Neuropathy and Balance

Balance is not one thing, it is several things. Balance involves several parts of the body generating and responding efficiently to movement. There are two primary pathways involved. The first is described in scientific terms as the afferent pathway. This pathway includes sensory information that is gathered by the eyes, the inner ears and the sense of touch (tactile system) and delivered to the brain.

The second pathway, known as the efferent pathway, includes the brain’s reaction to the incoming information. This response can be reflexive or volitional. A reflexive response might be the quick adjustment you make when stepping on something unexpected, like a rock or soft spot in the grass. A volitional response might be leaning forward a bit as you walk up a slope. It always bugged me as a student that they used such similar words with only one letter different. A good way to remember this is “Afferent Arrives, Efferent Exits.”

Neuropathy is the term for nerve damage or nerve disease. There are many types of neuropathy, but today we focus on diabetic sensory neuropathy. Here is a brief, condensed description clipped from the National Institute of Neurological Disorders and Stroke website.  Click here to see the more detailed information site.

“In diabetic neuropathy, one of the most common forms of peripheral neuropathy, nerve damage occurs in an ascending pattern. The first nerve fibers to malfunction are the ones that travel the furthest from the brain and the spinal cord. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs. Later, the fingers, hands, and arms may become affected.

Sensory nerve damage causes a variety of symptoms because sensory nerves have a broad range of functions. Larger sensory fibers enclosed in myelin register vibration, light touch, and position sense. Damage to large sensory fibers impairs touch, resulting in a general decrease in sensation. Since this is felt most in the hands and feet, people may feel as if they are wearing gloves and stockings even when they are not. This damage to larger sensory fibers may contribute to the loss of reflexes. Loss of position sense often makes people unable to coordinate complex movements like walking or fastening buttons, or to maintain their balance when their eyes are shut.”

The brain is constantly tuned in to information coming in from the eyes, ears and sense of touch. A healthy brain makes adjustments and prioritizes information to help you maintain your balance. In a situation where there is a lot of surrounding visual movement (like watching a big movie screen), a healthy brain will rely on a healthy inner ear and a normal sense of touch to assure the brain that you are not moving also.

When one part of the system fails, the brain can become too dependent on the remaining healthy components. So, someone with neuropathy may become too dependent on their inner ears and vision. That may be fine as long as there is stable visual information, but unsteadiness can occur in the dark or in a busy visual environment (like the movies or being in a crowd). People with neuropathy also are more affected if they suffer any type of inner ear injury.

Treatment usually consists of medical management to halt or slow progression of the neuropathy, and exercises to strengthen the legs, improve reaction time, and make most efficient and equal use of the remaining healthy components of the balance system.

Photo courtesy of coloradofootinstitute.com