proprioception issue

[mrswillie]

Can anyone explain to me what proprioception actually is, what kind of tests are used to assess this, and what it means if you fail this test. I have been requesting records and notes per all the suggestions here and found something related to a problem with this, but I don't understand what the test even was.

[JenEpicFarms]

We are "wonderfully and fearfully made". This is never more clear than when something in your system goes wonky (er, that's a technical term). It's amazing how many actual system functions are behind what we tend to take for granted as just one simple movement.

I flunked the Romberg, and then when I saw this discussion it made me wonder if I was looking at it backwards (wouldn't be the first time :o) I was blaming my brain for telling me the object was closer or further than I thought, but it makes sense that it could be my brain telling me that I was closer or further away from the object than what I thought.

Thank you for all that great info!

[Quixotic1]

Great discussion, Sho!!!!

Quix

[shoshin]

I have proprioception problems and I looked into this a little bit to see if I could come up with some info that would help me, too. Proprioception is also sometimes called "position sense" and has to do with sensing joint position and limb position.

Proprioception is the "sense of position and movement of the limbs and the sense of muscular tension. The awareness of the orientation of the body in space and the direction, extent, and rate of movement of the limbs depend in part upon information derived from sensory receptors in the joints, tendons, and muscles. Information from these receptors, called proprioceptors, is normally integrated with that arising from vestibular receptors (which signal gravitational acceleration and changes in velocity of movements of the head), as well as from visual, auditory, and tactile receptors." (http://www.answers.com/topic/proprioception)

Proprioception is one of the sensory systems. "Fine touch, position sense (proprioception) and vibration sense are conducted together in the dorsal column system. Rough touch, temperature and pain sensation are conducted via the spinothalamic tract. Loss of one modality in a conduction system is often associated with the loss of the other modalities conducted by the same tract in the affected area." (http://cloud.med.nyu.edu/modules/pub/neurosurgery/sensory.html) I think I have problems with all of these except maybe rough touch.

This site splits the sensory tests up as "Light touch, pain and temperature comprise the cutaneous sensory exam, while position, motion, vibration, and pressure-pain comprise the proprioceptive portion." (http://www.vhct.org/case1799/neurologic_exam.htm)

The most common neuro text associated with proprioception seems to be the one where you close your eyes and the neuro moves your big toe up or down and you have to say whether it's up or down. When I was being examined by the neuro who dx'd me with MS, I was sitting there with my eyes closed waiting for him to start some test, which seemed to be taking a long time, when he asked me if I could feel him moving my toe. This freaked me out and I opened my eyes and looked really fast. Sure enough, he was moving my toe up and down. I could feel him touching my toe, but not the motion.

Apparently, the neuro is supposed to hold your toe from the sides during this test, but they usually seem to hold the top and bottom and I often seem to have more of a sense of which side of my toe they're pushing on than anything. So I think I pass this test, but I always feel like I'm guessing and somehow cheating.

The other common test that is related to proprioception is the Romberg test, where you stand with your feet together and close your eyes. If you can keep your balance with your eyes open, but wobble or fall with eyes closed, this indicates a proprioception problem.

Often, you can use vision to compensate for proprioception problems so proprioception and its related balance problems get worse in the dark or with eyes closed. So this make JenEpicFarms' misjudging where her body is in relation to objects sound not like a proprioception problem. Here's a post that might be helpful on that: http://www.medhelp.org/posts/Multiple-Sclerosis/Balance-issue-or-proprioception-or-both/show/864400

There were some other tests that I thought were related to this, but turn out to be coordination tests, like the test where you run your heel up and down your shin and the test where you close your eyes, hold your arms out to your sides, and touch your nose.

With the heel on the shin test, I often have trouble finding my knee with my foot without looking. Ess mentions not knowing where our body is because of numbness, but I think that is a separate problem from proprioception. I have both problems. For example, I have trouble with my balance because I don't feel the bottom of my feet well so I'm not sure exactly what kind of surface I'm walking on or I'm slow to adjust or react when my feet touch something. However the proprioception problems are more like I don't know where my body is in space and it's not related to touching anything, like when I can't find my knee with my foot. Or when I do the closed-eye, finger-to-nose test, I always seem to have to make a little last minute adjustment when I get close to my nose.

sho

[JenEpicFarms]

Wow, that's a pretty extensive list...gotta say though that HGC was the winner in my book (laughed my tail off :oD )

Was that your handiwork?

- Jen

[Lulu54]

While you are honing your vocabulary skills, you might want to  check out this Health Page, too:

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Commonly-used-MS-Acronyms/show/438?cid=36

[jensequitur]

Yeah, i do that too.  I'll reach down and try to pick something up, and it takes five times before my fingers grab it.  Sometimes I slow down and think about it, because I'm getting tired of dropping it!

[JenEpicFarms]

Hey, you're quick! At the risk of sounding like a ninny, I am not too sure exactly WHAT my fingers are doing when I'm dropping things everywhere (I just know I feel very fumble fingered, and sometimes pick the same thing up and drop it a few more times before I can actually hang on to it :oP )

Guess I'll add myoclonic jerk to my growing vocabulary list - thank you for the clarification!

[jensequitur]

Usually when I sling stuff, it's because my hands have decided to let go of the object.  I do have spasticity in my hand, but that's mostly just tightness and cramping.  The involuntary movement you describe is really more of a myoclonic jerk.

[JenEpicFarms]

Now that I think about it, I have another question for you.  When you "sling" stuff, is it because your fingers are doing their own thing? The ring and middle fingers of my left hand have suddenly snapped inward [in a curled position toward the palm] several times in the past week or two. Are yours doing something like that? Is it spasticity? Okay that was three questions (well, at least I can still count :o)

It wasn't a total calamity until yesterday when I fed Taya (a horse) a treat. About the time I put the treat up to her mouth on my palm, those two fingers popped forward. You'll just never guess where they went either...right in Taya's open mouth. Poor girl - she bit down on the treat AND my two fingers. I yelped and put my other finger in her mouth to open it (which she did immediately), but she got me pretty good...

[JenEpicFarms]

Eggs? *Laugh* Oh, ick. Bet mealtime at your house is quite the adventure ;o)

I have only this week realized how hard I was concentrating on just walking down the hallway at school in a fairly straight line (by watching my own personal row of tiles). My daughter caught up with me in the hall and started talking; the minute I shifted my attention I started weaving ever so slightly (hmmmm...)

Not much fun having the "buzz" without the party is it? :oP

[jensequitur]

Hey, Jen, I've had the same problem with holding on to stuff for a while now.  I would sling stuff across the room because my hands would let go at the wrong time.  I still have a hard time with it, but I've found that if I pay attention to what I'm holding the whole time, I have better luck.  This gets difficult with eggs, because my instinct is to squeeze tighter if things are shaky.

[JenEpicFarms]

Thank you Jen; I do know it feels kind of like I'm wearing one contact lens (everything looks a little bit funky). I'm not having trouble actually putting my hands on things, just that periodic sensation that I'm going to run into something big which usually turns out to be a false alarm (it's pretty disconcerting though).

Now if I could just manage to HOLD ON to the things I pick up, that would be great! I seem to be stricken with "Boss" (Bar of Soap Syndrome). It's really annoying.

:o)

[jensequitur]

I don't think so.  It sounds more like a problem with your visual perception.

[JenEpicFarms]

I'm bumping here, mainly because I'm still wondering about this part of my post above:

I also jump back (or to the side) sometimes because I think something is RIGHT THERE and I'm going to hit it, but when I look again there is plenty of room. What is up with that? Is that the same thing or a new vocabulary word? Not that I'm complaining mind you (because anything after Dermatomyositis is not so big a word after all *grin*)

Does anybody know if this is a part of proprioception?

[jensequitur]

Proprioperception problems...  I haz them...

I have problems with my legs most of all.  My right one is barely there, and on bad days, the left one isn't there either.  It's weird trying to walk around when they feel so odd - kinda floaty and buzzy.

Here's a RadioLab presentation on the problem - quite entertaining.

http://www.wnyc.org/shows/radiolab/episodes/2006/05/05

[JenEpicFarms]

AHA! This is the one I meant to bump (accidentally bumped the wrong one a minute ago).

[JenEpicFarms]

Thank you for the explanation (I feel like I'm studying for a vocab test here). Would this be the reason your body can be "listing" to one side? I have a problem with that when negotiating obstacles, turning corners, and going through doorways. I haven't actually started bouncing off them yet, but at my current practice rate  methinks my days are numbered there...Ha.

I also jump back (or to the side) sometimes because I think something is RIGHT THERE and I'm going to hit it, but when I look again there is plenty of room. What is up with that? Is that the same thing or a new vocabulary word? Not that I'm complaining mind you (because anything after Dermatomyositis is not so big a word after all *grin*)

- Jen :o)

[essdipity]

Here's my non-medically educated understanding of this: Proprioception is about knowing where we are in space. That means *all* of us, arms, legs, feet, head. Our sense of proprioception is what helps us keep our balance and works against vertigo.

If we can't tell where our feet are, either because of numbness or some other cause, we are likely to trip and fall easily. If we close our eyes and start to fall over, that means we don't know which way is up. If we lurch into walls and doorways, our proprioception is not telling us how to move to avoid obstacles, or it is giving us wrong information.

Tests for this are likely to be a part of a neuro's very comprehensive physical exam. For me, my balance and clear-headedness are better when most of my body is touching something tangible on both sides, such as being in the driver's seat of a car.

Impaired proprioception comes from brain lesions, possibly the pons?? I hope others more knowledgeable will jump in here.

ess