If you’ve ever tried spinning in circles while looking up to the sky, you’ll know the accompanying dizziness that can follow. But what stops ballet dancers, who pirouette endlessly for a living, from falling into each other like a set of dominoes?
Years of training in “spotting”, the technique of quickly and repeatedly bringing your gaze to two specific points in front and behind you, certainly helps, but new research suggests that the brain’s ability to adapt plays a powerful role. And it could help better treat and diagnose people who suffer from chronic dizziness.
Neuroscientists at Imperial College London recruited 29 female ballet dancers and spun them around in a chair in a dark room. When the chair was stopped, the dancers were asked to turn a lever to indicate how quickly they still felt they were spinning. This measured their perception response to dizziness. Eye reflexes – the quick flicking of the eyes from moving around rapidly – were also measured. In normal people, these two responses correlate well, but in the dancers there appeared to be an uncoupling: while their eye reflexes kept going, their perception response fell.
A group of 20 female rowers, who were similar in age and fitness, were also recruited as a control group. Brain scans were then taken to analyse the brain structures of all the individuals.
In cases of chronic dizziness, tests are usually taken of the vestibular organs in the inner ear. These fluid-filled organs use tiny hairs to sense the movement of the fluid, which in turn send signals to the brain. The continued movement of fluid explains one of the reasons you can continue to feel dizzy after you’ve stopped moving. But this doesn’t go far enough to explain dizziness in chronic suffers, said Barry Seemungal, co-author of the study, published in Cerebral Cortex. 
“We measured sensation perception and eye reflexes and found dancers were much more resistant to non-dancers,” he said. “In the rowers, sensation correlated very well to reflexes, but in dancers the two were not correlated – they had de-coupled. In a person with chronic dizziness, the duration of their perceptual response is much longer; there’s a disproportionately higher reaction compared to a dancer who shows powerful resistance.”
An MRI scan then looked at the amount of grey matter (the bit that calculates) and the white matter (the part of the brain that makes connections) in the cerebellum. This also threw up differences between dancers and non-dancers.
“A statistical comparison between brain structures showed that in dancers an area of the cerebellum was smaller than in the rowers. This part of the brain also known to be involved in processing signals from the ear. And the more experienced the dancer, the smaller it is. The cerebellum can process signals that are then sent to areas of the brain linked to perception. In dancers it reduces the flow of signals – it acts like a gate.”
The researchers then looked at the cerebral cortex, which is associated in perception, and found stronger white matter in the control group. “More white matter means you’re more likely to be dizzy – in dancers we didn’t see it,” Seemungal said.
Seeing is believing
So how can these findings help people with chronic dizziness? For a start, we now have recognition that the brain is the organ that controls balance and, crucially, that it’s able to adapt.
“Traditional testing considers the ear as the organ of balance,” Seemungal said. “I’m a neurologist so I consider it as the brain.”
“The brain takes in lots of different information to make an assessment and compensates if it needs to. The ear is one source, vision is another. If you hear a noise to the right and move your head to look at it, your brain combines the estimates and places greater weight on the more reliable, in this case the eye.”
“But vision can be ambiguous – for example when you’re sat on a train and another one moves and you think you’re the one moving. As a general principle the brain prioritises visual motion over vestibular organs [the ear]. Another example is the ventriloquist’s doll, it combines the auditory and visual inputs but relies more on the visual so you think it’s the doll that’s talking.”
“If your vestibular organs aren’t working well, your brain won’t trust them and even trivial visual stimuli can trigger a dizzy sensation. But traditional testing relies on testing the vestibular organs, which might indicate nothing is wrong.”
People with chronic dizziness can be treated for underlying causes but also longer-term physio treatment. Depending on the form of the condition, this can include exposing them to self-motion (the swaying we all do but don’t notice if we don’t suffer from dizziness) and visual motion to get the brain more habituated.
One lucky find (for the researchers anyway) was that one of the dancers involved in the study later went on to develop chronic dizziness. This enabled the team to test her against their original findings. They found that although her reflex functions had remained the same, her perception response had become stronger.
Professor Nicky Clayton, a Professor of Comparative Cognition at Cambridge and Scientist in Residence at Rambert, the contemporary dance company, said: “As a dancer you learn tricks that allow your body to move in very flamboyant ways but without losing control. One of the tricks I learned was that when you get that sense of spinning, you use your core muscles to pull up; and that you’re disengaging with that feeling of fluidity and creating a stabilising energy.
She added: “Dancers think in very abstract ways … The way in which the brain talks to the cognitive system, whether through its plasticity or psychologically, is more than just spotting. Spotting helps you to focus but it’s not the only thing.”
Simon Lloyd, an ENT specialist, said: “The tests could potentially be useful because at the moment we have no effective way of testing how well parts of the balance system within the brain are working. Testing this would also allow us to measure how people are responding to treatment.”