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405614 tn?1329147714

Balance issue or proprioception or both?

Which is which, or do both play a factor?

1.  Leave table at restaurant, walking by a row of empty chairs.  Realize I forgot something, turn back to go get it, and slam my left knee into the chair at the end of the row.  I knew it was there, but I wasn't looking at it.

2.  Canister vacuum on top of file cabinet; attachments sitting loose.  I know it's all there, bend down to pick something up from in from of the file cabinet, and get a round imprint from one of the long tube attachments in the middle of my forehead.

3.  Head into kitchen to stir beans on stove; bruise right shoulder on corner of doorway.

4.  Putting something in back seat of car, go to stand up and bang my head on the top of the door frame.

5.  Walk into living room to sit on couch and watch TV; trip over cat scratching post that has been there for ages.

There are times when my balance issues are more clear, like when I fell of the box in PT, or I'm walking through a store and it feels like the floor moves underneath me.

Other times I wonder if its lack of attention to what I'm doing, or lack of true perception of where I am in relation to other things.  I'm usually pretty careful, especially since I fell in the garage not long after my tremors and stuff started more than a year ago.

I couldn't sleep, and this question popped into my head, so I thought I'd ask.

Thanks,

Kathy
24 Responses
572651 tn?1531002957
Wow Kathy,  you must look pretty banged up with all those bruises.   I tend to be klutzy to start with and you add in my balance issues and I accumulate some nice black and blue spots too.  

What's the time frame on all this happening? I would think that's a big clue - if it all happened in a day or two vs spread out over a week or so would be telling.

my best.
Lulu
405614 tn?1329147714
Well, the banging the knee happened last week, a few days before I fell off the box at PT (have a bump/bruise on left hand where I caught myself on exercise bike).

The other things have happened over the past year, with many more incidents, like the time I was laughing and joking with my roommate and fell into the half-wall in the bathroom face-first, getting paint on my glasses and a bruised cheek and eyebrow.

I've done a lot of turning corners and hitting things, stuff like putting things in the fridge and hitting my head on the bottom of the freezer door.

My roommate has started to warn me about stuff, and she's always told me that if I give I believe I'm a clutz, I'll be one. She's given up on that project and tells me if she thinks I'm going to trip over or run into something.

I used to climb mountains, do rock climbing, hike on narrow exposed trails, practice judo (you really are aware of what your body's doing in judo!).  That was mostly quite a while ago, but I've mostly been very sure-footed.  I could walk to college along a highway while reading a book, and never trip or get hit by a car.  :o)  I did get told off by my judo instructor, who saw me doing it.  :o}

These things happen more often when my symptoms are flaring up.  They have improved somewhat since I've been taking Provigil, but in the few months I've been taking it I've still done a fair amount of banging into things.

I have Arnica gel for the bruises.  Haveyou tried it?  It can help them fade more quickly, and it feels good, too.  

The twisted knee was bad; I had visions of getting that total knee sooner rather than later, but it has calmed down, thank goodness.

Thanks,

Kathy
790496 tn?1315619257
Just what I needed you have made me laugh because everything that you just described has happened to me. Doing dishes, opening the cabinet to put a glass away not closing it and smacking my head 3 seconds later, or going to the bathroom and bending down to sit and smacking my head on the towel bar that has been there for 20 yrs. You get so upset at the time thinking to yourself how can I be so stupid, but I found that after the initial shock you wind up laughing at yourself. They say laughter is the best medicine, you just gave me a dose THANKS !

Lynn
405614 tn?1329147714
You are soooooooo right!  Laughter IS the best medicine!  It kind of freaks my roommate out at times; I think she might think I've knocked a screw loose, lol, when I laugh when I've banged, bopped, or walloped myself!

She's getting used to it, though.  I went on a trip with her in January, and SHE packed the arnica gel for me.  :o)

Kathy
648910 tn?1290666683
Sorry to say I also belong to this club and I have wondered which was the cause.  Either way it still causes bruises and some interesting moments...terry
635835 tn?1272542983
Ok let's see if I can help at all.

Balance is finding a state of action and reaction in our bodies.  3 systems contribute to our balance.  1 - vision 2- vestibular 3- proprioception.

We all know about vision - Visual input is a huge factor to our balance and the system that we rely on most as we age because of the deterioration of the other two.

The vestibular system is our inner ear system which gives our body information about our  spatial orientation (turning, upright, sideways, moving, stationary etc.) There are also vestibular reflexes that coordinate with our vision and our postural muscles that help us to fixate on objects and stabilize our gaze.

I find proprioception the most difficult sensation to explain to my patients.  At it's simplest it is the internal feedback we get from our joints/muscles/ligaments.  They have there own sensory receptors just like touch or pain or temperature do.  Proprioception is also how we learn and fine tune skills.  How you can walk without looking at your feet.

All three systems work together to form our balance.  As one is declining or challenged we rely more heavily on others.  

Running into external objects for various reasons would not be proprioception since that is an internal sense.  In my opinion the senses that seem more involved in your bumps are visual processing and the ability to adjust your movements in space to avoid things.  The cerebellum is the area of your brain involved in adjusting and fine tuning movements to have your body perform the way you planned.  This happens so quickly we don't notice it - but when you do anything there is a constant monitoring from your vision and proprioception to your brain and back down to your muscles to make sure you are performing the activity correctly.  

I hope that helps and makes sense.
405614 tn?1329147714
Wow, thanks, that was a good explanation.

I have had trouble with blurred vision since my symptoms began last February, but I've had a totally complete neuro-ophthalmic work-up, and everything was totally normal, even my VEP.

Would it then follow that this could all be vestibular, in line with my light-headedness, vertigo, loss of balance?  Even the blurred vision, if my vestibular reflexes aren't coordinating my vision with my postural muscles, my gaze is not fixed, or stable?

I wonder where my malfunction in fine-tuning really lies?  Would your opinion be, given that my visual processing checks out with the neuro-ophthalmologist, that there is some other miscommunication that affects my ability to adjust my movements in space to avoid things?

So many questions!

Thanks for your input!

Kathy




486038 tn?1300066967
Kathy- great question and good answers!

I had to laugh at myself today. I whacked my head on a open cabinet door above my head hard enough to see stars and then later this afternoon I was walking past our swinging door and somehow managed to hit my head on it as I walked past it- very hard on the same side of my head. It would be NO surprise to anyone that I have a very bad left-sided head-ache tonight that tylenol isn't touching? :)

~Sunnytoday~
405614 tn?1329147714
I think you're supposed to avoid hitting the same place more than once in a day... Yeah, if that were possible, we wouldn't be running into stuff in the first place.

It's good to see you; seems like I haven't seen much of you lately.  Not that I've been around consistently, myself.  Hope all is well with you.

Kathy
333672 tn?1273796389
FWIW, I think I bump into things both from balance problems and from proprioception problems.

Before my balance problems got so bad, I used to brush up against walls and door frames a lot. I don't think it was a balance issue. It felt like a misjudgment of where my body was so I'm pretty sure it was a kind of proprioception problem. I don't do that so often any more.

As my balance problems on flat surface increased, I have a tendency to fall into things. I think Quix once described this as being like a pinball and that's how I go down the hall sometimes. It's different from the above because I know I'm losing my balance and I am using whatever I fall up against to break my fall.

When I went to PT, I had a test that involved a booth with a moving floor that had computer sensors in it that tested how well the three elements of the balance system are working. It spits out a graph ranked from 1-100 for each element and also shows what's normal for your age.

When I started PT, my vestibular system was barely above zero and my somatosensory (which sounded to me like it's mostly the sensations on the bottom of the feet) was below normal, and my visual was well above normal. After four weeks, my vestibular went up to around thirty, which is still way below normal, but much better than it was. The somatosensory also went up a little, although the PT told me there wasn't anything that therapy could do about that.

sho
Avatar universal
Tomorrow I'm having a VNG test, so maybe I'll learn more about what info that can give. It's interesting that for 48 hours in advance I can have no sedatives, no stimulants, no aspirin or nsaids, no alcohol, no nothing. I can understand how these could affect the outcome if I were somehow 'under the influence,' but 48 hours seems really long.

I don't have your symptoms, except for the floor moving one, which of course causes me to compensate as best I can. If I'm outside and walking on uneven terrain, yikes.

With luck I'll find out whether this is peripheral or central. Would this be a good test for you?

ess
405614 tn?1329147714
sho, that test sounds interesting, and different from what the VNG sounds like; I wonder if it was a similar test or something totally different.  It sounds like the physical therapy was pretty helpful.  I'd be willing to give it a try.  

ess, I certainly hope that list of "no"s doesn't include pain medication and Lyrica; don't know if I could stand 48 hours without.  I don't think you're supposed to stop taking Lyrica abruptly, so I suppose they would let you continue that.

So today is your VNG:  I'll will be looking forward to how it went for you.  I'm so tired of losing my balance and being dizzy/lightheaded that I'm ready to see if my neuro or somebody will order one for me.  Any kind of answers and possible treatment are worth the try.

Kathy
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