How to deal with coordination and balance with HNPP

My muscles are twitching continuously as I write this, which is among a long list of symptoms that tend to appear with HNPP such as lack of coordination, weakness and generally falling over for no apparent reason.

Well of course there’s a reason. But for most it can differ quite significantly.

HNPP affects both motor and sensory nerves, which causes weakness in the foot and lower leg muscles. Deformities of the feet are also common, making it difficult to walk and often resulting in falls. In its later stages, HNPP can also affect the muscles in the hands. Sensory nerves carry messages from your senses through your spinal cord to your brain, while motor nerves travel in the opposite direction. They carry messages from the brain to your muscles.

If nerve cells, or neurons, are damaged or destroyed, it distorts the way the neurons communicate with each other and with the brain.

Causes of falls

The physical causes can be many and complex, there are, however, some factors that feature very regularly:

• A previous fall – Somebody who has fallen in the last year is more likely to fall again. This may be because the same factor that caused the first fall is still present, or it may be that fear of falling has reduced their level of activity, making them weaker and more prone to fall.
• Medications – Some widely used drugs, including anti-depressants and diuretics, can cause dizziness and loss of balance. Taking a combination of four or more drugs also ramps up the danger of falling.
• Poor balance and impaired gait – Balance problems are common with HNPP. Inability to walk in a straight line or at a steady speed; requiring support in order to walk; inability to stand on one leg or to sit down in a controlled manner, can all indicate an increased likelihood of falling.
• Effects of illness – Several acute and chronic conditions increase the likelihood of falling.
• Poor vision – Not surprisingly, you are more likely to trip if you can’t see obstacles clearly. Bifocal and varifocal glasses can also cause problems by distorting the view, if you look through the wrong part of the lens. With peripheral nerve issues, neuropathy can affect the eyes. According to the website at E Medicine Health, there are two specific types of what is referred to as cranial neuropath and these are optic neuropathy and auditory neuropathy. Optic neuropathy refers to damage or disease of the optic nerve that transmits visual signals from the retina of the eye to the brain according to E Medicine Health.
• Environmental hazards – Most falls occur in the home. Familiar culprits are trailing flexes, uneven rugs, poor lighting, general household clutter left in passageways. Climbing on chairs or stools to reach items stored in high cupboards. Outside, it is often damaged, uneven paving or unexpectedly high kerbs that cause problems.
• Numbness – numbness in the feet can make it difficult to maintain balance, especially in the dark.

What can be done?

Dr Scott Berman, who also suffers from neuropathy writes in Coping With Peripheral Neuropathy, that if the nerves that carry position sense are damaged we depend on eyes more. If your feet can’t tell your brain where you are and your eyes can’t see, then you will fall. [1] Here are some of his suggestions:

• Using nightlights all the time – this makes sure you’re aware of your surroundings
• Use a cane or canes, arm braces – this sends information about the floor to your arms, and from there to your brain
• Touching surfaces lightly with hands may improve balance
• Proofing your environment – using walkers, canes, grab bars in showers, shower seats, bed rails, car door frame handles etc. may help prevents falls. Also securing rugs and carpets around the edges, reduce floor clutter, modify low furniture and much more.
• Get a Personal Emergency Response System if you live alone – these are buttons on a bracelet or necklace to summon help
• Get a physical therapist to help plan ways to help avoid falls
• Get an occupational therapist, if you are still working, to set up your workplace for your safety
• Buy adaptive equipment – kitchen gadgets and special utensils, reaching instruments to make life easier.
• Get adequate footwear – Adam Sternbergh, in his article, “You Walk Wrong” says wrong footwear has wrecked our gait. Inserts can often offload pressure points on your feet and will reduce the chance of ulcers. Make sure you have soft slippers for hard floors.
• Look into getting a stairlift if you have a fair few steps in your home.
• Think about doing low-impact exercises that improve balance such as Tai Chi and water aerobics.

The last thing you need is an injury on top of the chronic pain and fatigue, so finding methods to prevent falling and gaining good balance is essential to stop future health problems.

• Page 38, “Coping With Peripheral Neuropathy”, Berman, Scott M.D