Losing Sense of Body Position and Movement With Ataxia: Understanding Proprioception Loss

Frequent stumbling and poor balance are among the earliest signs of ataxia, especially Friedreich ataxia. These are signs of ataxia affecting your proprioception, which is your body’s ability to sense its position in space.

Proprioception loss can lead to frequent falls, which can increase your risk of injuries and reduce your independence.

Like other symptoms and complications of ataxia, proprioception loss can cause challenges with getting around and taking care of yourself. Since proprioception loss can be one of the earliest signs of ataxia, you should tell your doctor right away if you suddenly have trouble with balance and body position awareness.

Understanding Proprioception

Just like your eyesight and hearing, proprioception is one of your natural senses. It’s complex, but it allows you to sense and be aware of your body’s position and movements. You don’t have to focus on it — it happens automatically.

Many parts of your body help support your proprioception, and damage to any of them can result in proprioception loss. You can thank the following body parts and systems for helping you stay balanced and aware of your position.

• Cerebellum — This part of the brain coordinates movements and maintains balance.
• Muscles and joints — You have sensory receptors in your muscles and joints that help with balance.
• The vestibular system in your inner ear — Certain structures inside the inner ear can detect head movements.
• Your eyes — Your proprioception can still work when you close your eyes or lose your vision.

When you have certain types of ataxia, damage to any of these can worsen symptoms of proprioception loss. For example, if you’re walking around in low light and can’t see as clearly, you may also feel more off-balance. However, cerebellar ataxia may not worsen when you take away visual cues.

What Proprioception Loss Looks Like With Ataxia

Once you know what proprioception is and how proprioception loss affects you, it becomes easier to recognize signs of increasing proprioception loss while living with ataxia.

Signs of proprioception loss progressing in ataxia can include:

• Experiencing spatial awareness problems, such as frequently walking into walls or objects
• Having increasingly uncoordinated movements
• Needing to watch your feet while you walk
• Not knowing the position of your feet while standing
• Unintentionally using too much force when using your hands
• Becoming more heavy-footed (stomping while walking)
• Missing objects when reaching for them
• Needing to hold onto walls or railings for support or guidance

Tell your doctor if you believe your proprioception is getting worse while living with ataxia.

Factors That Make Proprioception Loss Worse

Certain factors can make it harder to know your body’s position and stay balanced when ataxia already affects your proprioception.

Addressing or avoiding some of these factors might help improve your proprioception:

• Alcohol consumption — Alcohol makes you less steady on your feet and can worsen existing proprioception loss.
• Vitamin deficiencies — Proprioception loss is a main feature of ataxia with vitamin B12 or vitamin B1 deficiencies. These deficiencies can cause or worsen proprioception loss in ataxia.
• Low lighting — Darkness or low lighting make it harder to see, which can worsen proprioception loss for people with sensory ataxia.
• Fatigue — A possible symptom of ataxia, muscle fatigue can worsen proprioception and increase balance issues.

Evaluating Proprioception Loss in Ataxia

If you experience signs of worsening proprioception, your doctor may want to evaluate you with an exam and tests. They may also test for conditions other than ataxia that can cause proprioception loss or make it worse. Evaluating proprioception might involve the following tests.

Romberg Test

A Romberg test is a common proprioception test to check your dorsal column pathway. This pathway is a part of the spinal cord that integrates sensory input and largely controls proprioception. Friedreich ataxia affects this part of the spinal cord and causes proprioception loss because of it.

During the test, you stand with your feet together and your arms either crossed or at your sides. Part involves closing your eyes, and part involves having your eyes open. Your healthcare provider watches you for signs of poor balance, like swaying or falling over.

Joint Position Reproduction Test

A joint position reproduction (JPR) test, also called joint position matching, involves memorizing a way of positioning your joints and later reproducing it by memory.

For this test, you hold the position for five or 10 seconds as your healthcare provider observes you. The positions are highly specific and require working proprioception to recreate.

Blood Tests for Nutrient Deficiencies

Your doctor may want to give you a blood test to check for any nutrient deficiencies that contribute to proprioception loss or ataxia as a whole. They’ll check for low vitamin B12 levels, which can affect your sensory nerve function and affect proprioception.

Magnetic Resonance Imaging

MRI scans are commonly used to evaluate some forms of ataxia because they can show how much shrinkage has occurred in parts of the brain. Your doctor might look at your cerebellum or other areas for visible evidence that your ataxia (and proprioception) is worsening.

Coping With Proprioception Loss

Proprioception loss can create challenges in everyday life. Your doctor can give you tips for coping with proprioception loss as you manage your ataxia.

Physical Therapy

Physical therapy is a mainstay treatment for proprioception loss as well as balance and gait issues. A licensed physical therapist can teach you exercises that help improve your proprioception and balance, including balancing on one leg at a time and walking in a straight line.

Problems with proprioception can involve all of your muscles, so exercises to improve balance and proprioception often target many muscle groups. A physical therapist can coach you with individualized balance and gait training based on your needs.

Assistive Devices and Footwear

Assistive devices like walking aids and orthotic shoe inserts can help you stay more balanced while standing or walking with proprioception loss. These can be especially helpful for people with foot deformities like pes cavus (short feet with very high arches), which are common in people with Friedreich ataxia.

Home Modifications

It may help to modify your home so that it’s easier for you or your child with ataxia-related proprioception issues to get around. Clear pathways, keep the floors clean, and make sure your home is well lit so that it’s easy to see.

You might also consider installing railings in places where falls are more likely to happen, like near the stairs or in the bathroom.

Talk to Your Doctor

If you notice signs of declining proprioception in yourself or your child with ataxia, let your doctor or care team know about the changes. They may recommend tests to evaluate your senses or your ataxia progression.

Your doctor can tell you if your proprioception loss is directly related to ataxia progression or if there are other conditions or behaviors that are interfering with your senses. They can also offer more practical tips for managing proprioception loss in ataxia.

When To Seek Immediate Care

Get immediate medical care if you notice sudden and dramatic changes in proprioception. If you suddenly can’t stay upright or keep falling, you should get in touch with your doctor right away.

It’s also important to get immediate medical care if you notice concerning or unusual symptoms alongside proprioception loss, such as nausea, vomiting, or signs of a stroke.

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