While everyone knows about the “five senses” – sight, hearing, smell, taste, touch – most likely you have paid little attention to another important sense, the sense of balance, unless you have problems with balance. Many of the neuromuscular diseases do affect balance.

Your sense of balance informs the brain about where your body is in space, including what direction your body moves and faces and if your body is still or moving. Your sense of balance relies on sensory input from a number of systems. Disruption in any of the following systems can affect your balance and equilibrium:

--Proprioception involves the sense of where the body is in space. Sensory nerves in the neck, torso, feet and joints provide feedback to the brain that allows the brain to keep track of the position of the legs, arms, and torso. The body then can automatically make tiny changes in posture to help maintain balance.

--Sensors in the muscles and joints also provide information regarding which parts of the body are in motion or still.

--Visual information provides the brain with observations regarding the body’s placement in space. In addition, the eyes observe the direction of motion.

--The inner ears (labyrinth and vastibulocochlear nerve) provide feedback regarding direction of movement, particularly of the head.

--Pressure receptors in the skin send information to the brain regarding what parts of the body are in space and which part touch the ground (when standing), a chair (when sitting), or the bed (when reclining).

--The central nervous system (the brain and spinal cord) integrates and processes the information from each of these sources to provide one with a “sense of balance.”

Problems with balance may occur in many individuals with neuromuscular disease, including children and adults. For example, problems with proprioception often occur in individuals with diseases such as Freidreich’s ataxia, Charcot Marie Tooth, myopathy, and spinal muscular atrophy due to loss of sensation in the joint. Visual losses and severe muscle weakness can lead to balance difficulties for those with mitochondrial myopathy. Loss of muscle strength occuring in neuromuscular disease can also contribute to balance problems.

If you have problems with your balance, this can contribute to problems such as poor gait, clumsiness, and falling. Falling can cause injury, including minor injuries such as cuts and bruises, as well as major injuries such as bone fractures and head injury. Poor balance can also lead to sensations such as disequilibrium, light-headedness, dizziness, and vertigo. Balance problems may also lead to social embarrassment.

If you have neuromuscular disease, you may benefit from consulting our physicians regarding methods for improving balance. Methods may include learning new movement habits, improving concentration and attention to movement, engaging in physical therapy and appropriate moderate exercise, making home modifications, and use of assistive devices.

Even though sense of balance has often been overlooked unless problems develop, your sense of balance provides important sensory information that impacts your quality of life. A better understanding of this important sense can help you to cope better with the challenges of living with neuromuscular disease.

Resources:

CMTA, (n.d). Understanding CMT: Types and Causes. CMTA website. Retrieved 2/18/17 from https://www.cmtausa.org/understanding-cmt/types-and-causes/

Kids Health from Nemours, (2016). Balance Disorders. KidsHealth from Nemours website. Retrieved on 2/18/17 from https://kidshealth.org/parent/medical/ears/balance_disorders.html

MDA, (2008). A Teacher’s Guide to Neuromuscular Disease. Retrieved 2/18/17 from https://www.mda.org/sites/default/files/publications/Teachers_Guide_NMD_P-225.pdf

MedicineNet.com, (2002). Balance – How Do We Do It? Retrieved on 2/18/17 from https://www.medicinenet.com/script/main/art.asp?articlekey=14637

Medvascek, C., (2002). All Fall Down: Staying Upright With a Neuromuscular Disease. Retrieved on 2/18/17 from https://www.mda.org/quest/article/all-fall-down

NINDS, (2010). Friedreich’s Ataxia Fact Sheet. NIH NINDS website. Retrieved on 2/18/17 from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Friedreichs-Ataxia-Fact-Sheet

WebMD, (2014). Dizziness, Lightheadedness and Vertigo – Topic Overview. WebMD website. Retrieved on 2/18/17 from https://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overview