Oops. Ouch.

Here’s one of those quandaries: Which is worse, accidenting one’s self frequently, or not responding well to anæsthetic?

It’s not that I react badly to local/topical anæsthetic, just that I don’t react to it much at all. But I’m getting ahead of myself. Which is not unusual because I’m often unsure of where I am in space.

Being chronically uncoördinated is technically known as “dyspraxia”. Lacking official diagnosis of such, I just say that I’m clumsy because my proprioception is crap. “Proprioception” is one of those many-ways-useful words I learned in entomology studies; it refers to unconsciously knowing where a body is in space by the relationships of the various body parts. Unlike other kinds of sensing that rely upon external inputs (the familiar five you learnt in primary school of sight, hearing, smelling, tasting and touch*), proprioception is an internal sense derived from the bones, ligaments, muscles and tendons, as processed by the cerebellum.

Proprioception, along with equilibrioception (balance) aids in kinesthesia, or movement sensing. Good kinesthesia allows for good hand and eye coördination, and the ability to build “muscle memory” or kinesthetic memory, where you know how to do something automatically from much practice, such as dialling phone numbers or riding a bike.

They say that you never forget how to ride a bike. Which (barring medical disasters) is true, although sometimes it takes a person a few dozen meters to get back into the bicycling groove. Despite repeated sessions with my dad, I didn’t learn to ride a bicycle until I was nine years old. To this day, I’m still a wobbly rider, because my sense of balance is poor, and because I don’t peddle smoothly.

Likewise, I didn’t learn to tie my shoes until I was eight years of age. I still abhor tie shoes, as my laces frequently come undone during the day. I went through driver’s education twice for road skills, as learning to manœuver the vehicle through space proved tricky, and I had to be familiar doing that for a year before I could add in learning to operate stick shift (manual transmission). Curiously, I prefer driving stick because it gives me something more to do with my hands, thus helping keep me focused on the process (I think that’s an ADHD thing). Nonetheless, because I have trouble coordinating hands and feet simultaneously, I do the clutch pedal and stick shift sequentially rather than simultaneously.

Sequential-over-simultaneous is true for many things that require both hand and foot action. Despite the old joke, I can “walk and chew gum at the same time”, because chewing isn’t tied to laterality (left/right) or hand/feet issues. (Not that I’m a gum-chewer anyway.) But my family has learned that because driving takes so much active concentration, my conversational skills diminish while driving – if I have to pay attention to the conversation, I’m likely to end up on “autopilot” and take us to the grocery, or otherwise end up on the wrong street: “Mom, those are grain silos; we’re going to the hospital.”

Part of laterality is trouble keeping left and right straight, although I don’t get port/starboard confused (perhaps those words are stored in a different part of my brain). I’m neither fully right- nor left-handed; I’m lefty taught right-handed penmanship, and do many things with either hand, tho’ none well. There are days when I can write fairly nicely, assuming I’m not in a hurry and that I’m not trying to constantly shift my depth perception between a blackboard/ whiteboard/ projection screen and my paper.

In addition to getting hands and feet coördinated, there’s also the hands and eyes coördination issue. I have trouble finding things in space 12-24” from face, and tracking things against the sky or ceiling makes ball games really difficult (even before I got bifocals). Because I’ve always been terrible at ball games, I was always last chosen for team, and the opposing team would chant “Easy ‘Out’!” when it was my turn up to bat or kick the ball because I would miss or foul or if I managed to hit the ball then I was awkward making that transition to running to first base. I bat badly left-handed, but horribly right-handed. Gym class sucked.

I even been known to “fall off the floor” (fall over while seated on the ground) when stretching. You’d think that being very limber would be useful in dance or gymnastics, but those require (you guessed it!) coördination. Being doublejointed (can do way too many things on the Beighton Scale) also plays into the arthralgia (joint pain) possibly from osteoarthritis that makes me stiff. Despite the chronic pain, “being stiff” for me sometimes means that I go from being hypermobile to reduced mobility into the “normal” range.

The upshot of all this is that sometimes I walk or move oddly. So when I stumbled down a city sidewalk and my daughter’s beau asked me, “Are you okay?” I replied, “Yes,” which sounded odd, and I added, “I just have crappy proprioception, arthralgia, and motor tics.” Somehow that did not make for a clearer or more reassuring answer, but I managed to avoid crashing into the door frames or shop tables, so it was okay.

I do run into a lot of stuff. I walk into door jambs, trip over “nothing”, things tumble from my hand, I spill my purse, get luggage caught in doorways and turnstiles, and loose groceries. Wire-frame glasses have proven to be the better choice over plastic, because they bend instead of breaking when I walk into something (like a support pole in a greenhouse). Likewise we keep burn cream in refrigerator (where it’s nice and cool) rather than the bathroom medicine chest because I get burned in the kitchen, not the bathroom. Bathtime means playing “What’s my bruise?” Only twice can I recall that I have not had bruises somewhere on me. (Do I bruise easily? How would I know?) Living such a life also means picking up random skills such as window glazing, because I’ve accidentally broken several windows.

Another kind of perception is nociception, sensing pain externally on the skin or internally. Once thought to simply be a kind of strong pressure input of tactition (touch sensing), pain is now considered to be a sensory mode of its own, albeit more subjective than some others. It’s a good thing I have a high pain tolerance, as dental or other local anaesthesia doesn’t give much relief and it always wears off much faster than the dentist thinks it ought to. The fact that I have motor tics and will randomly twitch throughout the dentistry process makes it difficult for him to discern my discomfort level, at least until I start making the traditional exclamations of “Augch!” and chair-arm clutching gestures, at which point the anæsthetic has long worn off, and my pain tolerance level is beginning to max out.

Dentistry is also impacted by TMJ, Temporo-Mandibular Joint disorder, where my jaw will make clicking sounds if I eat something very chewy. I wear a bite block at night to prevent waking up with cracking headaches. Having crumbling molar fillings replaced with crowns required using a rubber block to prop open my jaw, lest I end up with excessive post-op swelling and pain. I have a very nice dentist; he also gives me sunglasses to block out the work light, headphones to listen to music, and a little nitrous oxide. We also did the four crowns over two visits, which made it easier on all of us.

Some things can temporarily reduce proprioceptive ability, such as when I’m very tired, rather ill (the Mono + Lyme episode was notoriously bad), or having migraines. (Migraines have a disturbing way of dramatically increasing or decreasing sensory inputs.) “Phantom leg syndrome” (which I don’t have, still having all my limbs) is an example of false proprioceptive processing, and I’ve often wondered if arthropods who have lost limbs or portions thereof suffer from this. Given that it’s subjective, we’d have a hard time asking them (this gives me a mental image of a seven-legged spider on a psychotherapist’s couch). Another phantom sensory issue is tinnitus, which I have had in increasing measures for some years.

Real sensory input can also affect proprioception, and overall sensory integration, such as novel or high-intensity sensory inputs. This means that really loud or bright environments make it difficult to sort things out, especially new places that are loud and/or bright, such as airports, railstations, shopping malls, amusement parks. Although hyposensitive to some of my inner sensory inputs, there’s a contrasting hypersensitivity to some external sensory inputs, with hyperacussis that causes a pronounced reaction to sudden, loud or sharp noises. I get the feeling that with these hypo- and hypersensitivities, my sensory equiliser is permanently out of whack.

Knowing what the issues stem from helps. I can now compensate for poor proprioception by wearing snug clothing that will give me more sensory input, so I can better know where I am in space. Oft times I slide one foot over top step to find where the stairs begin. Good architectural design calls for high-constrast colours on the edges of stairs, but that assumes good depth perception and good motor control on the part of the user.

Proprioception, laterality and sequencing issues also means difficulties in learning new tasks – even though I can do any of the steps sufficiently well, albeit much more slowly in an overcompensative effort to avoid spilling, breaking, mis-keying et cetera, it’s difficult to get everything done in a smooth, correct sequence. My former graduate school advisor could never understand why it was so hard for me to learn to glue 1 centimeter-long 18-micrometer-diameter wire electrodes to 1 millimeter-long insects. Eventually I learned that I had to develop a method that worked for me, rather than trying to emulate a method that worked for others. The end result was the same, but a person doesn’t have to do things the same way to succeed, and realising that (even in my forties) has been a big boon to me.

* In addition to vision (seeing), audition (hearing), olfaction (smelling), gustation (tasting), and tactition, we also have proprioception, nociception (pain), equilibrioception (balance), and thermoception (heat sensing). Various animals have additional senses: bees can see polarized and ultraviolet light (but not red), bees and birds have magnetoception, sharks and rays have electroception, and cetaceans and bats have echolocation.

13 Comments

  1. tmj cure said,

    2 March 2012 at 7:36

    You have very interesting topics about your experiences. It helps a lot that you share them to your readers. It teaches us things about health/disorders that we are not usually aware of. Great read!

  2. 2 March 2009 at 2:03

    […] You can see my pictures on this page. Several people have suggested that I have Ehlers-Danlos and/or Marfan’s because I have really long fingers and can hardly find women’s shirts that fit because of my long arms. (Funny thing is, I’m the shortest person in my family of origin at 5′5″; the rest are around the 6′ range, but similarly proportioned.)  More discussion of the proprioceptive issues is here. […]

  3. tmj said,

    11 July 2008 at 3:23

    Wow great information now my body feels sore after reading all that info. Very interesting reading on the phantom leg syndrome.

  4. qw88nb88 said,

    10 June 2007 at 13:28

    Ooh, Ménière’s sucks! Sorry to hear that you have to deal with that as well as other things.

  5. Sally said,

    10 June 2007 at 8:53

    Ticking the boxes, no not competing with you ! just revelling in your wonderful descriptions, some of which apply to me … proprioception (why I have to be in touch with something all the time I am out of the chair, oh life got so much easier when I began to use the wheelchair), biofacals – can’t do bifocals, can’t type in the right order too ! … Meniere’s syndrome (tinnitus, hyperacussis) is notorious for not coping with bifocals, so I have 4 pairs of spectacles with different prescriptions. Now, echolocation, that would be really helpful, provided I could turn down the volume !

  6. 1 June 2007 at 18:01

    I fall off the floor every morning. Only coffee helps me stop doing it. I guess I’m getting dyspraxic. Funny but the most brilliant young woman I know also has this problem.

  7. Bev said,

    31 May 2007 at 16:56

    Hey Andrea,

    You are a Thinking Blogger. Come on over to my hive to see your award.

  8. 29 May 2007 at 21:33

    Tinnitus and visual snow, they seem to go
    With clicking joints for the horror show
    You see I bend but I don’t break
    But then me muscles seem to shake
    Much more sometimes the buggers ache

    Its a wonder I can play the flute at all.
    But that’s the way it is withall

  9. 29 May 2007 at 21:25

    Tinnitus and visual snow, they seem to go
    With clicking joints for the horror show
    You see I o bend but I don’t break
    But then me muscles seem to shake
    Much more sometimes the buggers ache

    Its a wonder I can play the flute at all.
    But that’s the way it is withall

  10. daedalus2u said,

    28 May 2007 at 21:45

    I think that hyperflexibility is related to low NO. Part of what regulates bone density is nitric oxide produced when bone strains (changes dimensions due to stress). The magnitude of the strain (length change per unit length) reflects the amount of NO produced, which then stimulates some amount of bone rebuilding. With low basal NO, it takes more strain to generate the same NO signal at the place where the bone needs to get thicker. So the operating point of bone stiffness gets moved to a region of less stiffness. Tendon stiffness is regulated the same way. The loss of NO following menopause is why women then get osteoporosis.

    There is a story my grandmother used to tell of having some sort of sores on the soles of her feet, the doctor telling her that she needed to clean them with alcohol, and assuming that she needed someone to do it for her, because the only way that he could look at the soles of his feet was through a mirror. She proceeded to say that no, she could put her leg behind her head, and proceeded to do so. This was probably 60 years ago when she was maybe 60?

  11. Ms. Clark said,

    28 May 2007 at 8:39

    Do you seem to choke more often than those around you? I mean like inhale saliva by accident? I do this. I’m good at choking on food, too. I’ve never sucked a big piece of food into my windpipe, more like little pieces, and more often liquids. I don’t remember seeing either of my kids choke like I do, nor either of my siblings. Nor my parents. For a long time I thought it was normalish… but I don’t think so.

    It’s really awful and embarrassing because I end up coughing for a minutes afterward and have to keep wiping my eyes because they water really badly. I had an episode as I was right about to check out in a grocery store. Right before the clerk looked up to see me (the next customer in line) I started choking. (sigh)

    I also have mysterious bruises and some hyperflexibilty, and pretty serious clumsiness… and proprioception issues.

  12. Jannalou said,

    28 May 2007 at 5:12

    I have bruises all over my legs. Sometimes I discover a particularly nasty one and wonder where it came from. That’s how normal an occurrence it is for me to walk into something.

    Of course, right now I have a sprained foot/ankle, which is just great fun when combined with the pains from all the walking I did on Friday night, and I think I strained some abdominal muscle when I fell, to boot. (For the story, go read today’s entry on my blog.)

  13. Bev said,

    27 May 2007 at 23:21

    When I saw the title to this post, I thought you must have been stung by bees!

    Very interesting post. I have many of the same issues. Never fell off the floor, though, not yet.


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