular Rehabilitation Therapy (VRT)”

Overview of Vestibular Rehabilitation

Vestibular Testing

Treating and Managing Vestibular Disorders

Calm, Cool, and Compensated

Vestibular Rehabilitation from a Pilates Point of View


© Copyright 2017, Seattle Dizzy Group. All rights reserved.


Posted by: seattledizzygroup | September 22, 2017

Balance and Falls Prevention Awareness

September 18-24, 2017 is Balance Awareness Week!

The goal of Balance Awareness Week is to “Defeat Dizziness” by reducing the time it takes to diagnose a vestibular disorder.

Through Balance Awareness Week, the Vestibular Disorders Association (VEDA) hopes to raise public awareness about vestibular disorders and encourage people who have experienced symptoms like dizziness or vertigo to become informed about their condition and seek help from a vestibular specialist.  Increased awareness can reduce the time it takes patients to receive a diagnosis and put them on the road to recovery.

Find out how you can get involved at

The human balance system is complex, involving the inner ear, eyes, joints & muscles, and brain. When one part of the system is damaged by disease or injury debilitating dizziness and imbalance can result.

To learn more about vestibular and balance disorders, visit:

Balance Awareness Articles:

Raise Balance Awareness

Balance Awareness Facts, Figures & Trivia

A Balancing Act: Improving Balance and Preventing Falls

Exercise & Tai Chi Moving for Better Balance 


September 22-28, 2017 is Falls Prevention Awareness Week!

Among older adults, falls are the leading cause of injury deaths, unintentional injuries, and hospital admissions for trauma. Falls can take a serious toll on older adults’ quality of life and independence. The first week of Fall each year is Falls Prevention Awareness Week with the goal of spreading the message that falls are preventable.

More information about Falls Prevention Awareness Week:

September 22, 2017 is Falls Prevention Awareness Day!

This year is the tenth annual Falls Prevention Awareness Day which is celebrated on the first day of fall.  In honor of this notable milestone, the National Council on Aging (NCOA) has chosen the theme 10 Years Standing Together to Prevent Falls. This event raises awareness about how to prevent fall-related injuries among older adults.

More information about Falls Prevention Awareness Day:

Falls Prevention Resources:

Falls Prevention Fact Sheet

NCOA List of Falls Prevention Articles

Help Raise Awareness with Seattle Dizzy Group!


In celebration of Balance Awareness Week and Falls Prevention Awareness Day/Week, Seattle Dizzy Group will host our Seventh Annual Walk for Balance Event on Saturday, September 23, 2017 (12-2:30 pm at Green Lake).  Join us for this fun community event where we will “Walk a Mile in Dizzy Shoes” together to help create greater awareness for vestibular and balance disorders and show our support for people living with chronic dizziness and imbalance–in Seattle and beyond.

Event details:

(Also, find out how Seattle Dizzy Group is Making a Difference for Balance Awareness) 


Walk for Balance TM

© Copyright 2017, Seattle Dizzy Group. All rights reserved.


Posted by: seattledizzygroup | August 31, 2017

Coping with the Isolation and Loneliness of Chronic Illness

Strategies to Overcome Feeling Alone with Chronic Illness

Chronic illness may cause or increase isolation and feelings of loneliness. Adjusting to a “new normal” includes finding ways to cope with feeling alone and maintain social connections while living with chronic illness.

These articles discuss the isolation of chronic illness and offer strategies to overcome feelings of loneliness:

The Isolating Loneliness of Chronic Pain & Invisible Illness

Isolation Risk of Chronic Illness

Handling Isolation that Comes from Chronic Illness

How to Cope with Loneliness

Curing the Loneliness of Illness

Things to Do When You’re Mostly Housebound

Ways to Maintain Healthy Relationships & Social Activity Despite the Challenges of Living with Chronic Illness



© Copyright 2017, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | July 31, 2017

Caregiver Tips

Helpful Suggestions for Caregivers & Supporters of the Chronically Ill

Adjusting to a “new normal” can be as challenging for those in a caregiving or support role as it is for a chronically ill loved one. It is important to find ways to maintain healthy relationships in spite of chronic illness.

These articles offer advice for caregivers and supporters as well as loved ones with chronic illness:

A Not-To-Do List for Caregivers of the Chronically Ill

How to Help Your Caregiver

The 5 Caregiver Commandments: How to Support a Loved One with Invisible Illness

7 Ways to Keep Your Relationship Strong Despite a Chronic Illness

Supporting Relationships Through Chronic Illness



© Copyright 2017, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | June 30, 2017

Balancing Activity and Rest

Importance of Resting with a Chronic Illness

It can be challenging to balance activity and rest with a chronic illness. Every activity costs energy and too quickly brings on fatigue. For the chronically ill, “making the most of each day” includes getting adequate rest.

This infographic illustrates The Spoon Theory which is a helpful tool for explaining the energy impacts of activity while living with a chronic illness:


These articles discuss energy limitations and offer strategies for increasing activity level and managing fatigue while living with a chronic illness:

The Spoon Theory

With Chronic Illness, I Will Always Pay Tomorrow for What I Do Today

When Our Chronically Ill Bodes Say “Rest” Why Don’t We? 

Tips on Increasing Your Activity Level & Managing Fatigue

Fatigue, Stress and Responsibility



© Copyright 2017, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | May 31, 2017

Exercise and Tai Chi Moving for Better Balance

How to Exercise with a Vestibular Disorder

by Myra Emami, PT, NCS

of Cascade Dizziness and Balance PT

(Presented to Seattle Dizzy Group on 4/8/17)

This presentation discusses the health benefits of exercise and offers exercise strategies to improve balance including modifications for overcoming the challenges of chronic vestibular impairment as well as an overview of Tai Chi Moving for Better Balance which is a research-based exercise program that has effectively demonstrated reduced falls, risk of falls, and fear of falling.

Presentation Objectives:

  • Discuss how to incorporate exercise when you have a dizziness or balance disorder
  • Different types of exercises: strengthening, balance, aerobic, community based
  • How to modify the exercises based on balance impairment or dizziness issues
  • Tai Ji Quan Moving for Better Balance
  • Practice a few Tai Chi exercises


  • Strengthen functionally: Sit to stands, walking lunges
  • Functionally strengthen with balance exercises
  • Core exercises: Reverse crunches seated, standing cross knee crunches, medicine ball lifts in standing. Upright core exercises tend to work best for patients with dizziness issues.

Aerobic Exercises Benefits

  • Improved cardiovascular pulmonary health, lower blood pressure
  • Increases endorphins to combat depression
  • Burn cortisol to combat stress
  • Improves stress
  • Improves GI system
  • Improves memory and overall brain function, increased brain volume
  • Improves immune system
  • Increased energy level, combats fatigue
  • Decreases weight

Aerobic Exercise

  • Sustained activity that increases your heart rate
  • AHA (American Heart Association) recommended guidelines: 5x/week 30 minutes moderately intense exercise or 3x/week 25 minutes intense exercise
  • Target Heart Rate: 220 – age x 0.7 (Example: 60 year old = 112)
  • BORG Scale goal 13-15 (light to somewhat hard)

Borg Scale

  • 6 No exertion
  • 7 Extremely light
  • 8 Extremely light
  • 9 Very light
  • 10
  • 11 Light
  • 12
  • 13 Somewhat hard
  • 14
  • 15 Hard
  • 16
  • 17 Very hard
  • 18
  • 19 Extremely hard
  • 20 Maximal exertion

Type of Aerobic Exercises

  • Walking, power walking, walking with poles
  • Jogging, running
  • Equipment: biking, treadmills, ellipticals
  • Swimming

Aerobic Exercise with Balance Issues

  • Recumbent biking
  • Nustep
  • Power walking with 2 poles
  • Swimming: laps with resistance boards

Aerobic Exercise with Dizziness Issues

  • MRD, dysautonomia, vestibular disorder, motion sensitivity
  • Start with short sessions and gradually build up. Short duration and decreased frequency. 2-3x/week
  • Dizziness will be the limiting factor instead of Target Heart Rate.
  • Warm up and cool down especially important.
  • Staying hydrated especially important, consider electrolytes.
  • Low sensory environment
  • Use midline visual target.
  • Limit exercise that causes head movement.
  • Recommended: recumbent biking, Nustep, slow progressive walking program with hiking poles

Balance Exercises

  • Balance: ability to control the COM (trunk) over the BOS (Base of Support = feet) in a given environment or task without taking a step.
  • Vestibular
  • Anticipatory postural control
  • Limits of stability
  • Reactive postural control

Vestibular Exercises

  • Vestibular: One of 3 main balance systems (eyes, ears, sense of touch in feet) which is located in the inner ear and orients you to where you are in space and is responsible for righting reactions that keep you upright.
  • Static: Static standing with or without head turns eyes closed standing in an unstable position.
  • Dynamic: Walking with head turns
  • Modifications for balance: Feet position
  • Modifications for dizziness: Slow reps with midline sensory orientation

Reactive Postural Control

  • Automatic shifting in COG (Center of Gravity) in response to external and unexpected disturbances. (Example: Stepping reaction when you are about to fall).
  • Ankle/hip/stepping strategies
  • Tai Chi exercise

Limits of Stability

  • How far can you move over your base of support before you fall. The boundaries within which the body can maintain stability and not change the BOS (Base of Support) without step or reach.
  • Expanding the LOS (Limits of Stability) is critical for fall prevention.
  • Tai Chi LOS exercise

Anticipatory Control

  • Ability to proactively shift your COG (Center of Gravity) over your BOS (Base of Support) to successfully achieve a motor task such as stepping over an object.
  • Single leg stand: Inability to stand greater than 5 seconds indicates a high fall risk.
  • Key is ability to shift your weight over your BOS
  • Tai Chi anticipatory control exercise

Tips for Success

  • Find an exercise buddy
  • Make it easy – exercise at home or gym close by
  • Make it successful – start out slowly and gradually build up
  • Make it safe – practice in a corner for safety
  • Make it a habit – same time (for example, first thing in the morning)
  • Make it fun – use upbeat music
  • Cognitive behavioral approach: make your brain want it by thinking about the benefits of exercise

Other Recommended Exercise: Tai Chi

  • Lowers stress, improves sense of well being
  • Calms your mind, reduces anxiety
  • Grounding – reduces dizziness
  • Increases leg strength and core muscles
  • Improves bone density
  • Turns off the sympathetic nervous system
  • Better sleep
  • Better immune system
  • Thickens brain’s cortex – improved cognitive function
  • Improves balance and reduces fear of falling

Tai Ji Quan: Moving for Better Balance


  • Designed by Fuzhong Li, a research scientist and tai chi master, published multiple research studies on Tai Ji and balance
  • 6 month program 2x/week: Significant reduction in falls with this program (55% decreased fall risk)
  • Different than traditional Tai Chi programs: Evidence and research based exercise protocol that has been shown to reduce fall risk. Designed for balance training to improve functional mobility. Fall prevention focus. Maximizes excursion of COG (Center of Gravity) around edge of BOS (Base of Support) to optimize motor control.
  • Traditional Tai Chi: Health promotion focus, designed for self defense so that the COG is constrained within the BOS to optimize force and stability for combat.

Tai Chi Balance Exercises

  • Reactionary postural control: ankle/hip/stepping strategy
  • Limits of stability training: Butterfly
  • Form one: Hold the ball. Anticipatory postural control. Active movement.

Limits of Stability Training

  • Goal: Shift your center of gravity further and further outside your base of support to improve your balance.
  • Stay safe working in a corner, in front of a chair, or countertop so you can catch yourself if you lose your balance.
  • 10x each direction 1-2x/day
  • Keep trunk straight, don’t bend at your hips!
  • Keep it challenging by working at the limits of your stability!

Forward and Backward Weight Shift

  • Stand with feet shoulder width apart.
  • Shift weight forward so that your weight is on your toes.
  • Return to center. Repeat 10x
  • Shift weight backward so that your weight is on your heels.
  • Return to center. Repeat 10x

Side to Side Weight Shift

  • Stand with feet should width apart.
  • Shift weight to the right so that all your weight is on your right outer foot.
  • Return to center. Repeat 10x
  • Shift weight to the left so that your weight is on your left outer foot.
  • Return to center. Repeat 10x
  • Hold an imaginary Tai Chi ball when you weight shift (right hand on top when you shift to the right, left hand on top with left weight shift).

Clock Turns

  • Move from center to 1:00
  • Move from center to 7:00
  • Move from center to 11:00
  • Move from center to 5:00


  • Hold an imaginary Tai Chi ball at center, right hand on top.
  • Weight shift forward and backward for the body.
  • Move left hand in a big circle to make the left upper wing.
  • Left hand on top to reform the ball.
  • Move the right hand to make a big circle for the right upper wing.
  • Right hand on top to reform the ball.
  • Left hand backwards to the left back wing.
  • Left hand back on top.
  • Right hand backwards to make the right back wing.
  • Remember to work at the limits of your stability!

Anticipatory Control Exercises

  • Goal: Be able to stand on one foot to step over obstacles, be more stable walking, be safer going up and down stairs, transferring into a tub, stepping on or off a curb, etc.
  • Practice each exercise for 5-10 minutes, 1-2x/day

Side to Side

  • Stand with feet shoulder width apart.
  • Hold a Tai Chi ball with right hand on top.
  • Weight shift all the way to the right.
  • Move the Tai Chi ball to the right.
  • Lift your left heel up.
  • Lightly balance on your left big toe.
  • See if your can lift your left foot completely off the ground.
  • Try lifting your foot off for a few seconds.
  • Move the ball out further to the right if you keep losing your balance to the left.
  • Repeat on the left side with the Tai Chi ball to the left, lifting your right foot.


  • Stand with one foot forward and one foot back, a few inches apart.
  • Hold a Tai Chi ball forward.
  • Shift your weight to your front foot so that all your weight is there.
  • Lift your back heel off the ground.
  • Lightly balance on your back toe.
  • See if you can lift your entire foot off the ground for a few seconds.
  • Move the ball further forward if you feel falling backwards.
  • Shift your weight backwards so that all your weight is on your back foot. 
  • Lift your front toe off the ground.
  • Lightly balance on your front heel.
  • See if you can lift your entire foot off the ground for a few seconds.
  • If you keep falling forward, move your hands backwards to help you weight shift.
  • Repeat with the opposite leg.

Walking with Single Leg Standing

  • Take a step.
  • Weight shift forward.
  • Single leg stand for a few seconds.
  • Take another step and repeat.
  • Move slowly and deliberately, focusing on your comlete weight shift.

Exercise and Tai Chi Handout

Additional Health & Wellness Blog Posts:


Myra Emami, PT, NCS

of Cascade Dizziness and Balance PT

Myra Emami is a graduate of the University of Washington and has been practicing physical therapy for over 15 years. She specializes in vestibular rehabilitation and balance/fall prevention and obtained her Herdman Certification in Vestibular Competency in 2012.

Myra’s passion in vestibular rehab started after a personal experience with dizziness and vertigo, which helps her understand what her patients are going through. When patients talk about their dizziness, I can relate to how they feel. It’s important for patients to understand they can get better with the right strategy. Myra utilizes the latest evidence-based research in vestibular rehab in order to develop effective treatment strategies.

Myra also specializes in neurological disorders such as strokes and Parkinson’s Disease and obtained her APTA Neurological Clinical Specialist Certification in 2013. In her clinical practice, she applies her neurological background to emphasize the concept of neuroplasticity: The brain’s remarkable ability to change and build new connections to improve function. Neuroplasticity has far-reaching implications and amazing possibilities for almost every aspect of human life including balance disorders, movement dysfunction, and for reducing symptoms such as dizziness. She believes in a holistic healing approach delivered with care and compassion, with a focus on education and self-empowerment.

Myra’s accomplishments include the development of an acoustic neuroma post-surgical inpatient physical therapy protocol and Return-to-Play concussion protocol to facilitate safe return of young athletes to sports after a concussion. She organized and leads a multi-campus vestibular study group.

More information about Myra Emami



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 2017, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | April 30, 2017

New Hope for Tinnitus Sufferers

Integrated Approach to Treat Tinnitus

by Richard Wyckoff, PhD

of Eastside Integrative Psychology

(Presented to Seattle Dizzy Group on 3/11/17)

This presentation gives an overview of tinnitus including common causes as well as new treatment options.

What Is Tinnitus?

Tinnitus is a medical condition that causes sensation of noises such as buzzing, ringing, chirping or other sounds. It is not a hallucination even though other people are not able to hear it. It is not a mental illness, although it can cause symptoms such as anxiety and depression and irritability.

About 17% of people of all ages get it, but it is twice as common in the elderly. While most people with tinnitus do not require treatment, about 25% of those affected have intrusive tinnitus that can interfere with daily activity and sleep and cause great distress.

Many of these people are so bothered by tinnitus that treatment is required. They may experience intense anxiety, worrisome thoughts that will not stop, increased irritability, difficulty handling even minor stressors, depression and even suicidal thoughts.

What Causes Tinnitus?

The original source of disease is often trauma to the ear, such as an infection, blocked canal, otoslerosis, tumor, Meniere’s Disease, or drugs such as aspirin or antibiotics. Hearing loss or excessive exposure to loud sounds can also trigger tinnitus. Sometimes, however, tinnitus can appear without any of these precipitating factors.

The original problem leads to changes in the brain that cause tinnitus. Specific areas of the brain that control hearing, emotions and stress regulation are involved. For example, when cochlear lesions interfere with hearing in a specific frequency band width, the brain may attempt to compensate by generating this sound internally.

There are also neural pathways between the emotional centers of the brain, called the limbic system, and the auditory centers. Some of these neural pathways are excitatory (that is, they stimulate the auditory centers), while others are inhibitory (that is, they calm the auditory cortex).

Normally these competing pathways maintain balance and harmony. However, with tinnitus these pathways can be over or under active. This change in spontaneous neural activity can create the sound as well as the distress.

Treatment Options

In the past, treatments have been very limited. Some may gain a measure of relief through strategies that mask the noises with other noises. Others may find some benefit from a process of desensitization from the noises. Generally, psychiatric drugs are not indicated, and for some people they can make the problem worse. Surgical neural implants have helped some people. Many suffer needlessly. If you or someone you love suffers from tinnitus, an integrated approach to treatment can be very effective.

Some individuals are genetically predisposed to tinnitus because they have difficulty synthesizing certain neurochemicals and/or difficulty maintaining proper balance of certain key minerals. These individuals can be identified with a thorough diagnostic assessment including a review of symptoms, personal history, family history and medical history. A simple blood test and urinalysis can determine whether certain biochemical imbalances may contribute to the symptoms.

Biochemical imbalances may result from Kryptopyrrole Disorder (which causes a deficiency of B6 and zinc), Copper/Zinc Imbalance (usually caused by low zinc), or MTHFR Mutation (which causes overmethylation or undermethylation). These imbalances are corrected with advanced individualized nutritional therapy (which means the patient takes nutrients instead of drugs to address the problem).

Some patients may also benefit from concurrent psychotherapy to help them address the emotional consequences of tinnitus.

Find out more about tinnitus and behavioral medicine:


Richard Wyckoff, PhD

of Eastside Integrative Psychology

Dr. Richard A. Wyckoff is a licensed clinical psychologist who has been in practice since 1969 and has practiced in the Seattle area since 2005. He has specialized for many years in adult and geriatric behavioral medicine, dementia care and pain management.

From 1998 to 2004, he was grant-funded in Pennsylvania to teach behavioral alternatives to psychoactive medication in long term care. He co-authored three books with his wife Linda on behavior management. He currently specializes in the diagnosis and nutritional treatment of biochemical imbalances that cause mental health concerns.

In 2011 he founded the Alliance for Nutrition and Mental Health, an organization of mental health practitioners who are interested in incorporating nutrition science into their mental health practice. Currently, he is writing a new book with the working title, The Metabolic Mind, discussing how nutrition, lifestyle and everyday practices can help people build better brains to improve daily functioning. He has been trained by Dr. William Walsh of the Walsh Research Institute to provide advanced individualized nutrient therapy for those with treatment resistant mental health disorders associated with genetic and epigenetic metabolic factors. He is also working toward a post-doctoral diploma in orthomolecular psychology.

More information about Dr. Wyckoff:


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 2017, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | March 31, 2017

Importance of Self Care

Practicing Self Care for Coping with Chronic Illness

“You yourself, as much as anybody in the entire universe, deserve your love and affection.” – Buddha

 Self care is an act of self love.

Self care is about being deliberate in taking time for yourself for the betterment of your mind, body, and soul. Self care is not about being selfish. It is about replenishing and refreshing your spirit in different ways.

Self care is in integral part of everyday life especially when living with chronic illness.  In fact, it should be the very top priority.

These articles discuss the importance of practicing self care in your daily life and offer self care ideas for coping with chronic illness:

Self Care and Chronic Illness

Seven Types of Self Care Activities for Coping with Stress

The Coping with Chronic Illness Self Care Quiz




© Copyright 2017, Seattle Dizzy Group. All rights reserved.

Posted by: seattledizzygroup | February 28, 2017

Managing Fatigue Naturally

Natural Ways to Decrease Fatigue

by Jennifer Pilon, ND

of Bastyr Center for Natural Health

(Presented to Seattle Dizzy Group on 1/14/17)

This presentation gives an overview of common medical, emotional, and foundational causes of fatigue and offers natural ways to manage fatigue and increase energy and vitality.

Presentation Goals:

  • Outline common causes of fatigue
  • Understand how managing chronic medical conditions properly can impact fatigue
  • Understand the role of naturopathic medicine in treatment of fatigue
  • Understand the importance of foundations of health in managing fatigue
  • Empower you to address fatigue in foundational, sustainable ways

What Is Fatigue?


Weariness, weakness, depleted energy


Excessive Daytime Sleepiness

Drowsiness, decreased alertness, falling asleep easily

Causes of Fatigue

Physiologic Causes

  • Poorly managed chronic medical conditions
  • Medication side effects
  • Adrenal gland dysfunction
  • Nutrient deficiencies
  • Chronic viral infections
  • Mitochondrial dysfunction
  • Food sensitivities
  • Toxic accumulation

Psychological Causes

  • Depression
  • Anxiety
  • Seasonal Affective Disorder

Foundational Causes

  • Lack of exercise/deconditioning
  • Disordered sleep
  • Chronic stress
  • Lack of purposed and meaning

Medical Conditions That Can Cause Fatigue

Medications and Fatigue

Many commonly used medications can cause fatigue. Some examples:

  •  Blood pressure medicines (especially beta-blockers)
  • Antidepressants
  • Sleep aids (“hypnotics”)

Medications may deplete important nutrients. Some examples:

  • Metformin depletes B12 (important for nervous system and blood cell production)
  • Statins (for cholesterol) can deplete CoQ10 (can cause muscle pain and muscle fatigue)
  • (*This website gives what nutrients might be depleted by which medications–so you may want to supplement)

Talk to your doctor about your options for medication management.

See your ND to talk about mitigating side effects.

Adrenal Gland Dysfunction

Adrenal Gland Anatomy and Function

Cortisol – Friend or Foe?

Released by adrenal glands in response to stress and low blood sugar


  • Stimulates release of epinephrine – “fight or flight” response
  • Suppresses immune system
  • Decreases bone turnover
  • Increases blood sugar
  • Increases blood pressure
  • Increases formation of short-term memories, decreases recall

Symptoms of Adrenal Gland Dysfunction

Supporting Healthy Adrenal Function

Persistent Viral Infections

  • This is a controversial topic in medicine
  • Some viruses like to live in immune cells and may “reactivate” during times of stress or immune suppression
    • Most commonly Epstein-Barr virus
  • Possible symptoms:
    • Chronic fatigue
    • Flu-like symptoms
    • Brain fog
    • Recurring sore throat and/or swollen lymph nodes
  • Diagnosed with antibody lab testing
  • Your ND can provide nutritional medicine, hydrotherapy and herbal medicines to help

Food Sensitivities

Factors Contributing to Food Sensitivities

  • Low stomach acid
  • Impaired integrity of gut lining (“Leaky Gut”)
  • Intestinal dysbiosis
  • Total toxic burden (“full bucket”)
  • Immune hyper-reactivity


Food Sensitivities – How Your ND Can Help

  • Guidance through Elimination/Rechallenge Diet with symptom tracking (eliminate foods for period of time, usually a few weeks, and then reintroduce foods one by one to test tolerance)
  • Expertise in diet modification, especially in the presence of chronic disease
  • Target digestive support to heal the digestive tract
  • Symptomatic relief from digestive symptoms with herbal medicine
  • Identifying other potential immune-exciting triggers
  • Addressing toxic burden and other contributors to a “full bucket”

Dietary Deficiencies and Fatigue

Toxic Burden and Fatigue

Certain toxins have clear links to fatigue and cognitive problems (lead and mercury, for example)

We are exposed to toxins daily, through food, air, and skin

Toxins can affect:

  • Nervous system
  • Immune system
  • Kidney function (especially lead)
  • Skin
  • Liver function

Living Clean – The Basics

  • Eat a varied diet, rich in fruits and vegetables
    • Cruciferous veggies
    • Beets
    • Artichoke
    • Onions, garlic
  • Buy the Dirty Dozen organic
  • Fiber is your friend – ideally 30g/day from food
  • Consume adequate protein – important for phase 2 metabolism
  • Sweat regularly – careful with chronic diseases
  • Exercise!
  • Be Seafood Savvy – stick with smaller fish (mackerel, anchovies, sardines)
    • King mackerel, marlin, orange roughy, shark, swordfish, tilefish, ahi tuna, and big eye tuna all contain high levels of mercury

Clean 15

Pesticides in Produce

The growing consensus among scientists is that small doses of pesticides and other chemicals can cause lasting damage to human health, especially during fetal development and early childhood.  Scientists now know enough about the long-term consequences of ingesting these powerful chemicals to advise that we minimize our consumption of pesticides.

Environmental Working Group (EWG) recommends buying organic produce whenever possible in order to reduce exposure to pesticides. However, organics are not accessible or affordable for everyone, so the Clean Fifteen and Dirty Dozen shopping lists help consumers make the healthiest choices given their circumstances. Conventionally grown produce is still better than not eating fruits and vegetables. (

EWG research has found that people who eat five fruits and vegetables a day from the Dirty Dozen list consume an average of 10 pesticides a day. Those who eat from the 15 least contaminated conventionally grown fruits and vegetables ingest fewer than 2 pesticides daily.  The Guide helps consumers make informed choices to lower their dietary pesticide load.  (Learn more at

Clean Fifteen

  • Onions
  • Avocadoes
  • Sweet Corn
  • Pineapple
  • Mangoes
  • Sweet Peas
  • Asparagus
  • Kiwi
  • Cabbage
  • Eggplant
  • Cantaloupe
  • Watermelon
  • Grapefruit
  • Sweet Potato
  • Honeydew Melon

Dirty Dozen

  • Celery
  • Peaches
  • Strawberries
  • Apples
  • Blueberries
  • Nectarines
  • Bell peppers
  • Spinach
  • Cherries
  • Kale/Collard Greens
  • Potatoes
  • Grapes

Environmental Working Group’s Guide to Pesticides in Produce

Detoxification – How Your ND Can Help

  • Expertise in identifying specific toxins of issue
    • Exposure history 
    • Evidence-based laboratory testing
  • Targeted nutritional and supplemental detoxification support
  • Strategies for maximizing diet and lifestyle to minimize exposures
  • Perspective

Disordered Sleep

Consequences of Poor Quality or Insufficient Sleep:

  • Anxiety
  • Depression
  • Frequent illness
  • Weight gain
  • Hormonal imbalances (thyroid, reproductive, adrenal)
  • Decreased healing ability
  • Impaired blood sugar regulation
  • Decreased ability to form and recall memories
  • Poor work performance and decreased productivity
  • Increased blood pressure

Factors that Disrupt Melatonin:

  • Blue light exposure in general
  • Shift work
  • Lack of daytime sunlight
  • Exposure to light at night
  • Aging (may decrease melatonin production)

Sleep Hygiene Basics

  • Cut out stimulants
    • coffee, black/green/white tea, colored soda, energy drinks, dark chocolate
  • Consistent sleep/wake times
  • Pay attention to your body
    • Pushing past initial sleep signals an increase stress hormones
  • No TV or work in the bedroom
    • Create positive associations with your bedroom
  • Exercise regularly
  • Dim light in your home after dark
  • Avoid screens 1-2 hours before bedtime (or at least use a blue light filter, for example tinted glasses or an app for screens like F.lux)
  • Use a bedtime alarm app to remind you to wind down for a chosen bedtime
  • Optimal sleep environment: cool, dark, and quiet

Sleep – How Your ND Can Help

  • Addressing depression and/or anxiety
  • Supplementation and diet to stabilize blood sugar
  • Herbal medicine to calm the nervous system, improve sleep quality, and balance adrenal function
  • Stress management techniques
  • Physical medicine to decrease chronic pain that may be affecting sleep
  • Screening for symptoms of obstructive sleep apnea and referral for sleep studies

Mood Disorders – The Basics

  • Approximately 6.6% of American adults have active depression
  • 16.6% of Americans will experience major depressive episode at some point
    • Prevalence of depression is higher in individuals with chronic disease
  • Fatigue is a symptom of depression
  • Sleep disturbance, lack of interest and difficulties with concentration and memory may be confused with fatigue
  • Depression can cause physical symptoms, too!
  • Seasonal Affective Disorder (SAD)
    • Seasonal pattern of major depressive episodes

Mood Disorders – How Your ND Can Help

  • Addressing foundations of health – diet, exercise, sleep and meaningful living
    • Light therapy for SAD – Fluorescent 10,000 lux light
    • Start with 10 minutes in the morning, eyes open, 16-31 inches from the face
  • Counseling, support groups, etc.
  • Identifying and treating physical problems affecting your mood
    • Blood sugar regulation, thyroid dysfunction, menopause, etc.
  • Herbal and nutritional mood support
  • Medication and side effect management

Exercise and Energy


  • Improves mood and memory
  • Increases energy production by cells
  • Improves brain function
  • Provides an opportunity for social connection
  • Increases muscles strength and endurance, conditioning you for everyday life

Start with regular, low-moderate intensity

Overtraining can also cause fatigue and mitochondrial dysfunction

Sustainable Skills for Increased Energy

  • Prioritize your health – manage chronic disease (including mental illness) well
  • Prioritize your sleep
  • Manage stress well
  • Diet, diet, diet!
    • Increase fruits and vegetables and emphasize lean proteins and whole grains that you tolerate
    • Identify and eliminate food sensitivities
  • Exercise regularly
    • Apps like 7 Minute Workout and Nike Training Club
    • YMCA is a great resource
  • Identify and eliminate toxic exposures

Additional Health & Wellness Blog Posts:


Jennifer Pilon, ND

of Bastyr Center for Natural Health

Dr. Pilon combines the strengths of conventional medical care with naturopathic wisdom to ensure that patients get safe and effective treatment. She uses counseling, clinical nutrition, supplements, herbal medicine, hands-on therapies and medications when necessary.

Dr. Pilon believes the key to creating long-term changes in your health is to take small, sustainable steps.  She practices from the Health at Every Size philosophy, an approach that focuses on health instead of weight.

Dr. Pilon’s clinical interests include women’s health, male and female infertility, adjunctive treatment of depression and anxiety, environmental medicine and detoxification, hormonal problems (thyroid, adrenal, menopause, etc.), and management of common chronic health conditions such as asthma, high blood pressure, arthritis, IBS and pre-diabetes.

More information about Dr. Pilon



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 2017, Seattle Dizzy Group. All rights reserved.

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