Disturbed balance - proprioception

The word proprioception comes forward quite often when the nuisance of the effects of brain injury comes up. What does it mean? It comes from the Latin words proprios and perception (self-perception).

 

Proprioception is a sense organ. This sense is very important for the motor and balance of the body. Proprioception is also called position sense or postural sense or kinesthesia.

 

Thanks to proprioception, a person knows what the position of the body is, where the legs or arms are located, that the body is crooked, sloping, flat or upright or upside down.

 

The body provides the information of sensory cells about body posture and the movement that is made by the central nervous system.

It also provides information about the strength of arms and legs, joints and tendons, and information about fatigue or that muscles are ready to take action, about muscle tension or that arms or legs feel heavy or tired.

 

Proprioception is one of the three pillars of balance.

The balance is determined by information from:

• The positional sense or proprioception through muscles, joints and skin to know the position of the body
• The vestibular organ in the middle ear (vestibular system)
• Eyesight / eyes what a person sees (vision or visual perception). What someone sees depends in part on the correct control from the brain of the eye muscles and undamaged brain areas that process visual stimuli.

 

If one of these three systems fails, the other two are deployed to compensate. Proprioception is the most difficult to compensate.

 

The proprioception may be disrupted by brain injury or excess intake of vitamin B6, but also by drunkenness.

 

If the vestibular system is disturbed or if there is eye injury or visual complaints such as CVI, nystagmus (trembling eyes) due to brain injury, there are (serious) problems with the balance.

 

There are also complaints with balance if there are complaints in those areas of the brain that process and transmit the stimuli.
It remains difficult to diagnose whether something is damaged by head trauma in the equilibrium organ or the connection between eyes and balance, muscles, sensors and balance.

 

 

How does it work?

The muscles contain muscle spindles, sensors that transmit information to the sensory nerves.

This information reaches the cerebellum via the spinal cord, where it is processed from the three senses: vision, proprioception and balance.

 

Sensors are located not only in the muscles but also in the skin and connective tissue, around muscles and joints, and in tendons, joint capsules, connective tissue membranes, and nerve endings. These "proprioceptors" monitor the position of joints, the tension in tendons and ligaments, and the degree of muscle contraction.

 

Ataxia

Ataxia is a completely different imbalance. It is a movement disorder, a disorder of coordination.
There is an unsteady gait and uncoordinated arm movements. Speech may also be affected.
Usually, a lesion in the cerebellum (cerebellar ataxia) is the cause, for example, caused by inflammation or a brain tumor, a hemorrhage or infarction, or multiple sclerosis.
Sometimes, ataxia is caused by medication side effects or by a hereditary condition (e.g., Friedreich's ataxia), or a metabolic disorder.

 

Proprioception Overstimulation

Brain overstimulation may occur when too much information is received from the senses or when this information is poorly filtered.

In addition to sensory information from touch, sight, hearing, smell, and taste, proprioception can also cause overstimulation.
Patients even report feeling seasick or "drunk," as if their balance is disturbed. You can therefore become overstimulated by movement, head position, or a feeling of uncertainty about how you move in a space. [source published research and surveys Hersenletsel-uitleg]

 

When proprioception is impaired due to a brain injury or, for example, whiplash, the brain relies more heavily on information from the eyes. This alone can lead to visual overstimulation when the environment becomes more complex and crowded.

 

Neurological tests

• Romberg's test: The participant is asked to stand still with both feet together for half a minute. Then, the person is asked to close their eyes to see if they can remain still for another half minute. If the person cannot do this, there may be problems with proprioception, the balance organ, or the nerve pathways. This may include ataxia, neuropathy, or Meniere's disease. In case the person cannot stand still even with eyes open, damage to the cerebellum is suspected. Drunkenness may also cause impaired proprioception. Balance deteriorates rapidly after the age of 70.
  
• Finger-to-nose test: The participant is asked to bring her or his index finger to the nose with eyes closed. If the person misses by more than two centimeters, there are proprioceptive problems.
  
• Standing on one leg: The participant is asked to stand on one leg for half a minute in two attempts, both on their dominant and non-dominant leg. Arms should be held alongside the body.
  
• Tightrope walk: The participant is asked to walk one foot at a time in a straight line, with the heel touching the toes of the foot behind.
  
• Straight line walk: The participant is asked to walk in a straight line.

 

See also our page on neurological tests.