What makes me clumsy

Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process. Anxiety is the type of condition that is felt from head to toe. It's a condition that is characterized Joint pain is most often related to getting older and exercising. So it's a bit surprising that joint pain can Most people think of anxiety as the presence of fearful or worrisome thoughts. But this is not always the core Anxiety is felt literally from head to toe.

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We use Cookies to give you the best online experience. More information can be found here. The reference lists of selected articles retrieved in the original online search were also screened for relevant studies not identified through electronic searches by the lead and last author. Citation searches of the identified relevant studies were conducted using PubMed and Scopus databases. If any title or abstract did not provide enough information to decide whether the inclusion criteria were met, then the full text was obtained.

All of the full-text studies were then independently evaluated. Discrepancies in judgement were first resolved by discussion with two reviewers, however, if consensus was not reached, a third reviewer was used to arrive at a decision.

An assessment of the risk of bias and precision was conducted by the lead and last author using the risk of bias assessment tool of Viswanathan and Berkman Individual items from this bank identified by the authors as relevant to this review were then selected, defined and applied to each of the studies retrieved for analysis, with the subsequent risk of bias findings tabulated see Table 1.

To support this quality assessment, a numerical value was assigned to each criterion. If an assessment was determined as high, it received a numerical score of 1. Any lower assessment received a score of 0. We then classified the overall score of quality as low 0—2 , moderate 3 , 4 or high 5 , 6 after Zhang et al. The sum of all values provided the basis to quantitatively assess overall quality.

Table 1. Risk of bias [adapted from Viswanathan and Berkman 18 ]. In order to standardize the data extraction process between the reviewers, detailed data extraction sheets were devised and used to acquire information concerned with research questions about the role of the neck in joint position and movement sense and motor performance of the upper extremity.

These results are shown in Tables 3 — 5. Table 3. Definitions of clumsiness and investigations of performance of upper limb kinesthestic tasks. Table 4. Association between the neck and changes in accuracy in completion of upper limb sensorimotor tasks. Table 5. Association between pain and self-rated function and upper limb sensorimotor task performance. The online search strategy identified studies. Additional records identified through other sources numbered Duplicates were removed leaving 1, studies.

From this process 42 studies were selected for full-text retrieval and assessed for eligibility. Consensus was reached to include 18 studies in the review. The most common reasons for rejecting articles were that they: were animal studies; didn't have sufficient detail; were not relevant e.

Search results and the selection process are summarized in Figure 1. Figure 1. Adapted from Moher et al. From the studies included in the review, all were prospective. Eight were cross-sectional studies and ten were case series.

This classification is a widely accepted system for describing the different levels of dysfunction and symptomatology for whiplash. One study assessed motor performance of dominant and non-dominant hands The risk of bias analysis for all studies included in this review is presented in Table 1. All studies were prospective, used objective measures and had a high level of detail in describing the exposure used.

One study did not accurately report statistical analysis Two studies operationally defined this as a deficit in coordination of upper limb movement or an impairment in upper limb proprioception 11 , Both Sandlund et al.

The change in head-neck position was, therefore, less than full range of neck motion. The aim of their study was to investigate the effect of changes in head and neck position on the perception of elbow position in people with chronic and disabling neck pain after a whiplash injury. The group suffering WAD recorded reduced proprioceptive acuity compared to their healthy counterparts when the head-neck of the healthy group was moved to the same average degree of rotation as the WAD group away from midline neutral position.

Sandlund et al. They hypothesized that people with WAD have impaired shoulder proprioception. Clumsiness was not explicitly referred to in the remaining studies. In particular this table identified: the head-neck movement performed; the position of the body during upper limb task performance; the upper limb kinesthetic task performed, including the visual condition of the participant during the performance of the upper limb task; the instruments used for measurement of upper limb performance; the outcome measures reported; and the results of the studies.

One study 27 induced neck rotation by passive movement of the trunk against a fixed head while neck muscles were relaxed or when neck muscles were actively contracted and a further two studies 28 , 33 required participants to actively move their head-neck to different angles of rotation. Fookson et al. Berger et al. Two studies induced dorsal neck muscle fatigue prior to measurement of the upper limb kinesthetic task 30 , Three studies did not explicitly indicate participants' posture during testing although it may be presumed that participants were seated 12 , 23 , All studies used objective means of measurement for upper limb task performance.

These complaints included subclinical neck pain 20 , chronic neck pain 21 — 24 and WAD 11 — 13 , In all studies, these natural maneuvers resulted in a deterioration in performance of upper limb sensorimotor tasks.

Of the eight studies included in this review that conducted prospective, cross-sectional research all broadly included a neck pain group and a healthy group as previously reported. We were interested in exploring whether any relationship existed between upper limb sensorimotor task performance and measures of pain or self-rated function and disability. The results of this analysis are provided in Table 5.

Six of the eight studies specifically reported on this relationship 11 — 13 , 21 — Four of six studies reported an association between disability, self-rated functioning and sensorimotor task performance 11 , 21 — 23 and a similar relationship applied to the intensity of pain. This systematic review found a small body of literature of moderate to high quality, with all but one study, demonstrating that in the presence of neck pain or injury or when a natural intervention is applied to the head-neck that provokes the neck to function close to extreme limits in a healthy cohort, this is associated with a deterioration in the accuracy of performance of upper limb sensorimotor tasks, or the accurate perception of upper limb joint position.

As far as we are aware, this is the first study to link experimental and clinical studies that demonstrate disordered sensorimotor integration to altered neck sensory input. The result of this review highlights the importance to clinicians to specifically investigate whether their patient experiences clumsiness or fumbling associated with their neck pain or injury and to implement rehabilitative strategies to address this issue.

As noted, analysis of the details of these studies was restricted to a qualitative analysis principally due to the variability in study designs as well as outcome measures used to measure upper limb sensorimotor task performance.

Nevertheless, the overall quality of the studies was considered moderate to high. We conclude that the strong consistency of the results of this review overrides any deficiency in the assessment of the quality of the studies specifically as this relates to the reporting of inclusion and exclusion criteria, the reporting of statistical analyses or some lack of detail in describing exposures.

All the studies included in this review can be broadly divided into one of two categories. That is, sensorimotor tasks involved on-going assessment of segment-to-segment movement and position. In the first category the conclusion reached by all studies was that changes in head-to-trunk orientation, extensor neck muscle fatigue or in the presence of neck pain or injury is associated with a decrease in accuracy in estimating a previously presented upper limb joint position.

This inaccuracy was interpreted as a disruption in the updating of the internal body schema as a consequence of altered neck afferent input. The second category of studies is more complex to analyze because these studies examined upper limb task performance on multiple levels. On the first level, the CNS must identify the position and movement of the upper limb, that is, it makes reference to an internal representation of the body as described above.

The CNS must do this while, on the next level, the upper limb moves and positions itself in relation to an object in external space. Therefore, the CNS must also encode an external target position. Blouin et al. This is achieved partly by using proprioceptive input from the neck and integrating this information with that of vision although there is evidence that proprioception may play a dominant sensory input in motor planning Indeed as articulated by Guerraz et al.

In this regard it is worth noting the study of Guerraz et al. The return phenomenon occurs as a result of a change in the perception of position of the head-to-trunk position rather than the actual head-to-trunk position, the perception of which changes over time.

This was first demonstrated by Gurfinkel and Levik [as cited by Levik 35 ]. In the Guerraz et al. When the head was returned to be aligned with the trunk, participants reported the perception that their head tilted in the opposite direction with respect to the initial direction of tilt.

Interestingly so too did the angular deviation of the drawn straight line with the degree of deviation decreasing as the perception of head tilt reduced. Guerraz et al. Over time, as participants perceived that their head slowly returned to a neutral position so too did the extent of line orientation of the drawing task although there was no significant correlation between them.

The authors argued that the return phenomenon was responsible for participants' perception of their head position rather than the actual head position and this was reflected in the motor task of line drawing. This study highlighted the depth of the concept of the system of internal representations of body constructs both within intrapersonal space as well as the body's relationship to external objects in the environment as described by Levik Therefore, the results of the study during the initial stages of head tilt are consistent with the finding that neck proprioceptors contribute to the continual updating of the internal body schema.

Eight of the 18 studies of this review investigated upper limb sensorimotor task performance in the presence of neck pain. All but one of these studies determined that in the presence of neck pain, the accuracy in performance of sensorimotor tasks was reduced. Furthermore, six of these studies reported a positive association between the severity of reduction in performance of the upper limb task and levels of pain, physical functioning or levels of reported self-efficacy.

While the number of studies that reported these findings is small and the variety of testing procedures varied, the results of this review point to a relationship between neck pain where an individual experiences a higher level of reduced physical functioning or self-efficacy and clumsiness. It is of interest to note here the findings of 24 the only study that did not report the association.

Their study investigated sensorimotor function in violin and viola players with and without neck pain. They found no difference in the performance of motor tasks between violinists and violists with and without neck pain.

As concluded by these authors it may be that fine motor tasks associated with the playing of their instruments may be a more appropriate way to assess whether a deterioration in function is actually occurring.

Further, to our knowledge, it is not yet established whether the types of finely developed motor skills of these musicians might mask the effects of a deterioration in sensorimotor function as measured by standard upper limb sensorimotor tests.

Disruption anywhere along this pathway can have a significant impact. Common culprits include poor vision, strokes, brain or head injury, muscle damage and weakness, arthritis or joint problems, inactivity, infection or illness, drugs and alcohol and, of course, stress or fatigue. A sudden change in co-ordination may suggest a localised stroke. This is a medical emergency. Brain tissue starts to die at a rate of up to two million brain cells a minute if the blood supply is reduced or cut off.

Strokes are most common in those over 60 but can occur at any age, even in children. Recognising the signs and acting fast can reduce the chance of long-term brain damage and disability. The acronym FAST is used to draw attention to the signs of a stroke and to stress the importance of seeking urgent medical help. Finally, 'T' stands for 'time'. Other less classic signs of stroke can include confusion, loss of balance or dizziness, blurring or loss of vision and sudden headache.

If blood-thinning medication is given early within hours in the case of a clot, permanent paralysis or nerve damage may be avoided. Strokes due to a bleed are more difficult to treat. The risk factors for stroke include a family history of stroke, high blood pressure, heart disease, diabetes, obesity, high cholesterol, smoking and excess alcohol intake.

They are very similar to those for other heart and vascular disorders. Stroke can cause temporary or permanent disability. Unfortunately, in some cases, permanent disability remains. Stroke kills more people each year than breast, lung and bowel cancer combined. Of those who survive, 65pc will make a reasonable recovery. Prevention is best but every minute counts. If you think someone you know is having a stroke, call an ambulance.

Don't delay. If clumsiness onset occurs more gradually but is consistent, other types of brain injury, tumour or illness should be considered.

Your GP can do a full neurological exam and refer you for a brain scan or to see a specialist as appropriate. Clumsiness associated with forgetfulness can be a sign of stress, especially if it is worse in stressful situations.