July 19, 2024

Information coming into your body from your senses uses afferent nerves (sensory) to send information to your central nervous system for processing, then using efferent nerves it tells the muscles and joints to move (motor).
So similar to a computer; the information comes in through keyboard or mouse (sensory) to the computer (central nervous system) then information is outputted to screen or printer (motor).
The sensorimotor system is part of the nervous system, it integrates information from the eyes, vestibular apparatus, proprioceptors, and other sensory receptors into muscular activity that acts to stabilize joints and maintain balance.1
In diabetes, chemo induced neuropathy and trauma to peripheral nerves using SMT all showed improved balance, improved sensation, reduced tingling, reductions of pain and improved proprioception (feeling position or location of body). 2-6
The single most successful find during the studies using sensorimotor training of patients was that the programs had to be tailor made for each patient targeted to their specific symptomologies.2 Therefore, very much not a one size fits all model.
When assessing the patient with neuropathy you want to test range of motion of joints and assess if weight bearing can be tolerated and then synergistic movements and integrated whole body movements can be encouraged.
The patient is to progress through four levels, moving from simpler reflexive stabilization strategies to more involved automatized movement strategies:
- Increase how often or more pressure, vibration, texture temperature is used on the bottom of foot or hands this helps with increasing proprioception.
- Challenging posture by making the patient kneel, sit, stand, jump lay down on belly then on back all help the pathways. Also challenge center of gravity for example two legged to one legged activities, exercise balls, wobble boards progressively increasing instability will increase muscle activation and this stimulates the subcortical pathways for spatial awareness.
- We have stored patterns of movement (motor engrams) in the brain and CNS as a result of unconscious reactions to protect us. For example, re-training going up and down the stairs and increasing the speed the patient goes up and down can recover the motor pathway.
- Functional activities integrated into skill building and goal setting.
Remember if other sensory cues are interfered with, the person’s pathway is blocked (crowded street) they cannot see the curb or their attention is lost (interrupted or loud noises) when walking the neuropathic patient is not getting the sensory information that they need for balance. Because they cannot feel their feet they rely on this information for safety. This can be very unsettling to the neuropath and if their stored motor patterns for walking are poor as well the risk of falling is very high. The conscious part of the brain may be telling them they are fine but the unconscious information in the CNS and brain will react as if they are not safe causing the person to tense up and/or hold a lot of tension while walking. Using tension for strength and coordination for walking is extremely tiring and therefore the person can walk very small distances and feel exhausted! With sensorimotor training improving balance, sensation and motor pathways can recharge the patient’s body battery and make them feel much more energetic.
1. Riemann and S. Lephart, “The sensorimotor system, part l:the physiologic basis of functional joint stability,” The Journal of Athletic Training, vol .37,no.1, pp.71-79, 2002.
2. Streckmann, M. Balke, G. Cavaletti, A. Toscanelli, W. Bloch, B. Decard, H. lehmann and O. Faude,"Excercise and Neuropathy: Systematic Review with Meta-analysis," Sports Medicine, vol. 52, pp.1043-1065, 2022.
3. -L. Lin, R.-H. Wang, F.-H. Chou, I.-J. Feng, C.-J. Fang and H.-H. Wang, "The effects of exercise onchemotherapy-induced peripheral neuropathy symptoms in cancer patients: a systematic review and meta-analysis," Supportive Care in Cancer, vol. 17, pp. 5303-5311, 2021.
4. Nees, N. Finnerup, B. Armin and N. Weidner, "Neuropathic pain after spinal cord injury: the impact of sensorimotor activity," PAIN, vol. 158, no. 3, pp. 371-376, 2017.
5. I. Ahmad, M. Noohu, S. Verma, D. Singla and M. Hussaine, "Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheralneuropathy," Gait and Posture , vol. 74, pp. 114-120, 2019.
6. Ahmad, S. Verma, M. Noohu, M. Shareef and M. Hussain, "Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial & quot; J Musculoskeletal Neuronal Interact, vol. 20, no.2. , pp. 234-248, 2020.