Mayo Clinic Connect
What exactly is proprioception? Anyone with experiences?
Johnny3, proprioception is a three-dollar word for the third balance system. Your inner ear provides the first system. The auditory (hearing) and vestibular (balance) nerves are often wrapped around each other, so a problem with hearing often impacts your primary balance system as well. The second balance system, vision, is not good to use: every time you move your head or go around a corner while driving, your focal point changes and you lose your concept of where you are in space. So, it's time to learn to use proprioception to be confident of where your are.
Simply put, proprioception is what makes you lean into the wind just enough to stay upright. It's all the information you get from your feet, ankles, knees, hips, etc.–mostly from your feet, which are not just something underneath your body but a great source of balance. I learned to use proprioception over 30 years ago; at that time, there were almost no PTs who specialized in vestibular rehab (VRT). Today, more and more PTs work with VRT, or are at least aware of it. I learned how to do VRT while working on a book about Meniere's–the author sent me exercises via e-mail. In less than a month, I was far more stable, and after two months I could do many of the things I had been unable to do. It has to be practiced every day to work, but the reward is really worth it.
To start, find a place in a hallway with walls on both sides, or a cooperative helper. Feet not very far apart, close your eyes. Repeat this until you can stand without wobbling. Then, try walking in a hallway with your eyes closed, any tripping hazard removed (like throw rugs). It's easiest to start in your sock feet, then progress to hard-soled shoes as you gain confidence. At the same time, whenever you walk anywhere, avoid staring at the surface right in front of you; instead, look at the world around you. Glance down just to confirm that there's nothing to trip you within the next several feet, then walk ahead without looking down, thinking about what your feet are telling you. This is the really important thing: always paying attention to information from your feet! You may find it easier to walk around in your home after dark with all lights off. I do this every night before I go to bed. As you get more skillful, start walking outside in low light conditions over relatively even surfaces, like a sidewalk. Progress to walking over rougher surfaces in low light. Initially, you should do at least one 15-minute session every day. You will find that you have more confidence not only in walking but in driving and doing things with your hands. After paying attention to what your feet tell you becomes natural, you can quit doing exercises, except for walking in low light situations or the dark at least once every day. At that point, you will have taught yourself to rely on proprioception. You won't need to think about what your feet tell you–it will be natural. Don't ever rely on night lights! Be extra careful when you first wake up, as you must move around a little before your ability to balance kicks in. A good thing to do is to dress standing next to a dresser or counter WITHOUT touching the surface. This includes putting on your socks, which will require a bit of learning. I find that I need to be up and about for at least a half hour before being able to put on socks standing without touching any surface.
If all older folks worked on proprioception, there would be far fewer injured due to falls. *end of lecture!*
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Thank you for responding. Very informative. Much gratitude in you time and effort in responding to this discussion. Your effort into this therapy sounds relentless. I noticed older folks don't give up! My further research on this subject is seeing if it relates to hand movements such as typing, hand to mouth, etc. Or if this is another subject area to explore.
Learning proprioception definitely improves hand/eye coordination. Before I started VRT, I had to spread my fingers apart, each onto my desk top, and close my fingers until they connected with the pen or pencil I was trying to find. Post VRT, I can simply reach down and pick the pen up without hesitating. It has also helped a great deal in the kitchen, where I no longer chop my fingers instead of the veggies!
When you start VRT, you may think it's not going to help, that it's a silly thing to do, that it's too simple to work. All wrong! I guarantee that, if you try VRT and work on it (really work, not just sorta do it), you will begin to see improvements within a couple of weeks, and much greater improvement after a month or six weeks. Again, you only need to do the formal exercises until proprioception becomes natural for you. At that point, you need to remember to use it every day, do a little walking in the dark (or with your eyes closed), but it is a tiny price to pay for the improvement in how you will feel.
Also, 30 years ago, it was believed that you couldn't benefit from VRT until your condition was stable. For Menierians, that meant not having crises. When Meniere's struck again, turning my situation into a bilateral (both ears) one in May, I have been thrilled that I'm not having serious balance issues. I have ramped up the VRT to compensate for the increased imbalance, but I've been able to do really difficult instream work for our fisheries agency recently, even climbing algae-encrusted boulders to get above a waterfall, over a huge slide comprised of clay that's almost as slippery dry as it has been wet. Most PTs now agree that you can't wait in the hope of getting better before starting VRT–it is the way you will get better. If only I had known that 30 years ago, perhaps I would have escaped four years of creeping around, perpetually afraid of falling, never knowing exactly where I was or where other things were.
Welcome, and good luck with VRT!
Thank you for your time and effort in responding. Continue with great success in your therapy.
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So VRT is available from physical therapists? Do most PTs teach this or is it a specialty?
Some information on VRT I found on UTube
Maryjax, in response to your question, not all PTs have VRT experience, but it is becoming more common. Again, 30 years ago there was little known about VRT, almost no therapists.
The YouTube video from the House Clinic is great! These are really easy exercises, a good place to start. For me, it's easier to do real things instead of set exercises, which is why I make a practice of getting dressed and undressed while standing, without touching anything. Especially challenging to don panty hose! Remember that your balance is never as good when you first wake up, so don't try VRT first thing.
FWIW, the House Clinic is perhaps the best known place to go for vestibular rehab. At one time, Dr. F. Owen Black in Portland, Oregon was THE best diagnostician, but fell short in teaching people how to live well in spite of their vestibular problems. Vestibular.org was originally named "Dizziness and Balance Disorders," changed their name 20 or 25 years ago. Believe that you can live well in spite of vestibular disorders. Like many other things, most people will eventually have less efficient inner ears and need to work on balance. The ROI (return on investment) is great, well worth the effort.
I’m taking Tai Chi which is great for balance and is similar in many ways, but I’ll add some VRT since I’m over 65 now.
Maryjax, Tai Chi is a good form of VRT. There is the provisio that it's best to get evaluated by a VRT specialist and do exercises chosen by him/her to start, to give you a good foundation. For long term success, finding something that fits your lifestyle (like Tai Chi or my walking in difficult low light situations) will work better than sets of exercises because you're more likely to do it every day. And, you do really need to work on balance every day, no matter how busy you are. The exercises are a starting point, should teach you to be constantly aware of proprioception. Once that has become part of the way you move, you can rely far more of Tai Chi or some other activity that you can enjoy doing. Personally, I do much better if I can combine awareness of proprioception with some activity that I need to do anyway. For example, my mailbox is a quarter mile away on our gravel road. Walking there every day, I walk at least a short distance with my eyes closed, and I think about how the rough surface feels underfoot the entire distance. For me, it works because I do something that needs to be done while improving balance–in other words, not an exercise alone but a lifestyle. Every night, the last thing I do is turn off all the lights and walk through the house. While I do have a destination (bedroom), I think about what my feet are telling me the entire time rather than just blundering along. This seems to teach you not only what your feet have to say, but your place in space. As I walk past the library table in the living room, I lightly touch the edge of the table to ensure that I don't meander off into the bookcase on the opposite wall. This isn't "furniture walking" where you clutch the things you're passing, but a very light fingertip touch every couple of feet. Even if I drive out to run errands, I don't stop at the mailbox but walk there, which is sort of a manufactured thing to do as I could have simply pulled to the side of the road and grabbed the mail–but that "job" gives the exercise additional meaning and is far more likely to happen than promising that I'll do so many step down/ups or marches in place or lunges. It's hard for me to be happy with exercising just to exercise: I like to accomplish something while doing the exercise.
Once you're relatively stable, challenging your vestibular system by, say, climbing a ladder, is excellent and will give you more stability for two or three days. For me, the good thing about cleaning gutters (one of the worst things homeowners must do) is that I can wade to fish for a couple of days afterwards without relying on a wading staff! Painting is often challenging, esp. as you follow a trim line a distance, even off a ladder but far better from a ladder. A couple of years ago, before I became bilateral, I was with a fisheries group that had to cross a very high swinging bridge (emphasis on the swinging part). I found that I did better than many of the younger norms because I focused on my feet and just walked across, while they were horrified at how high and unstable the bridge was. However, I still need to work on side-to-side motion, like fishing a fast piece of water that keeps rushing past or sitting in an anchored boat while other boats move around near me. I cannot watch a train at a crossing: just a couple of minutes will mean my most recent meal wants to make a repeat appearance. I'm certain that each of us is affected by different things, but we all need to learn to deal with things that will happen in our lives so that we can move about with ease, without fear. As your balance improves, you'll have far less fear of falling or of people pushing you down. Yeah, I've had that fear, know that it's not true, but still was haunted by it before I started rehab decades ago. I suspect I'll always have some fear of heights, especially when I need to walk along a narrow ledge with a steep drop downhill–but I can be far less fearful than I am now.
Shopping in a big box store is a challenge on many levels. It's almost a certainty that at least one group of fluorescent lights is flickering, which is bothersome even if you aren't aware of it happening. Everyone around you is moving in ways you don't always expect, especially kids. Every aisle is packed with brightly-colored boxes that jazz your vision as you walk past. The final blow is often checkout, where you bag your own items. Because you probably also have some reduction in hearing, make it easy on yourself: simply tell the checker that you don't hear well and ask her/him to wave at you if they need to ask a question or tell you something. That way, you can bag stuff without constantly looking back to see if that person is trying to communicate with you. If masks make it impossible (or nearly so) for you to understand what they're saying, be upfront about that. Most clerks are trained to say needless social things like, "Have a nice day" that are entirely unnecessary. If you make it clear that you really can't understand, most clerks will be careful to speak clearly and slowly after getting your attention if they need to tell you or ask you something. Cut to the chase and save your sanity–and the clerk's as well.
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