Horak et al.1 considered balance as a nervous system skill to detect any instability either in advance and immediately and to generate coordinated responses that could restore the supporting base of body mass core, preventing falls. Effective maintenance of balance involves a number of central nervous system (CNS) and peripheral nervous system (PNS) structures2. According to Woollacott3, vestibular system is one of the main structures to maintain balance, given that it is considered as an absolute reference in relation to the others that also participate in this function, such as visual and somatosensorial systems.

When the set of visual, labyrinthic and proprioceptive information is not properly integrated by the CNS, there is disturbance in balance status, which can be manifested by body imbalance, and may lead to falls4. Aging may be responsible for these disorders. The elderly may have difficulty to precisely regulate these stimuli, which can be improved through specific training programs. Considering that daily activities are present in innumerous conditions that involve sensorial redundancy, skills to analyze and select information are essential to prevent falls5.

Systems in our body have physiological reserves that are characterized in the nervous system by their capability to reorganization, known as neuroplasticity6,7. As a result of aging, reserves are reduced, but not depleted, therefore, the creation of an ideal environment for motor learning may determine a significant improvement of the function8. Pohl and Winstein9 stated that practice improves neural processing skills in the elderly as well.

Vestibular exercises, such as the ones described by Cawthorne and Cooksey, may serve as support for new arrangements of peripheral sensorial information, allowing new vestibular stimulation patterns necessary for new experiences to become automatic. This practice of balance would be capable of promoting improvement in reactions of balance and, consequently, reduce falls10. These exercises are part of a vestibular rehabilitation program and involve head, neck and eye movements, posture control exercises in different positions (seated, in two-leg and one-leg positions, walking), use of soft surface to reduce proprioceptive input, and exercises with closed eyes to exclude visual cues.

The purpose of the present study was to check a specific therapeutic approach for the vestibular system by the application of Cawthorne and Cooksey exercises, to see if they generated motor learning and contributed to improving balance and reducing the possibility of falls in the elderly.

The research project was approved by the Research Ethics Committee, Universidade Castelo Branco, according to Resolution 196, 10/10/1996, National Health Council.

Mean age of the studied group was 64.8 years (±2.95) and to the control group it was 65.46 years (±2.85).

Subjects presented a first assessment of BBS scores with the respective PQ showed in Table 1. The percentage of subjects in each PQ value is shown in Graph 1. No elderly subject presented PQ equal to 100%, which would be expectable in a survey with healthy elderly, but 24 of them (79.8%) presented PQ between 28% and 73%, which demonstrates that subjects without diseases present likelihood of suffering falls that is high enough to restrict their daily life activities. The process of aging, per se, determines gradual system failure, regardless of the presence of disorders, but there was a minimum of general BBS score, which inevitably occurs during the process, that is significant considering non-linear progression. Shumway-Cook et al.15 reported that 25% to 35% of the population aged over 65 years tends to suffer falls.

Graph 1.

Quantity (in percentage) of subjects and their respective rate of likelihood of fall (PQ) in the 1st assessment

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Data presented in Graphs 2 and 3 detected homogeneity between both groups in the 1st assessment, because there were no statistically significant differences in results (p > 0.05).

Graph 2.

Values of Berg Balance Scale (score) in control and studied groups in 1st and 2nd assessment

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Graph 3.

Values of Likelihood of fall (%) in control and studied groups in the 1st and 2nd assessment.

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This study managed to demonstrate that BBS is sensitive to detecting abnormalities in balance of healthy elderly. The elderly in the studied and control groups did not present statistically significant difference when assessed for the first time (p > 0.05), but for the second assessment we observed statistically significant differences between the two groups (p < 0.005), provided by significant improvement in balance (p < 0.05) in the studied group after intervention (Table 2 and Graph 2). There was significant improvement in PQ (p < 0.05) for the studied group, with reduction of 30.4% in the likelihood of having falls (Table 3 and Graph 3), leading to the conclusion that a specific intervention, based on stimulation of specific system, generated positive functional responses in this studied group. The clinical importance of this result lies in the fact that falls are one of the main factors that contribute to morbidity and mortality of the elderly. Thus, preventing falls by improving balance provides basic conditions for the maintenance of physical independence.

Differences between the control and studied group to PQ both in the first and second assessment were not significant (p > 0.5 and p > 0.05, respectively), despite the tendency towards increase in difference between both groups in the 2nd assessment, which means that significant improvement obtained in the studied group, confirmed in this study, may not be extrapolated to other groups (Graph 3).

Data in Tables 4 and 5 and in Graphs 2 and 3 show, respectively, that the control group did not present significant differences between means of BBS (p > 0.05) in the 1st and 2nd assessments nor between PQ means (p > 0.05).

The results found in this study confirmed that according to BBS, healthy elderly subjects have balance disorders and run the risk of falling.

Cawthorne and Cooksey exercises applied as described in the procedures were capable of improving balance in our sample, consequently reducing the likelihood of fall.

The results and conclusions described here confirmed the expectations of different authors19–22 that suggested improvement in balance and in likelihood of falls when there was application of vestibular stimulation in healthy elderly, given that these subjects have really presented significant improvement.

Elderly subjects, who reported or not presence of posture instability and/or the event of fall, should be submitted to vestibular stimulation exercises, exercises that are easy to apply and affordable, which are preventive and curative concerning balance deficits and risk of falls. Considering that falls are aspects that substantially change the quality of life of the elderly and that life expectancy of the population in general has increased significantly, leading to increasingly higher elderly population every year, general therapeutic interventions directed to the elderly and specially those that provide prevention of falls owing to improvement of posture stability, will eventually lead to improvement in quality of life of this part of the population, which is currently the priority of any and all health policies.