The Effect of Reduced Somatosensation on Standing Balance: A Systematic Review

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J Diabetes Sci Technol. 2009 Jul 1;3(4):931-943.

The Effect of Reduced Somatosensation on Standing Balance: A Systematic Review.

Kars HJ, Hijmans JM, Geertzen JH, Zijlstra W.

Center for Human Movement Sciences, University Medical Center Groningen,

University of Groningen, Groningen, The Netherlands.

The objective of this review is to identify and review publications describing

the impact of reduced somatosensation on balance. Based on knowledge of the

association between specific somatosensory loss and deterioration of balance,

conclusions can be made about role of somatosensation in standing balance. A

systematic literature review is presented in which publications from the years

1993 through 2007 were searched in Medline and Embase. Medical Subject Headings

(MESH) terms and free text words (related to balance, somatosensory loss, and

lower limb) were used to perform the searches. Fifteen articles were selected

for detailed review based on predetermined inclusion criteria, and three of the

included articles described the effect of experimentally reduced somatosensation

on balance in healthy subjects. Ten of the articles described balance in

diabetic neuropathy (DN).

The last two included articles described balance in Charcot-Marie-Tooth (CMT)

disease type 1A (CMT1A) or type 2 (CMT2). The literature indicates that the

tactile sensation is reduced in DN, CMT1A, and CMT2 and when the plantar surface

of the feet was hypothermically anesthetized. Joint motion sensation seems to be

impaired in patients with DN, and passive joint position sensation appears to be

reduced in healthy subjects with anesthesia of ankle and foot from prolonged

ischemia. This reduced somatosensation seems to have a negative effect on

balance in patients with DN and CMT2; however, this appeared not to be the case

in patients with CMT1A and in healthy subjects.