Gait and Balance


Proprioception is your body’s ability to sense where your body parts are with your eyes closed or in darkness. Proprioception is essential for motor control.

Our vestibular system is like a gyroscope for the body.

Balance problems, gait impairment, neuropathy pain, sensory ataxia, vision, and dizziness may all have a role in why a person with superficial siderosis might slowly lose the ability to walk or stand safely without an assistive device. Changes in gait occur as a person’s vision, proprioception, and vestibular sense become progressively impaired. For example, while standing upright, SS patients can often lose the ability to hold still whether their eyes are open or closed. As a result, it may become impossible to walk from heel to toe, in a straight line, or on their tip-toes. In addition, their balance problems will begin to make it difficult to stand on one leg. The body’s natural response to gait impairment will be an unconscious effort to walk with your feet spread apart, forming a broad base, coming down first on your heel and then rocking onto the toe. This gait response is often compared to that of the “drunken sailor.”

Balance Impairment

Your balance may be affected by either or both of two sources. First, because the cerebellum plays such an essential part in coordinating movement, your balance will suffer from the loss of function. Loss of vestibular sense impairs the ability for smooth movement and can bring episodes of dizziness. You can blame the eighth cranial nerve. A person needs a functioning vestibular sense to control the position and direction of the head. It’s a sensory system like proprioception. Without a working sense of proprioception, a person could not touch their nose or elbow with their eyes closed.


Repeatedly falling will eventually result in injury. Supporting a person’s ability to walk while preventing falls is essential. The time needed to recover from a broken bone or pulled muscles will only worsen mobility problems. In addition, it’s critical to be adequately educated on the correct use of assistive devices.

Sensory ataxia and neuropathy pain can also aggravate falling. Many SS patients describe a complete loss of feeling, either on the bottoms or their whole foot. This sensation is a symptom of sensory ataxia, which results from peripheral neuropathy damage.

Fall Prevention Tips

  • Wearing flat or very low-heeled shoes.
  • Being conscious of where you are walking. For instance, stay away from a freshly washed floor.
  • Move electric cords, secure loose carpet or rugs.
  • Apply no-slip strips to slippery surfaces.
  • Walking with a cane is recommended for safety in the earlier stages.
  • Double hiking poles are excellent when walking over uneven terrain.
  • The use of an aluminum walker or rollator will benefit you when your balance issues go beyond the use of a cane.

Treatment Strategy

A physical therapist should be able to suggest exercises or vestibular exercises for gait training. These specialized training exercises are intended to induce brief periods of loss of balance to help you learn to adapt. Activities may include eye or head movements, distorting or eliminating visual input, and changing or moving weight-bearing surfaces.

If you’re having difficulty walking, speak to your physician.  Fall prevention is a vital step to improving your mobility, staying independent and safe from injury.

Sources: Superficial siderosis is a rare neurologic disease characterized by progressive sensorineural hearing loss, cerebellar ataxia, pyramidal signs, and neuroimaging findings revealing hemosiderin deposits in the spinal and cranial leptomeninges and subpial layer. The disease progresses slowly, and patients may present with mild cognitive impairment, nystagmus, dysmetria, spasticity, dysdiadochokinesia, dysarthria, hyperreflexia, and Babinski signs. Additional features reported include dementia, urinary incontinence, anosmia, ageusia, and anisocoria. Superficial siderosis MedGen UID: 831707 •Concept ID: CN226971 •Finding Orphanet: ORPHA247245

Living With SuperficialSiderosis Website PubMed Reference Library 

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