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  • Dr. Allison Andre, DPT

Your Body's Secret to Better Balance: The Importance of the Somatosensory System

To navigate the world with ease, balance is essential. It's what allows us to move through life with confidence and grace, whether we're walking, running, or simply performing daily activities.


Did you know that optimal balance depends on the coordinated and integrated input of several sensory systems, including visual, vestibular, and proprioception?

When these sensory systems work together seamlessly, we can move freely and safely through the world. However, disruptions or imbalances in any of these systems can lead to difficulties in maintaining stability and increase the risk of falls and injuries.


Somatosensory training is a powerful method I frequently employ with patients to enhance balance. It focuses on stimulating and improving the proprioceptive system, which provides information about body position, muscle tension, and joint movement. By incorporating specific exercises and techniques, somatosensory training can result in remarkable improvements in balance and stability.


Let's embark on a journey into the fascinating world of somatosensory balance training. We will explore the significance of all three sensory systems, uncover effective training methods, and discover how this specialized training can enhance our overall well-being and safety.


woman sitting on a balance board with ocean behind her

 

TABLE OF CONTENTS


 

Why Balance Is Important

As we age, falls become a common worry and can have a significant impact on our wellbeing. According to the World Health Organization (2007), a fall is defined as an unintended change in position leading to an individual coming to rest on the ground or at a lower level, not due to a major intrinsic event (such as a stroke) or an overwhelming hazard (such as being struck by a vehicle).


For older adults, falls can have various causes, including changes in balance, vision problems, medication side effects, and environmental hazards such as uneven flooring or poor lighting. The consequences of falls can be severe, leading to physical injury, discomfort, loss of function, and even a fear of falling. All of these can have a negative impact on one's overall quality of life and can have serious consequences, including fractures, head injuries, and other injuries that can lead to disability or death.


The CDC reports that falls are responsible for over 95% of hip fractures in older adults and are also a major cause of traumatic brain injuries (CDC, 2020).

Falls are a significant health concern for older adults, and they are the leading cause of both fatal and nonfatal injuries in this population.


One in four adults aged 65 and older falls each year, and falls are responsible for over 3 million emergency department visits and more than 800,000 hospitalizations annually in the United States (CDC, 2020).

The risk of falling increases with age, with adults aged 75 and older being four to five times more likely to be hospitalized for a fall than those aged 65 to 74 (CDC, 2020).


The consequences of falls in older adults can be devastating, leading to physical, psychological, and economic burdens. These alarming statistics underscore the critical importance of fall prevention, highlighting the need to prioritize effective strategies that can help reduce fall risk. One such strategy is somatosensory balance training, which has been shown to improve balance and stability, making it an essential component of any fall prevention program.




THE SOMATOSENSORY SYSTEM AND BALANCE



Have you ever wondered how you're able to stand upright without falling over? Well, it's all thanks to a process called postural control! Our central nervous system (CNS) works hard to regulate information from the visual, vestibular, and proprioceptive systems in order to produce the appropriate motor output needed to maintain a controlled, upright posture.


The ultimate goal of postural control is to achieve two things: postural orientation and equilibrium.

Postural orientation involves maintaining alignment between different parts of the body and the environment.
Postural equilibrium is all about stabilizing the body's center of mass in response to internal and external stimuli.

Of course, postural control isn't just a matter of mind over matter. There are important reflexes involved, like the Cervicocollic Reflex (CCR), the Vestibulo-ocular reflex (VOR), and the Vestibulospinal Reflex (VSR), that work together with the vestibular nuclei and cerebellum (which we covered in our previous module on the vestibular system). It's like a well-oiled machine, with the visual, vestibular, and somatosensory systems all working in tandem to help us maintain balance and stability.



eye depicting visual system

Our Visual System


Have you ever tried walking with your eyes closed? Don't try it now, unless you're ready for a tumble! The visual system plays a crucial role in our balance and postural control. Without our eyes, we'd all be stumbling around.


The visual system is responsible for providing information about our environment and our position in it. It helps us understand where our body is in space and in relation to objects around us. This information is then used by the brain to produce accurate and stable movements.

When it comes to maintaining balance, the visual system can sometimes be fooled y optical illusions. Have you ever stepped on what you thought was the last step, only to find out there was one more? Or have you ever felt like the ground was moving beneath you while you were standing still on a train? These are examples of the visual system being tricked by conflicting information.


As we age, the visual system can become less effective at providing accurate information, which can affect our balance and stability. And for those who have experienced a concussion or other traumatic brain injury, the visual system may become over-relied upon, leading to imbalances in the use of different sensory inputs.


Research shows a balance program with exercises focused on improving the visual system can significantly improve balance. For example, one published study in 2019 in the Journal of Aging and Physical Activity found that older adults who performed exercises that focused on improving their visual acuity and depth perception had better postural control and balance than those who did not perform these exercises.



feet in the sand

Our Proprioceptive System


The proprioceptive system, also known as the kinesthetic sense, is another crucial component of postural control and balance. This system is responsible for detecting the position, movement, and force of our joints and muscles. It provides us with a sense of where our body parts are in space and how they are moving relative to one another. For example, when we're walking on a rocky path, the proprioceptive system sends signals to our muscles and joints, allowing us to adjust our balance so we don't slip or fall. It's like your body's internal GPS.


Studies have shown that individuals with proprioceptive deficits have increased postural sway and are at greater risk for falls. For example, individuals with diabetic peripheral neuropathy, a condition that damages sensory nerves in the feet and lower legs, have been found to have decreased proprioception and an increased risk of falls.


"The proprioceptive system is a key player in our ability to maintain balance and stability, especially as we age." - Dr. Lynn Millar

To improve proprioception, exercises such as balance training and joint position sense training can be helpful. These exercises involve challenging the body's ability to maintain balance in a variety of positions and movement patterns, as well as improving the ability to perceive joint position.



ear, depicting our vestibular system
Modified CTSIB

Our Vestibular System


The vestibular system is an incredible feat of biological engineering, located right within our inner ear. It's responsible for maintaining our balance and spatial orientation, and it's comprised of two distinct parts: the semicircular canals and the otolith organs. The semicircular canals detect rotational movements, while the otolith organs detect linear acceleration and gravity.


The vestibular system works in tandem with the visual and proprioceptive systems to provide our brain with the sensory information it needs to keep us balanced and upright.

Within the vestibular system, there are several reflexes that help to contribute to balance and postural control.

The Cervicocollic Reflex (CCR) helps to stabilize our head in response to body movements.
The Vestibulo-ocular reflex (VOR) helps us maintain visual fixation during head movements.
The Vestibulospinal Reflex (VSR) is responsible for making rapid adjustments to our trunk and limb muscles to help us maintain balance when we experience postural perturbations.

The vestibular system also has close ties to the vestibular nuclei and the cerebellum, which work together to process and integrate the sensory information for postural control. When there's dysfunction within the vestibular system, it can result in various balance and vestibular disorders such as vertigo, dizziness, and loss of balance. Proper evaluation and management of vestibular disorders is crucial for preventing falls and enhancing our quality of life.



EVALUATING YOUR SOMATOSENSORY SYSTEM


The Modified Clinical Test of Sensory Integration and Balance (MCTSIB) is an easy and effective tool to both evaluate and treat sensory integration and balance issues. It is designed to assess the functioning of the visual, vestibular, and somatosensory systems. I love it and is my go-to tool when working with my patients!


Modified CTSIB
Modified CTSIB

The MCTSIB consists of a series of sensory conditions that challenge the individual's balance under different sensory inputs. These conditions include:

  1. Standing with a narrow base of support (BOS), eyes open on stable surface.

  2. Standing with a narrow BOS, eyes closed on stable surface.

  3. Standing with a narrow BOS, eyes open on unstable surface (a foam cushion is often used)

  4. Standing with a narrow BOS, eyes closed on unstable surface.

By systematically manipulating these sensory inputs, the MCTSIB provides valuable information about an individual's ability to maintain balance and adapt to various sensory challenges.


Have someone time you to see how long you are able to maintain the condition (up to 30 sec). The trial is over when (a) you open your eyes in an eyes closed condition, (b) raises arms from sides, (c) loses balance and requires manual assistance to prevent a fall.


In addition to evaluation, the MCTSIB is also utilized as a treatment tool. Based on the assessment results, a customized balance training programs that focus on improving sensory integration and optimizing postural control. These interventions may include specific exercises targeting the visual, vestibular, or somatosensory systems, or a combination of sensory inputs to enhance overall balance performance.


Interpretation of the Modified CTSIB Test


Condition 1: Eyes Open, Stable Surface

  • This condition assesses an individual's ability to maintain balance on a stable surface with visual input. The average duration of balance achieved in this condition indicates their baseline stability and can serve as a reference point for comparing other conditions.

Condition 2: Eyes Closed, Stable Surface

  • This condition removes visual input and relies more heavily on the somatosensory and vestibular systems for balance. A significant decrease in the average duration of balance compared to Condition 1 suggests a reliance on visual cues for balance control.

Condition 3: Eyes Open, Unstable Surface (with foam cushion or mat)

  • Introducing an unstable surface challenges balance control, removing proprioceptive input from the feet. The average duration of balance in this condition reflects an individual's ability to adapt and stabilize themselves on an unstable surface with visual and vestibular input.

Condition 4: Eyes Closed, Unstable Surface (with foam cushion or mat)

  • This condition combines the challenges of an unstable surface with the removal of visual input and proprioceptive input. There is a heavy reliance on vestibular cues for balance control. A decrease in the average duration of balance compared to Condition 3 suggests a reduced vestibular function.


SOMATOSENSORY BALANCE TRAINING


Train the somatosensory system, unlock your body's balance potential, and navigate life's challenges with unwavering stability. You can improve your balance via training the somatosensory system; here are a few examples of exercises tailored for each system to improve your visual, proprioceptive and vestibular systems:


Visual System Training for Balance

  1. Eye Tracking Exercise: Use a visual target, such as a small object or a moving finger, and track it with your eyes. Move the target in different directions and at varying speeds to challenge your eye tracking abilities.

  2. Visual Scanning Exercise: Scan your surroundings and focus on specific objects or points in different directions. This exercise helps improve visual awareness and enhances your ability to quickly shift focus.

  3. Balance Board with Visual Focus: Stand on a balance board or cushion while maintaining a steady gaze on a fixed point. This exercise challenges your balance while relying on visual input.


balance board with a foot on it

Proprioceptive System Training for Balance

  1. Single-Leg Stance: Stand on one leg while maintaining proper alignment and balance. Progress by closing your eyes or performing additional movements, such as arm reaches or head turns, to challenge proprioceptive feedback.

  2. Balance Pad Exercises: Perform exercises on a balance pad, such as squats, lunges, or step-ups. The unstable surface challenges the proprioceptive system and enhances balance control.

  3. Toe-to-Heel Walk: Walk in a straight line, placing the heel of one foot directly in front of the toes of the opposite foot. This exercise improves proprioceptive awareness in the feet and ankles.


person walking a tight rope

Vestibular System Training for Balance

  1. Head Turns: Slowly turn your head from side to side, up and down, and in circular motions. Start with gentle movements and gradually increase the range and speed of motion. This exercise stimulates the vestibular system and enhances its responsiveness.

  2. Balance Exercises on Unstable Surfaces: Perform balance exercises, such as standing or doing gentle movements, on unstable surfaces like foam pads, balance discs, or wobble boards. The instability challenges the vestibular system and helps improve its function.

  3. Tai Chi or Yoga: Engage in activities like Tai Chi or yoga that involve slow, controlled movements and shifting body positions. These practices promote body awareness, coordination, and enhance the integration of sensory information for better balance.


Tai-Chi


Balance is the key to navigating life with confidence, especially as we age. It's a complex interplay between various sensory systems, including the visual, vestibular, and proprioceptive systems and somatosensory balance training holds tremendous potential for improving balance and enhancing overall stability. By engaging in targeted exercises and activities that stimulate and strengthen these sensory systems, we can unlock our body's innate balance potential.


So, whether you're seeking to improve your balance for daily activities, sports performance, or simply to enjoy a more confident and stable life, somatosensory balance training offers a pathway to success. Embrace the journey and discover the transformative benefits that come with strengthening your somatosensory system. Remember, balance is not only a physical attribute but a metaphor for life's harmony, and by prioritizing balance training, we can navigate life's challenges with unwavering stability!



 

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