When my daughter was 8 years old, she'd regularly bound into a room, knocking things (and people) over. She'd rumble into things much like our golden retriever. Our excuse for the dog was that he did not realize how big he was. So, what was our daughter's excuse? We suggested she be more careful, move more slowly, and that she watch where she was going. It didn't really work. Have you known people with similar tendencies? Are you bad at sports because you're "uncoordinated?" Could a medical reason explain it? Can You Really Be "Accident Prone"? It does seem as though some people, like my daughter, experience more than their fair share of accidental injuries to themselves, others and nearby property. I'm convinced that most people who call themselves "accident prone" or "klutzy" are just in a hurry, impulsive, not paying attention or some combination of these. However, there are conditions in which coordination is impaired. And it's likely that at least some small percentage of the "bulls in china shops" have one of these conditions. More on that in a moment. To understand how a disease might impair coordination, it's worth understanding a bit about how our bodies handle normal coordination when everything is working well. Most of us take our coordination for granted. When everything is working as it should, it's fairly effortless to walk across a room without bumping into anything or falling. More complex tasks — like catching a fly ball, dancing or driving a car — may seem effortless to those who have practiced these activities. Yet, each of these requires a huge number of nerve signals traveling to and from the brain.
When certain muscles contract, others relax. When you salute, for example, you smoothly swing your arm and hand alongside your head rather than making a jerky movement that ends with you smacking yourself. And during movement, constant feedback tells us whether we're heading in the right direction or whether an adjustment is needed. While simple activities (such as walking) require almost no active attention, they clearly require some focus. Otherwise you'd never have heard the expression, "Watch where you're going!" The environment can change — your dog scurries underfoot, someone opens the refrigerator door as you walk by, a wasp lands on your nose. Each of these requires visual input, interpretation by the brain ("I'm really not happy about this wasp situation") and nerve signals to the muscles to take action, such as changing your stride (so you don't step on the dog), veering to the left (to avoid the refrigerator door) or swatting the wasp off your nose. As with so many things, we're most likely to appreciate how well our coordination systems work when they fail us. For example, a deficiency in vitamin B12 may occur among people whose diet is deficient or who cannot absorb the vitamin. This can lead to a number of problems, including nerve damage that affects your sense of position. For example, it may become hard to know precisely where your foot is as you're walking. Loss of balance and poor coordination are common with vitamin B12 deficiency. Fortunately, this condition is reversible if found early and treated with supplemental B12. Other causes of poor coordination include:
In fact, just about any illness, especially if it lasts a long time, may lead to immobility, muscle weakness and reduced coordination. This tends to get better as you recover. But getting your strength and coordination back after a hospital stay is an important goal of physical therapy or a stay in a rehabilitation facility. And, of course, healthy people can have poor coordination as well. Just ask anyone who has been sleep deprived, distracted, in a rush or just trying to do too many things at once. I suspect this is one reason people sometimes say, "The hurrier I go the behinder I get." We've all been embarrassed by a clumsy misstep. Maybe your hand knocked over a cup of coffee during a spirited conversation. Or maybe you backed into a stack of soup cans with your shopping cart. I once walked into a display case at a museum and had to get several stitches in my forehead. Yes, these mishaps are embarrassing. But they can also cause significant injury. A hip fracture, for example, causes more than just pain. An elderly person who falls and breaks her hip has a good chance of losing his or her independence. About 25% of hip fractures in the elderly lead to admission to a nursing home or other long-term care facility. And about 5% of those who break a hip will die of complications in the following months. So, while "clumsiness" is embarrassing and potentially painful, it can also be dangerous. If you find you are often knocking into things or injuring yourself, it makes sense to get checked out. There may be steps you can take to improve the situation. Not all "klutziness" is inevitable. That is, maybe you're actually not a klutz. Maybe your vision is bad. Or your medications are affecting your balance. Keep an open mind and don't assume your coordination (or lack of it) is something you have to live with. Try to be more mindful of your movements. Plan how you're going to move rather than rushing forward. Then see if how you move through space improves. Of course, it can be a trick to slow down a bit and pay more attention to your movements without becoming "hypervigilant" and paralyzed with carefulness. Keep in mind that most "klutzes," after medical evaluation, turn out to be normal and healthy. For these people, the focus should be less on medical testing (which, let's face it, can be endless) and more on finding ways to help. For example:
See your doctor if you've become more clumsy than usual, especially if your clumsiness seems to be increasing or is causing injuries. Chances are good that it's nothing serious. Work on your strength, balance and coordination through exercise. As for my daughter, she pretty much "grew out of it," excelling in softball in middle school and making her varsity field hockey team in high school. My guess is that she just needed to pay more attention to her environment. Improving one's "situational awareness" — paying attention to your position in space and to what is nearby — could be the cure for the common klutz. Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.
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