From the Guidelines
Diminished proprioception is a condition characterized by impaired sense of movement, action, and location, often caused by vitamin B12 deficiency, as highlighted in the 2024 NICE guideline summary published in the BMJ 1. This condition occurs when specialized nerve receptors in muscles, tendons, and joints are damaged or dysfunctional, preventing accurate information about body position from reaching the brain. Some common causes of diminished proprioception include:
- Peripheral neuropathy, often resulting from diabetes
- Vitamin B12 deficiency, which can lead to neurological or mobility problems, including myelopathy and sensory ataxia 1
- Certain medications
- Stroke
- Multiple sclerosis
- Normal aging Symptoms of diminished proprioception typically include:
- Poor balance
- Clumsiness
- Difficulty with coordination
- Increased risk of falls, especially in the dark when visual compensation isn't possible
- Need to watch their feet while walking
- Struggle with tasks requiring fine motor skills Diminished proprioception can be assessed through clinical tests, such as the Romberg test or having patients identify joint position changes with their eyes closed. Treatment focuses on addressing underlying causes when possible, such as vitamin B12 deficiency, and implementing physical therapy exercises that challenge and potentially improve proprioceptive function, including balance training on unstable surfaces or movements with eyes closed.
From the Research
Definition of Diminished Proprioception
Diminished proprioception refers to a reduced sense of body position and movement. This can result in impaired motor actions and a decreased sense of body ownership 2, 3, 4.
Causes and Effects of Diminished Proprioception
Diminished proprioception can be caused by various factors, including autoimmune responses, injuries, and diseases. For example, Ian Waterman suffered from a rare autoimmune response that attacked his sensory neurons, resulting in a complete loss of proprioception below his neck 2. This loss of feedback made it difficult for him to coordinate his movements, leaving him immobile and unable to stand, walk, or use his body to interact with the world.
Assessment and Rehabilitation of Diminished Proprioception
Proprioception can be assessed through various clinical tests, including joint position sense error, which is the most widely used objective measure of proprioception 4. Rehabilitation interventions can include active or passive movement training, somatosensory stimulation training, force reproduction, and somatosensory discrimination training 4. Active movement interventions have been found to be the most effective in restoring proprioceptive acuity 4.
Relationship between Proprioception and Vestibular Function
While diminished proprioception is a distinct concept, it can be related to vestibular function, as both are essential for maintaining balance and spatial orientation. Vestibular rehabilitation has been shown to improve gaze and postural stability, and improve function in individuals with vestibular hypofunction 5. However, the focus of vestibular rehabilitation is on addressing vestibular deficits, rather than specifically targeting proprioception 5.
Key Points
- Diminished proprioception can result in impaired motor actions and a decreased sense of body ownership 2, 3, 4.
- Proprioception can be assessed through various clinical tests, including joint position sense error 4.
- Rehabilitation interventions can include active or passive movement training, somatosensory stimulation training, force reproduction, and somatosensory discrimination training 4.
- Active movement interventions have been found to be the most effective in restoring proprioceptive acuity 4.