Balance can be improved in HSP

Falls can be prevented


In HSP, 4 main contributors to balance impairments can be identified:

  1. The first intrinsic risk factor is spasticity as it hampers the capacity to make sufficiently fast stepping responses in situations where you need to move to maintain balance and prevent falling
  2. muscle contractures and joint deformities do not allow good responses to maintain balance, whether or not that involves moving the feet
  3. muscle weakness does not allow good responses to maintain balance and contributes to falls through the inability of weak muscles to prevent falling
  4. reduced proprioception caused by delay in nerve signals results in delayed postural responses.


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Treatment options
Risk factors need to be assessed on an individual basis to come up with the right treatment mix.

Spasticity treatment options include Botox injections in the calves and specific stretching.

For muscle contractures and joint deformity, treatment may include Botox injections in the tibialis posterior muscle; orthopaedic footwear may help compensate for the contribution of deformed ankle joints to poor balance. Intensive stretching should always accompany these treatments to improve muscle length and inhibit muscle tone.

If at least some component of muscle weakness is because of disuse, a comprehensive physical training program designed by a physiotherapist will include strengthening and stretching components, with a preference for cycling or aquatic exercises over walking.

Impaired proprioception cannot be restored, however compensation strategies can be learned and employed, for example, by performing daily balance exercises at home such as alternately standing on one leg while gradually reducing assistance from a wall or table. Again, physiotherapists can design such exercises and teach them to you in one session.When balance impairment is so severe that falls occur regularly, the use of stabilising walking aids is necessary, not to lean on, but to obtain sensory information through the arms. So Nordic walking sticks are preferred over conventional canes or crutches or a walker – the objective is to use the minimal amount of support needed to prevent falls while still challenging the capacity to stay balanced to the extent possible.


Here is an article all about ways to improve your balance.



Balance impairments are common in patients with hereditary spastic paraplegia and are among the most debilitating symptoms, as they frequently result in falls and fall-related injuries. Several features of hereditary spastic paraplegia contribute to balance impairments and multiple treatment options exist. However, an overview of these underlying mechanisms and their treatment is currently lacking.



This paper reviews the pathophysiology, diagnostic workup, and management of balance impairments in hereditary spastic paraplegia. Recommendations are based on scientific evidence, when available, and otherwise reflect practice-based evidence supported by clinical experience.



Through diligent history-taking and clinical examination, followed by multidisciplinary treatment tailored to the identified underlying mechanisms, balance capacities can be improved in patients with hereditary spastic paraplegia and at least a proportion of falls can be prevented.


SOURCE: J Rehabil Med. 2017 May 16;49(5):369-377. doi: 10.2340/16501977-2227. PMID: 28471471


Pathophysiology, diagnostic work-up and management of balance impairments and falls in patients with hereditary spastic paraplegia.


Nonnekes J1, van Lith B, van de Warrenburg BP, Weerdesteyn V, Geurts ACH.


1 Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, 6541GX Nijmegen, The Netherlands. [email protected].

1 comment

  1. I love this article. I want to improve my balance and happily no special gear is required! But I need to work out how to regularly add this balance work to my day. So, I’ll say this – I’m working to improve my balance starting right NOW! I’ll report back here with my results. How about others join me for mutual support and encouragement? Start the program and report results back here?

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