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* * * 2006 ANNUAL GOANETTERS MEET - GOA * * *
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WHERE: Foodland Cafe - Miramar Residency - Miramar, Goa
WHEN: December 21, 2006 @ 4:00pm
More info:
http://lists.goanet.org/pipermail/goanet-goanet.org/2006-December/051398.html
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ANALYZING JIM'S MEDICAL PROBLEM
UNDERSTANDING BALANCE
Our normal balance is controlled by part of the brain called the brain-stem and
Cerebellum. This is located in the back-bottom part of the skull where the
head connects to the neck. It is one of those parts of the brain where one has
no conscious control of how it works. The cerebellum and brain stem control
balance by sending signals down the spinal cord to the muscles of the back and
the lower limbs.
However, for the brain to send the right signals, it needs some information to
process and then feedback on what muscles need to work more and others need to
relax. All this occurs in a split second. Thus we can maintain our posture and
balance, walk and be active without falling over - acts that we take for
granted, until we have problems doing them. The initial information and
feedback to the brain comes from three sources - Sensation in the soles of our
feet, muscles and joints of the lower limbs and back; Visual stimuli that tells
the brain the ground terrain and the alignment of the ground structures; and
the vestibule (labyrinth) in the inner ear which helps balance. The
five-thousand-dollar work-up that Jim underwent are to evaluate each of these
various organs. A new test to locate the origin of deficiency is called
"Posturography".
In Jim's case, because of his peripheral neuropathy, (PN) there is both muscle
weakness causing a foot drop in both legs, as well as a sensory loss in the
skin, muscles and joints. The reduced sensation in his soles is further
compromised by wearing a one inch hard boot sole for his foot drop. Remember,
nature had intended that we walk bare-footed.
So, all this time, Jim maintained his balance by his sight and ear stimulii
only. This may explain why over the last few years his imbalance increased
only late in the evenings and at night (when Jim got out of bed to go to the
bathroom). More recently with Jim losing his sight, the imbalance is occurring
even during the day. Imbalance in the bathroom and a fall is the most common
situation for hip fractures in the USA.
MANAGING IMBALANCE FROM NEUROPATHY
Well, enough of the bad news. Jim's brain is working fine. So, the question is
how can one stimulate Jim's brain even though two of nature's original signal
pathways (tactile sensation from the legs and visual stimuli) are failing him.
Well, we can get the signal pathway to originate in his hands. Thus, the hand
can be used for another point for spatial reference. No, Jim does not need to
walk on his hands or crawl on all fours.
One simple way for the sensory stimuli to get to the brain via the palm of the
hands is by using a cane or a walking stick. Most people use a walker or cane
to transmit part of the weight of the body from the trunk (thus reducing the
weight down the hips and lower extremities). Jim will be using his walking
stick for sensory transmission. The stick should be strong because at times,
Jim may use his cane for weight transfers.
The simple walking stick should do the trick. Jim is very unsteady in his
balance when he stands up from the living room chair. But he had no imbalance
when he gets up from his dining room chair. This suggests that with his hand
on the dining table, Jim's sensory stimuli to the brain had a point of
reference and achieved the right balance reaction immediately upon standing.
One can increase the effectiveness of the walking stick by using a stick where
the lower end has four prongs. The prongs work as toes in a foot. Most of
these canes have rigid metal prongs. There are some where two of the four
prongs have a spring mechanism with a gripper attachment which is useful in
inclement weather.
Jim should not use the cane as a weight bearing device, as long as possible.
The more Jim bears his own weight, the more likely it will prevent osteoporosis
and further muscle wasting. If Jim wants to strengthen his muscles in the
lower limbs without having the imbalance problem, he could exercise on a
stationary bike or in a standing and weight-bearing position. These exercises
promote proprioception (sense of position of various parts of the body) which
improves one's ability to balance.
Regards, GL
Final part to follow, which connects neuropathy to Goa!
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Goanet supports BMX, the alumni network of Britto's, St Mary's and
Xavier's -- three prominent institutions in Mapusa, Goa. Events
scheduled from Dec 16 to 21, 2006
For more details visit http://www.bmxgoa.com
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