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Face mask sign
  1. Jorik Nonnekes,
  2. Maarten Nijkrake
  1. Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
  1. Correspondence to Dr Jorik Nonnekes, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen 6500 HB, The Netherlands; jorik.nonnekes{at}radboudumc.nl

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Introduction

Wearing a face mask has become commonplace in public spaces since the COVID-19 pandemic. We have encountered several patients with sensory ataxia who have reported worsening of their gait when wearing a face mask. Here, we illustrate the problem in a patient with spinocerebellar ataxia type 2.

Case

A 52-year-old man with genetically confirmed spinocerebellar ataxia type 2 had both cerebellar dysfunction and peripheral neuropathy (bilaterally absent vibration sense to the knees). He spontaneously reported a worsening gait when walking while wearing a face mask, resulting in near falls. Without a face mask, his gait was ataxic with a widened base of support and irregular step size and step width (see video 1). We observed his gait worsen (with increased step placement variability and staggering) when he wore a face mask, with a fall in gait speed from 0.9 m/s to 0.7 m/s.

Video 1

Interpretation

Patients with sensory gait ataxia (eg, from polyneuropathy) rely on visual input when walking, compensating for their reduced proprioceptive input. They commonly have difficulties walking in the dark, for example, when visiting the bathroom at night. 1Wearing a face mask reduces the wearer’s opportunity to use sensory information for the lower visual field,1 and may thereby unmask the need for visual compensation in those who lack tactile information on the position of the feet in space.

This clinical observation may therefore not only provide a diagnostic clue but also highlight that wearing a face mask might increase the risk of falling in people with lower limb sensory impairments. Clinicians should inform people with sensory gait ataxia about the increased fall risk when visual input is reduced (not only when walking in the dark but also when wearing a face mask) and consider using a cane or walker in such situations.

Ethics statements

Patient consent for publication

Ethics approval

This case report is in line with local ethical guidelines (Medical Ethical Committee Arnhem/Nijmegen). Formal approval was not needed.

Reference

Footnotes

  • Contributors Data collection and writing of the manuscript: both authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Rajith De Silva, London, UK.

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