Improving Proprioception

Posted by Nurse Linda in Life After Paralysis on April 28, 2021 # Health

Proprioception is an awareness of where the body is in space. Generally, people know where and how their body is positioned without much thought about it. Messages are sent to the brain from the muscles, tendons, and joints for body position. An individual is constantly making slight body adjustments to position themselves or to move without much thought. It is such a coordinated effort within the body that it is sometimes called a sense, like sight, hearing, smell, taste, and touch.two women in wheelchairs on boardwalk

Our bodies learn proprioception throughout the lifespan. Babies start by learning to hold up their heads. It is a wobbly action at first. As they appear to be gaining strength in head control, their muscles are strengthening, but they are also gaining in proprioception which is gathering information from the body about how to hold up their head, which muscles to use when their eyes line up with the visual horizon, as well as the balance of their body and their head. Movements continue to be refined as skills and abilities are increased. If issues arise due to aging, accommodations are made to continue to support the body.

Eventually, people learn to move their bodies without looking at themselves. Movement becomes automatic. You know where to place your feet for standing. You know if your hand is opened or closed. You know if you are slouching and need to sit up straighter.

The ABCs of proprioception includes agility, balance, and coordination. The brain receives messages from the inner ear about rotation, acceleration, and agility. The eyes send visual information. The stretch receptors in the skin, muscles and joints send information about where the body is positioned in space. It is an unconscious way of knowing about your body position.

Paralysis can interrupt proprioception message flow about body positioning. The brain may not perceive input from the stretch receptors of skin, muscles, joints from nerves below the level of injury. A loss in any part of proprioception can lead to difficulty with balance, position sense, and feedback to the brain about what the body is doing.

Individuals who may have challenges with proprioception include spinal cord injury, stroke, brain injury, multiple sclerosis, Parkinson’s disease, ALS, arthritis, diabetes, peripheral neuropathy, joint replacement, and joint injuries. Anyone with a permanent or temporary issue with nerves and muscles can have proprioception issues.

Issues with proprioception can lead to difficulty with balance while walking or sitting, incoordination, clumsiness, poor posture control, difficulty with regulating the strength of movements, and avoiding activities due to fear of falling such as climbing stairs or walking on uneven surfaces. It may be difficult for individuals who use assistive devices for mobility to know if you are sitting with your body in alignment or if a body part is out of position.

Some tests can be done to see if you have proprioception issues. These include the Romberg test, where you stand with your heels together and eyes closed for 30 seconds. Loss of balance indicates a proprioception issue. In the thumb finding test, with your eyes closed, the thumb of one hand will be positioned while you are asked to touch it with your other thumb. Sequential finger testing is using your thumb to touch each of your fingers rapidly. In the distal proprioception test, the examiner moves your big toe up and down as you identify its position with your eyes closed. You may have had one or more of these tests in health assessments. A field sobriety test is used for temporary loss of proprioception due to intoxication.

There are some strategies that can be used to help improve your proprioception. The first is to enhance your senses of your inner ear and vision. Taking a moment to feel where your head is in space and use your line of vision to see if you are in alignment with the horizon. If you have sensation below your head, think about how your body is positioned where you can. For instance, if one shoulder higher than the other. Make a conscious decision to detect your body positioning where you can, as this becomes natural to your new normal. If vision or hearing is an issue, obtain glasses and hearing aids to improve your abilities.

Providing movement to your body below the level of injury improves sensory function. This was demonstrated by Christopher Reeve and continues to be an outcome in additional studies of movement. The body is designed for movement. It is essential. Moving your body provides stimulation to the area that is having difficulty communicating with the brain. In addition, the movement stimulates the muscle stretch reflex that is required for proprioception.

The upper extremities are a great start to move because our hands have the most movement of all the joints of the body. Be sure to move your arms and hands or have someone move them for you. If you are able with or without adaptions, try an arm cycle. This stimulates the muscle of the arms. Fingers have a lot of potential movement, so stretch your fingers or have them stretched several times a day. Do the same with the lower extremities to stimulate the muscle stretch reflex. Keep your body joints supple and without contractions to allow the muscle stretch reflex to be stimulated by the movement you provide.

Do not forget your trunk as an area of movement. This is a challenge. If you have the stability to lean side to side and front to back, you will be moving your trunk muscles. Be sure to have someone help you or stand by to ensure your safety. The top of your body is heavy, so leaning forward can flip you headfirst onto the floor. Be cautious. Some individuals do pressure release by leaning side to side and to the front in their chair. This is a great proprioception movement. Leaning or stretching the trunk back may have to be accomplished by lying on your side in bed. Those with higher-level injuries will need to have help in moving the trunk, although you can get front-to-back action with your tilt-in-space chair function.

Vibration therapy is a therapy that is used for tone or spasticity. There are indications that it may stimulate the muscle stretch reflex. You will need to check with your healthcare professional to see if this is a therapy that may benefit you and ensure your body can handle the treatment without complications. Vibration therapy can be done to individual muscles with a handheld device or through the use of a vibration plate that stimulates muscle groups.

Standing is a therapy that will put your body weight through your bones and muscles. This is a treatment that has many beneficial effects, one of which may be stimulation of the muscle stretch reflex, although each person’s body is different in muscular response. If you think this might be good therapy for you for bone health, stretching, or proprioception, talk with your healthcare professional about options. Many payors will approve a standing frame if you apply for it. Do not be daunted if your first request is refused. It may take a few attempts before you can get this therapy and equipment, which is done at home after learning how to use it.

Biofeedback is a therapy where a visual or auditory signal is provided for balance and body placement. The individual can get a warning when their body is out of alignment, so they will be able to react to correct the issue. Eventually, you can learn when your body is out of alignment.

Advanced therapies are good inputs to the muscle stretch reflex. Electrical stimulation, weight-supported walking, and robotics all stimulate the muscles and nerves of the body. Most of these therapies will be difficult to obtain outside of a rehabilitation setting but keep working with your healthcare professional to find ways to incorporate them into your routine.

Aquatic therapy is another option as the muscles are stimulated. The buoyancy of the water can assist in facilitating movement. Be sure to use a heated pool as cold water can cause the muscle to contract to make them more difficult to stretch. There are heated indoor pools in many communities with educated individuals that can provide assistance.

There are many options for assisting improvement in proprioception. One of the best, quickest and easiest ways is to move your body or have someone move it for you. The benefits to your bowel, bladder and skin are tremendous as well as to the muscle stretch reflex. Nurse Linda

Pediatric Consideration:

Children who have paralysis prior to learning to sit or stand are not at a disadvantage. They still learn body activities just in different ways. Adaptions or assistive devices can help them navigate the world. In pediatrics, habilitation is the focus. This is learning how to do things for the first time as opposed to rehabilitation which is relearning.

Proprioception is a difficult topic to understand for everyone. Children adapt to their world in learning how to the right themselves. Assisting a chile with moving their body stimulates a developing nervous system. As caregivers, it is our job to provide an environment where they will learn proprioception at their level. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

This project was supported, in part, by grant number 90PRRC0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.