We all learned early on about the five senses: touch, taste, sight, smell, and taste. These are ‘external’ senses. It turns out we have several ‘internal’ senses too: pain, itch, pressure, chemoreceptors, and others. One of the most important ‘internal’ senses for living a normal life is proprioception. Proprioception affects our lives every moment of every day, and allows us to complete numerous tasks, from simple to complex.
Proprioception gives you the ability to know where your limbs are in space. Inside muscles and joints are tiny little receptors which measure tension and contraction, and relay this information to the cerebellum, which then calculates where the limbs are in space. It then inhibits some muscles and fires others to complete the task you are doing. The information to the muscles is like the information sent to booster rockets on a spaceship; proprioception allows you to stay in orbit, or upright, so to speak. The soles of the feet and the ankles have thousands of proprioceptive sensors.
Take walking, for instance. When you go for a walk and notice a flock of birds flying, you track them with your eyes. Without proprioception, this would be impossible, as you’d have to look at your feet in order to keep them moving forward. Police use the sense of proprioception when conducting a sobriety test. They tell you to close your eyes and touch your nose. When not imbibed, this can be done easily. Alcohol interferes with central nervous system processing, making this task nearly impossible. A good typist (not me) train their fingers proprioceptively. Which brings me to the next point. Both disease and disuse impair proprioception. People who have suffered a stroke, or suffer from neuropathy have difficulty with balance and coordination. A sedentary lifestyle can also impair proprioception (remember the use-it-or-lose-it axiom). However, like most physiological processes, proprioception can be improved, which is a major focus of my home-health practice.
With these patients, I typically start on a solid surface, usually with the aid of a chair or counter to aid balance. I then progress to ballistic-type activities, then to uneven surfaces, then to using a blindfold. Some examples for a beginner are as follows:
*Rock back and forth from toes to heels, keeping the body straight. Minor disturbances to one’s balance is corrected at the ankles.
*Step and reach.
*Standing on one leg. Once this is mastered, moving the arms or turning the head may be added.
*Three steps and stop on one leg. Most falls don’t occur when standing still unless someone bumps into you. A progression would be to turn the head to involve more vestibular (ear) activation.
*Vertical ladder is just that; climbing an invisible ladder.
*Hopscotch, but no hopping, only stepping with turns.
*Once steady on the floor, I usually use a foam pad or boss ball. A folded in half yoga mat will do in a pinch, Then progress through the above exercises.
Generally most patients see some functional improvement with three to four weeks. Stroke and neuropathy patients take longer and have more homework to do.