Page 13 - A Guide to Physical and Occupational Therapy for CMT

Balance
Decreased balance and falls are often reported by individuals with CMT and
have a significant impact on quality of life. Balance physiology involves the
input of sensory information from the visual, vestibular (inner ear and balance)
and somatosensory (sensation) systems. Information regarding the body’s
position in space is gathered from the nerve sensors throughout the body
and compared in the brain. The brain then activates the appropriate muscles
to correct or maintain balance. These corrections are referred to as balance
strategies.

In people affected by CMT, normal balance physiology is impaired.
Somatosensory information may be limited due to the nerves’ inability to relay
back an accurate signal, which may confuse the brain in interpreting your
position in space. Weakness, specifically in these muscles, can decrease the
ability to use these muscles to correct for small changes in balance, resulting in
unsteadiness. Age-related changes in the vision and vestibular systems, as well
as other health issues, affect balance. Different types of CMT and the stage of
disease progression may result in variable presentations of balance impairment.
The assessment of balance is often guided by patient report, age and
abilities. Assessment of sensation, strength and functional abilities, including
gait and stair negotiation, are essential. An understanding of how your balance
ability and confidence affects your participation in daily activities both inside and
outside the home is also important.

Interventions to address balance issues are
guided by the results of the assessment, as
well as your personal goals. Interventions
are often multi-dimensional and should
be task-specific. Balance training may
be effective. The use of orthotics (foot
orthoses, lace up ankle supports,
ankle foot orthotics) and assistive
devices (walking sticks, canes, walkers
and powered mobility devices) may
be appropriate means of addressing
balance limitations. It is also important
to include patient education and fall
management as part of the intervention.