From the Guidelines
Closing the eyes would most likely cause someone with impaired proprioception to fall when standing with their feet together. Proprioception is the body's ability to sense its position in space without visual input, and individuals with impaired proprioception rely heavily on visual cues to maintain balance. When standing with feet together, the base of support is already narrowed, creating an inherently less stable position. Without visual feedback to compensate for their proprioceptive deficit, these individuals cannot accurately determine their body's position or make the subtle postural adjustments needed to maintain balance. This relationship between vision and balance is the basis for the Romberg test, a common neurological assessment where patients stand with feet together and then close their eyes. Those with proprioceptive impairments typically demonstrate significant swaying or falling when visual input is removed, as they've lost their primary compensatory mechanism for maintaining postural stability 1.
The importance of addressing gait and balance problems in the elderly is highlighted in a study published in 2025, which emphasizes the need for clinicians to be aware of any alterations in sensory or motor function, especially vision, hearing, gait, and balance, to fully interpret symptoms of cognitive or behavioral change 1. Furthermore, a study published in 2020 found that exercise interventions, particularly those that include balance training, are effective in preventing falls in community-dwelling older people 1.
Key factors that contribute to the increased risk of falls in older adults include a history of falls, mobility problems, and poor performance on the timed Get-Up-and-Go test 1. In the context of impaired proprioception, the removal of visual input by closing the eyes would exacerbate the existing balance deficit, making it more likely for the individual to fall.
In terms of prevention and management, exercise and physical therapy interventions have been shown to be effective in improving balance and reducing the risk of falls in older adults 1. However, in the specific scenario of an individual with impaired proprioception standing with their feet together, closing the eyes is the action that would most likely cause them to fall.
From the Research
Impaired Proprioception and Balance
People with impaired position sense, such as the 85-year-old man in the scenario, often rely on other sensory inputs like vision to maintain balance. When standing with their feet together, they are more likely to fall if they:
- Close their eyes, as this eliminates visual input and makes it difficult to maintain balance without proprioception 2, 3, 4 Other options like flexing the neck, extending their arms in front of them, flexing the knees, or turning the head may not directly cause a person with impaired proprioception to fall when standing with their feet together.
Role of Vision in Balance
Vision plays a crucial role in maintaining static balance, especially in individuals with impaired proprioception. Studies have shown that:
- Vision helps to compensate for the lack of proprioceptive input and maintain balance 5, 3
- Individuals with visual impairments have difficulty maintaining balance, especially in single-leg stance tests with eyes open and closed 3
- The absence of visual input, such as when closing the eyes, can significantly affect balance and increase the risk of falls 2, 3, 4
Key Findings
- Impaired proprioception can lead to difficulties in maintaining balance, especially when standing with feet together 6, 4
- Vision is essential for maintaining balance, and its absence can increase the risk of falls 2, 3, 4
- Individuals with impaired proprioception and visual impairments are at a higher risk of falls and may require targeted interventions to improve balance and reduce fall risk 2, 6, 3