The Dangers Of Mobility And Balance Impairment
If you’re living with mobility or balance problems, this is a familiar story. You’re innocently walking, and out of nowhere, an angry rogue floor knocks you down. No reason, just walking, then BOOM, down you go. Of course, laughing about an angry rogue floor helps lighten an embarrassing situation. The reality is balance problems will compromise your ability to exercise, puts you at risk for falls, injuries, or possibly breaking a bone.
Gary’s balance had slowly been deteriorating. His gait noticeably changed. His stance is wide, and he has trouble lifting his feet off the floor. As a result, it’s impossible to stop a fall. He was visited by a home physical therapy program a few years ago, but the director felt his neurological problems were beyond what the program could help.
Overview Ataxia is considered a symptom of your superficial ... More in superficial siderosis describes the incoordination resulting from loss of voluntary muscle control, often beginning with your arms or legs. This form of ataxia is considered a symptom of your superficial siderosis condition and differs from Hereditary ataxia or Sporadic ataxia, which are distinct neurological diseases. Superficial siderosis patients frequently experience different cerebellar ataxia symptoms combined with signs of central and peripheral vestibulopathy.¹
Ataxia or Vestibular?
There seem to be two underlying causes in Garys’ case. First, sometimes he describes a dizzy spinning sensation when he stands, closer to vertigo. Second, 15 years ago, he landed in the hospital after an exceptionally severe bout of rotational vertigo. This event was prediagnosis, so his ENT put him through a series of vestibular testing. Unable to determine the cause, the event was recorded as a vestibular event, cause unknown. These episodes of vertigo eventually tapered off to not happening ten years ago. That is until recently when it’s begun again.
Gary’s cerebellum and brainstem are heavily coated with hemosiderin and showing some atrophy. His symptoms tick off most of the ataxia boxes. His balance and gait are perfect examples of classic superficial siderosis progression. In the early years, he only experienced balance problems on uneven surfaces or in shadowed areas. Now it’s unsafe for him to walk without the aid of a walker. Recently he tried to cross the bedroom in the dark and fell, twisting his smaller aluminum walker into a mess.
There Is Always A Test
In 2018 Gary went to the kinesiology unit for a balance and gait evaluation. It helps to have a baseline test score for two reasons. The first is simple, how great is your fall risk? Second, your physical therapist is qualified to determine which assistive devices would best suit your case if they know your risk score.
Also, for superficial siderosis patients who have chosen to try chelation therapy, if your score remains constant with no progressive decline or if you see an improvement, then it’s a good indication your deferiprone is working.
POMA: Performance-Oriented Mobility Assessment
The performance-oriented mobility assessment (POMA).4 is commonly referred to as The Tinetti Test, in honor of its creator, Mary Tinetti. The evaluation was designed to indicate a fall risk accurately and maneuverability level to produce a better predictive result on re-testing.
Cerebellar degeneration or atrophy is often the underlying cause of cerebellar ataxia. The cerebellum plays a significant role in coordinating your fine motor function, gait, balance, vision, and swallowing. Cerebellar ataxia will also cause Overview The brain plays a crucial role in regulating sleep ... More, affect your executive function, Overview Superficial siderosis progression may have profound... More, mood, and increase your risk of Overview Depression is a common and serious mental health di... More.
The assessment contains two sections, Overview Proprioception is your body's ability to sense wher... More. Each part has a checklist of activities scored on points from 0 to 2, 0: profoundly impaired, 1: slightly impaired, and 2: normal function. For example, a standard gait test will return a maximum score of 12 and balance a 16. Both section scores are added together to determine the overall test score with a maximum of 28 possible.
Tinetti Tool Score Risk of Falls
Gary’s primary care physician had been the one to strongly suggest it was time to transition from a cane to a walker. I’ll say it wasn’t a welcome suggestion; however, when he scored a total of 15 on his Tinetti test, the physical therapist ordered the first of a few models Gary has now used. If we go anywhere there will be a lot of outside walking he uses a wheelchair.
Physical therapy, Vestibular Therapy, and strength training programs are great additions to your regular care plan. Rhys recently shared his physiotherapy session experience. Keep an eye out for our BEST LIFE series for ideas on how you can improve your balance and mobility.