Multiple Sclerosis and Loss of Proprioception

Proprioception is a complex sense and it can be altered with MS

Medical Exam
Physical therapist doing medical exam with little boy. microgen

How many of you have had this experience: You are passing your neurological exam with flying colors, proudly touching your nose with alternating fingers and walking heel-toe-heel in a perfectly straight line, and then comes the test you know you will fail. You are asked to place your feet together, stretch your arms out in front of you, and close your eyes. All of a sudden you're almost toppling over.

What you're experiencing is known as Romberg's sign, or a loss of proprioception. 

I became intrigued with the idea of proprioception after failing this part of my neurological exam repeatedly, as sometimes happens with MS.

What is Proprioception?

Put simply, proprioception is your ability to determine where you are in space in the absence of vision. It is based on sensory input from the joints and muscles. It is your awareness of your posture, weight, movement, and position of limbs, both in relation to your environment and in relation to other parts of your body. 

Proprioception has been called the "sixth sense," but it is rarely talked about because it is intact in most people. In addition, loss of proprioception is much more vague than, say, loss of sight or hearing.

How is Proprioception Affected in People with MS?

MS slows down communication between the central and peripheral nervous systems through a process known as demyelination.

Because proprioception involves instant and coordinated communication between these systems, MS can leave us a little less "in touch" with ourselves and where we stand, so to speak. Deficits in balance control in MS are likely due to problems transmitting proprioceptive information from the ankles, our primary source of sensory feedback for balance, to the brain.

 

A total loss of proprioception is virtually impossible, as we always have sensory information coming in from all our muscles and nerves. We also use proprioception to walk, eat, and pick up objects—not just for balance. Think about how hard it would be to chew if you couldn't feel your mouth (better yet, think about the last time you had novocaine at the dentist and soon after tried to eat a meal). Or perhaps you can recall how strange it feels to try using your arm or hand after it has fallen asleep. Sensation and movement are inextricably tied. 

Can Loss of Proprioception Be Treated?

Balance training interventions are sometimes used in people with MS in order to improve the three sensory systems responsible for balance: Proprioceptive, visual, and vestibular. Vestibular rehabilitation programs may be prescribed to you if you experience impaired balance and disability due to dizziness or a sensation of disequilibrium. A 2011 study showed that vestibular rehabilitation can be an effective treatment for MS patients who have deficits of upright postural control.

 

Sources:

Lanska DJ, Goetz CG. Romberg's sign: development, adoption, and adaptation in the 19th century. Neurology. 2000 Oct 24;55(8):1201-6.

Jeffrey R. Hebert, John R. Corboy, Mark M. Manago, Margaret Schenkman. Effects of Vestibular Rehabilitation on Multiple Sclerosis–Related Fatigue and Upright Postural Control: A Randomized Controlled Trial. Physical Therapy: Journal of The American Physical Therapy Association. August 2011. 

 

 

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