Balance and Proprioception in CMT

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Balance and Proprioception

Proprioception

by Dr. D. Bird, Chief, Neurology Section, VA Medical Center, Seattle, WA

Proprioception is a term that refers to our ability to know where a body part is

located in space and to recognize movements of body parts (such as fingers and

toes, feet and hands, legs and arm.). Our joints and muscles have tiny receptors

that respond to movement. These receptors send signals along peripheral nerves

to the spinal cord. These electrical signals then travel up the spinal cord to

the brain where connections with multiple higher level nerve cells allow us to

become aware of movement. Diseases that affect any part of this pathway may

result in abnormalities of proprioception.

Many types of CMT damage the myelin or axons or both of the peripheral nerves

carrying these impulses. Thus, a condition such as CMT that damages peripheral

nerves often impairs proprioception. The resulting abnormalities of

proprioception become evident as problems with walking, balancing, hand

coordination or manipulating

objects. This can be particularly disabling when combined with the muscle

weakness and bony abnormalities of the feet that often occur in CMT. The

problems with balance, walking and coordination are particularly difficult in

darkness or dim light because good vision helps to correct and overcome some of

the problems with proprioception.

There are no cures for the proprioception difficulties. However, there are

strategies that help to improve the problems. For example, always try to

maintain adequate lighting and be especially careful in dim light or darkness.

Have up-to-date appropriate correction of

visual problems with glasses and lenses and have eye specialists diagnose and

treat visual disorders such as cataracts.

Use canes and walkers when necessary. (Don't be embarrassed. They may prevent

serious falls).

Be patient and perform functions slowly that require good coordination.

Use simple assistive devices for fine motor tasks such as buttoning, zipping,

and eating if recommended by a specialist.

Watch out for steps, curbs and other uneven surfaces and, in your own home, keep

floor covering flat, simple and not moveable.

Physical and occupational therapists are especially trained to help with these

practical problems.