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Just Clumsy or Serious Medical Problem?

We've all done a pretty good impression of Inspector Clouseau at one time or another. Knocking over coffee cups, dropping keys, tripping over rugs — sometimes life feels like a slapstick comedy, and you’re the star.

Can klutziness be cured? If episodes of clumsiness happen more frequently, how can you tell if it's something serious — or just a temporary case of the fumbles? Our experts tell us what to look for (and not trip over) as we explore this common problem.

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Coordination: An Overview

As clumsy as you may feel, you're more coordinated than you think. It takes a genuine miracle of synchronized muscles, bones, and nerves just to get up and walk across the room.

"Coordination of the body is an extremely complicated process that involves input from both motor and sensory systems," explains Taylor Harrison, MD, clinical instructor in the neuromuscular division of the Emory University department of neurology in Atlanta.

Here's how our body parts work together:

Our eyes provide a constant stream of information about our surroundings and our position in space. The brain and nerves are our command-and-control “wiring,” carrying the messages on how and where to move down to the muscles.

The cerebellum is the part of the brain that specializes in coordination and balance. About the size of an orange, it’s located under the brain at the back of the head. The cerebellum "talks" constantly to other parts of the brain to maintain balance, posture, and fluid movements. Muscles and bones carry out the instructions transmitted by nerves, creating movement.

Normally these systems work together, playing off each other like an orchestra performing a symphony in perfect tune. "Problems in any of these areas may give rise to problems with coordination," says Harrison. Some of the most common culprits are:

Poor vision

Strokes or head injuries, especially to the cerebellum

Arthritis

Muscle weakness

Inactivity

Infections or illnesses

Fatigue and stress

Medicines

Alcohol and drug use

All of these causes of clumsiness can be treated or reversed completely, so it's important to eliminate them as possible contributors. Your doctor can help you with this.

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Steps to Cut the Risk of Falls

Perhaps the ultimate in clumsiness is actually losing your balance and falling down. If you or an aging parent frequently trips or falls, take it seriously. Falls can cause permanent disability, and many are preventable. According to the CDC, a few simple steps can reduce the risk of falls:

1. Begin a regular exercise program. Exercise increases strength and balance. Your doctor can help you design an effective program for your level of fitness.

2. Make your home safer by taking actions like these: Take all clutter off stairs. Turn lights on when you get up to use the bathroom at night. Tape down the edges of rugs with double-sided tape. Have handrails placed on all staircases, and put grab bars in shower stalls.

3. Ask your doctor to review your medicines. "Many medicines have dizziness as a side effect, and this can certainly contribute to falls or clumsiness," says Dr. Erica Duncan, associate professor of psychiatry at the Veterans Administration Medical Center in Decatur, Ga. If you suspect side effects from your medications, discuss this with your doctor to confirm and see what alternatives are available.

4. Have your vision checked. You may have a treatable vision problem like cataracts or glaucoma — or just need a new prescription.

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Clumsiness: When It's Serious

When does clumsiness merit a trip to the doctor? The answer is — whenever you think there might be a problem. We asked Harrison about three real-life cases of clumsiness; all were patients of this writer over the last three years. Their names have been changed. Do you see yourself in any of these common scenarios?

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A Keyed-Up Programmer

Dave, a 25-year-old computer programmer, felt the heat at work. He said deadlines made him klutzy, and he felt like he was knocking something over every time he turned around. This also happened the last time he had a big project due.

Diagnosis: routine life stress.

“It’s important to remember that simple things like lack of sleep, skipping meals, or stressful situations might affect our dexterity,” says Harrison. Taking care of ourselves when times get tough is the best medicine for this brand of the butterfingers.

High Sugar, Clumsy Feet

Arvind, 52, has lived with diabetes for almost 15 years. Sometimes he controlled his blood glucose levels tightly; other times, he let it slip. But Arvind noticed more and more that he was tripping on rugs and the edges of stairs. He also felt that it was harder to keep his balance at night.

Diagnosis: nerve damage caused by diabetes.

“Peripheral neuropathy is a disease of nerves associated with sensory loss in the hands and feet, and can affect coordination,” according to Harrison. Tight control of blood sugar is essential for diabetes patients to avoid this complication, which can lead to serious foot ulcers.

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Madeline, a 68-year-old woman, loves to garden. Recently she felt her right hand get heavy and numb while planting flowers. She said it felt like it went dead on her. This lasted only a few minutes before returning completely to normal. She remembered an almost identical episode about a year ago.

Diagnosis: transient ischemic attack (TIA), or "mini-stroke."

"This is serious," says Harrison, because TIAs make a "real" stroke more likely in the future. "Identifying risk factors for stroke, like diabetes, high blood pressure, and smoking," and treating those risk factors, will reduce the risk of stroke, adds Harrison.

Initial symptoms of stroke and TIA can be the same. The American Stroke Association lists these warning signs of a possible stroke: Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or understanding. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or coordination. Sudden, severe headache with no known cause.

Call for emergency medical help at the first sign of those symptoms. Don't wait to see if they go away and don't judge for yourself how bad they are.

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Can a Klutz Be Cured?

While it's necessary to rule out medical causes of clumsiness, the vast majority of people with coordination problems are medically "normal." What about the millions of us who are just tired of bumping into walls and banging shins on coffee tables? Can a normal (but clumsy) person improve his or her coordination? In other words, can a klutz be cured?

The answer is yes, according to Jim Buskirk, a physical therapist and co-founder of the Dizziness and Balance Center in Chicago. "The same techniques that we use to help people with strokes can be used to enhance performance in people without disabilities."

Buskirk uses these techniques to help athletes like members of the Chicago Wolves, a professional hockey team, improve eye-hand and eye-foot coordination. "A lot of it is vision training," Buskirk says, as "when athletes say in interviews, 'I'm seeing the ball better.'"

The key is exercises which give a workout to the vision and balance circuits. They are called "vestibulo-ocular reflex (VOR) exercises." Simply put, the VOR is made up of the connections between your eyes and brain that help you track objects. Eye-hand coordination depends on the VOR.

VOR exercises are proven to help improve performance in brain-injured patients. In normal people, the benefits, if any, are much harder to measure. A physical therapist can provide tools or exercises designed to develop the VOR, and methods are available on the Internet.

Good old-fashioned exercise may be the best cure for the common klutz, says Harrison. "Individuals with coordination problems may see improvement after regular exercise in dancing, aerobics, or even yoga or tai chi," which emphasize balance. "Experiment with different activities before finding one that's right for you," he adds.

By Matthew Hoffman, reviewed by Dr. Louise Chang

SOURCES: Emedicine.com: "Vestibular Rehabilitation." Taylor Harrison, MD, clinical instructor, neuromuscular division, department of neurology, Emory University, Atlanta. Erica Duncan, MD, associate professor of psychiatry, Veterans Administration Medical Center, Atlanta. Jim Buskirk, physical therapist, Dizziness and Balance Center, Chicago. CDC web site: "Preventing Falls Among Seniors." Goetz, C. Textbook of Clinical Neurology, 2nd edition, Elsevier Press, 2003.