Behavioural and neural basis of anomalous motor learning in children with autism

Autism spectrum disorder is a developmental disorder characterized by deficits in social and communication skills and repetitive and stereotyped interests and behaviours. Although not part of the diagnostic criteria, individuals with autism experience a host of motor impairments, potentially due to abnormalities in how they learn motor control throughout development. Here, we used behavioural techniques to quantify motor learning in autism spectrum disorder, and structural brain imaging to investigate the neural basis of that learning in the cerebellum. Twenty children with autism spectrum disorder and 20 typically developing control subjects, aged 8-12, made reaching movements while holding the handle of a robotic manipulandum. In random trials the reach was perturbed, resulting in errors that were sensed through vision and proprioception. The brain learned from these errors and altered the motor commands on the subsequent reach. We measured learning from error as a function of the sensory modality of that error, and found that children with autism spectrum disorder outperformed typically developing children when learning from errors that were sensed through proprioception, but underperformed typically developing children when learning from errors that were sensed through vision. Previous work had shown that this learning depends on the integrity of a region in the anterior cerebellum. Here we found that the anterior cerebellum, extending into lobule VI, and parts of lobule VIII were smaller than normal in children with autism spectrum disorder, with a volume that was predicted by the pattern of learning from visual and proprioceptive errors. We suggest that the abnormal patterns of motor learning in children with autism spectrum disorder, showing an increased sensitivity to proprioceptive error and a decreased sensitivity to visual error, may be associated with abnormalities in the cerebellum.

Teratogenic effects of pyridoxine on the spinal cord and dorsal root ganglia of embryonic chickens

Our understanding of the role of somatosensory feedback in regulating motility during chicken embryogenesis and fetal development in general has been hampered by the lack of an approach to selectively alter specific sensory modalities. In adult mammals, pyridoxine overdose has been shown to cause a peripheral sensory neuropathy characterized by a loss of both muscle and cutaneous afferents, but predominated by a loss of proprioception. We have begun to explore the sensitivity of the nervous system in chicken embryos to the application of pyridoxine on embryonic days 7 and 8, after sensory neurons in the lumbosacral region become post-mitotic. Upon examination of the spinal cord, dorsal root ganglion and peripheral nerves, we find that pyridoxine causes a loss of neurotrophic tyrosine kinase receptor type 3-positive neurons, a decrease in the diameter of the muscle innervating nerve tibialis, and a reduction in the number of large diameter axons in this nerve. However, we found no change in the number of Substance P or calcitonin gene-related peptide-positive neurons, the number of motor neurons or the diameter or axonal composition of the femoral cutaneous nerve. Therefore, pyridoxine causes a peripheral sensory neuropathy in embryonic chickens largely consistent with its effects in adult mammals. However, the lesion may be more restricted to proprioception in the chicken embryo. Therefore, pyridoxine lesion induced during embryogenesis in the chicken embryo can be used to assess how the loss of sensation, largely proprioception, alters spontaneous embryonic motility and subsequent motor development.

Effects of Kinesio® Tape in low back muscle fatigue: randomized, controlled, doubled-blinded clinical trial on healthy subjects

BACKGROUND

Muscle fatigue of the trunk extensor musculature plays a considerable role in chronic low back pain (LBP). The underlying physiology of fatigue is complex and not fully understood. The Kinesio® Taping (KT) supports damaged structures while allowing mobility and at the same time may influence some of the mechanisms associated with muscle fatigue such as blood flow and proprioception.

OBJECTIVE

The aim of this study is to determine the influence of KT on the resistance to fatigue of the lumbar extensor musculature in a sample of young healthy subjects.

METHODS

A randomized, controlled, doubled-blinded clinical trial was conducted. Ninety nine healthy subjects were randomized in to the three arms of the study Kinesio® Tape (KT), placebo (P) and control (C). Directly after application of KT we measured lumbar extensor musculature endurance with the Biering-Sorensen test. Subjects and researchers were blinded to the intervention. Time achieved (seconds) was compared between groups with one-way ANOVA with confidence intervals of 95%.

RESULTS

There were significant differences between the time achieved in the KT group versus the control group (p < 0.05). The placebo group performed better than the control group but worse than the KT group, these were not significant in either case.

CONCLUSIONS

KT appears to improve the time to failure of the extensor muscle of the trunk obtained using the Biering-Sorensen test. These findings suggest that KT influences processes that lead to muscle fatigue and that KT could be effective in the management of LBP.

Robot-assisted training of the kinesthetic sense: enhancing proprioception after stroke

Proprioception has a crucial role in promoting or hindering motor learning. In particular, an intact position sense strongly correlates with the chances of recovery after stroke. A great majority of neurological patients present both motor dysfunctions and impairments in kinesthesia, but traditional robot and virtual reality training techniques focus either in recovering motor functions or in assessing proprioceptive deficits. An open challenge is to implement effective and reliable tests and training protocols for proprioception that go beyond the mere position sense evaluation and exploit the intrinsic bidirectionality of the kinesthetic sense, which refers to both sense of position and sense of movement. Modulated haptic interaction has a leading role in promoting sensorimotor integration, and it is a natural way to enhance volitional effort. Therefore, we designed a preliminary clinical study to test a new proprioception-based motor training technique for augmenting kinesthetic awareness via haptic feedback. The feedback was provided by a robotic manipulandum and the test involved seven chronic hemiparetic subjects over 3 weeks. The protocol included evaluation sessions that consisted of a psychometric estimate of the subject's kinesthetic sensation, and training sessions, in which the subject executed planar reaching movements in the absence of vision and under a minimally assistive haptic guidance made by sequences of graded force pulses. The bidirectional haptic interaction between the subject and the robot was optimally adapted to each participant in order to achieve a uniform task difficulty over the workspace. All the subjects consistently improved in the perceptual scores as a consequence of training. Moreover, they could minimize the level of haptic guidance in time. Results suggest that the proposed method is effective in enhancing kinesthetic acuity, but the level of impairment may affect the ability of subjects to retain their improvement in time.

Long-term plasticity in adult somatosensory cortex: functional reorganization after surgical removal of an arteriovenous malformation

The temporal scale of neuroplasticity following acute alterations in brain structure due to neurosurgical intervention is still under debate. We conducted a longitudinal study with the objective of investigating the postoperative changes in a patient who underwent cerebrovascular surgery and who subsequently lost proprioception in the fingers of her right hand. The results show increased activation in contralesional somatosensory areas, additional recruitment of premotor and posterior parietal areas, and changes in functional connectivity with left postcentral gyrus. These findings demonstrate long-term modifications of cortical organization and as such have important implications for treatment strategies for patients with brain injury.

The effect of sensory feedback on crayfish posture and locomotion: II. Neuromechanical simulation of closing the loop

Neuromechanical simulation was used to determine whether proposed thoracic circuit mechanisms for the control of leg elevation and depression in crayfish could account for the responses of an experimental hybrid neuromechanical preparation when the proprioceptive feedback loop was open and closed. The hybrid neuromechanical preparation consisted of a computational model of the fifth crayfish leg driven in real time by the experimentally recorded activity of the levator and depressor (Lev/Dep) nerves of an in vitro preparation of the crayfish thoracic nerve cord. Up and down movements of the model leg evoked by motor nerve activity released and stretched the model coxobasal chordotonal organ (CBCO); variations in the CBCO length were used to drive identical variations in the length of the live CBCO in the in vitro preparation. CBCO afferent responses provided proprioceptive feedback to affect the thoracic motor output. Experiments performed with this hybrid neuromechanical preparation were simulated with a neuromechanical model in which a computational circuit model represented the relevant thoracic circuitry. Model simulations were able to reproduce the hybrid neuromechanical experimental results to show that proposed circuit mechanisms with sensory feedback could account for resistance reflexes displayed in the quiescent state and for reflex reversal and spontaneous Lev/Dep bursting seen in the active state.

The effect of sensory feedback on crayfish posture and locomotion: I. Experimental analysis of closing the loop

The effect of proprioceptive feedback on the control of posture and locomotion was studied in the crayfish Procambarus clarkii (Girard). Sensory and motor nerves of an isolated crayfish thoracic nerve cord were connected to a computational neuromechanical model of the crayfish thorax and leg. Recorded levator (Lev) and depressor (Dep) nerve activity drove the model Lev and Dep muscles to move the leg up and down. These movements released and stretched a model stretch receptor, the coxobasal chordotonal organ (CBCO). Model CBCO length changes drove identical changes in the real CBCO; CBCO afferent responses completed the feedback loop. In a quiescent preparation, imposed model leg lifts evoked resistance reflexes in the Dep motor neurons that drove the leg back down. A muscarinic agonist, oxotremorine, induced an active state in which spontaneous Lev/Dep burst pairs occurred and an imposed leg lift excited a Lev assistance reflex followed by a Lev/Dep burst pair. When the feedback loop was intact, Lev/Dep burst pairs moved the leg up and down rhythmically at nearly three times the frequency of burst pairs when the feedback loop was open. The increased rate of rhythmic bursting appeared to result from the positive feedback produced by the assistance reflex.

More a finger than a nose: the trigeminal motor and sensory innervation of the Schnauzenorgan in the elephant-nose fish Gnathonemus petersii

The weakly electric fish Gnathonemus petersii uses its electric sense to actively probe the environment. Its highly mobile chin appendage, the Schnauzenorgan, is rich in electroreceptors. Physical measurements have demonstrated the importance of the position of the Schnauzenorgan in funneling the fish's self-generated electric field. The present study focuses on the trigeminal motor pathway that controls Schnauzenorgan movement and on its trigeminal sensory innervation and central representation. The nerves entering the Schnauzenorgan are very large and contain both motor and sensory trigeminal components as well as an electrosensory pathway. With the use of neurotracer techniques, labeled Schnauzenorgan motoneurons were found throughout the ventral main body of the trigeminal motor nucleus but not among the population of larger motoneurons in its rostrodorsal region. The Schnauzenorgan receives no motor or sensory innervation from the facial nerve. There are many anastomoses between the peripheral electrosensory and trigeminal nerves, but these senses remain separate in the sensory ganglia and in their first central relays. Schnauzenorgan trigeminal primary afferent projections extend throughout the descending trigeminal sensory nuclei, and a few fibers enter the facial lobe. Although no labeled neurons could be identified in the brain as the trigeminal mesencephalic root, some Schnauzenorgan trigeminal afferents terminated in the trigeminal motor nucleus, suggesting a monosynaptic, possibly proprioceptive, pathway. In this first step toward understanding multimodal central representation of the Schnauzenorgan, no direct interconnections were found between the trigeminal sensory and electromotor command system, or the electrosensory and trigeminal motor command. The pathways linking perception to action remain to be studied.

Transcriptional profiling at whole population and single cell levels reveals somatosensory neuron molecular diversity

The somatosensory nervous system is critical for the organism's ability to respond to mechanical, thermal, and nociceptive stimuli. Somatosensory neurons are functionally and anatomically diverse but their molecular profiles are not well-defined. Here, we used transcriptional profiling to analyze the detailed molecular signatures of dorsal root ganglion (DRG) sensory neurons. We used two mouse reporter lines and surface IB4 labeling to purify three major non-overlapping classes of neurons: 1) IB4⁺SNS-Cre/TdTomato⁺, 2) IB4⁻SNS-Cre/TdTomato⁺, and 3) Parv-Cre/TdTomato⁺ cells, encompassing the majority of nociceptive, pruriceptive, and proprioceptive neurons. These neurons displayed distinct expression patterns of ion channels, transcription factors, and GPCRs. Highly parallel qRT-PCR analysis of 334 single neurons selected by membership of the three populations demonstrated further diversity, with unbiased clustering analysis identifying six distinct subgroups. These data significantly increase our knowledge of the molecular identities of known DRG populations and uncover potentially novel subsets, revealing the complexity and diversity of those neurons underlying somatosensation.

DOI:http://dx.doi.org/10.7554/eLife.04660.001

In the nervous system, a network of specialized neurons—known as the somatosensory system—carries information about sensations including touch, muscle position, temperature and pain. Distinct sets of somatosensory neurons are thought to carry information about the different types of sensations. In young animals, the precise switching on, or ‘expression’, of genes controls the formation of the network of neurons. However, it is not known exactly which genes are expressed in what types of neurons, where, or when.

Here, Chiu et al. used a technique called flow cytometry using different fluorescent markers to isolate a group of cells called Dorsal Root Ganglion (DRG) neurons in mice. These neurons have long thread-like fibers that extend from the spinal cord to the skin, muscles and joints all over the body. These fibers carry sensory information to the spinal cord, where it can be relayed to the brain and processed. The experiments compared three distinct types of DRG neuron and found that they differed in their ability to send information to other cells.

Chiu et al. analyzed the expression of all the genes in the three types of DRG neurons. Each type of neuron had distinct groups of genes that were being expressed. Also, several genes that are known to be important for sensation were expressed at different levels in the different types of cells. Next, large numbers of single cells were analyzed to find out the finer details about the three types of neuron. These findings made it possible to further divide the DRG neurons into six distinct subsets that matched previously known groups of somatosensory neurons, and also identified new ones.

Chiu et al.'s findings reveal the complexity and diversity of the neurons involved in carrying information about sensations towards the brain. This is an important step in classifying the nervous system, and uncovers many genes previously not linked to sensation. The next challenges lie in understanding how the expression of these genes in each type of neuron relates to their unique roles.

DOI:http://dx.doi.org/10.7554/eLife.04660.002

Proprioceptive dysfunction in focal dystonia: from experimental evidence to rehabilitation strategies

Dystonia has historically been considered a disorder of the basal ganglia, mainly affecting planning and execution of voluntary movements. This notion comes from the observation that most lesions responsible for secondary dystonia involve the basal ganglia. However, what emerges from recent research is that dystonia is linked to the dysfunction of a complex neural network that comprises basal ganglia–thalamic–frontal cortex, but also the inferior parietal cortex and the cerebellum. While dystonia is clearly a motor problem, it turned out that sensory aspects are also fundamental, especially those related to proprioception. We outline experimental evidence for proprioceptive dysfunction in focal dystonia from intrinsic sensory abnormalities to impaired sensorimotor integration, which is the process by which sensory information is used to plan and execute volitional movements. Particularly, we will focus on proprioceptive aspects of dystonia, including: (i) processing of vibratory input, (ii) temporal discrimination of two passive movements, (iii) multimodal integration of visual-tactile and proprioceptive inputs, and (iv) motor control in the absence of visual feedback. We suggest that these investigations contribute not only to a better understanding of dystonia pathophysiology, but also to develop rehabilitation strategies aimed at facilitating the processing of proprioceptive input.

Proprioceptive rehabilitation of upper limb dysfunction in movement disorders: a clinical perspective

Movement disorders (MDs) are frequently associated with sensory abnormalities. In particular, proprioceptive deficits have been largely documented in both hypokinetic (Parkinson’s disease) and hyperkinetic conditions (dystonia), suggesting a possible role in their pathophysiology. Proprioceptive feedback is a fundamental component of sensorimotor integration allowing effective planning and execution of voluntary movements. Rehabilitation has become an essential element in the management of patients with MDs, and there is a strong rationale to include proprioceptive training in rehabilitation protocols focused on mobility problems of the upper limbs. Proprioceptive training is aimed at improving the integration of proprioceptive signals using “task-intrinsic” or “augmented feedback.” This perspective article reviews the available evidence on the effects of proprioceptive stimulation in improving upper limb mobility in patients with MDs and highlights the emerging innovative approaches targeted to maximizing the benefits of exercise by means of enhanced proprioception.

The contribution of proprioceptive information to postural control in elderly and patients with Parkinson's disease with a history of falls

Proprioceptive deficits negatively affect postural control but their precise contribution to postural instability in Parkinson’s disease (PD) is unclear. We investigated if proprioceptive manipulations differentially affect balance, measured by force plates, during quiet standing in 13 PD patients and 13 age-matched controls with a history of falls. Perceived limits of stability (LoS) were derived from the differences between maximal center of pressure (CoP) displacement in anterior–posterior (AP) and medio-lateral (ML) direction during a maximal leaning task. Task conditions comprised standing with eyes open (EO) and eyes closed (EC): (1) on a stable surface; (2) an unstable surface; and (3) with Achilles tendon vibration. CoP displacements were calculated as a percentage of their respective LoS. Perceived LoS did not differ between groups. PD patients showed greater ML CoP displacement than elderly fallers (EF) across all conditions (p = 0.043) and tended to have higher postural sway in relation to the LoS (p = 0.050). Both groups performed worse on an unstable surface and during tendon vibration compared to standing on a stable surface with EO and even more so with EC. Both PD and EF had more AP sway in all conditions with EC compared to EO (p < 0.001) and showed increased CoP displacements when relying on proprioception only compared to standing with normal sensory input. This implies a similar role of the proprioceptive system in postural control in fallers with and without PD. PD fallers showed higher ML sway after sensory manipulations, as a result of which these values approached their perceived LoS more closely than in EF. We conclude that despite a similar fall history, PD patients showed more ML instability than EF, irrespective of sensory manipulation, but had a similar reliance on ankle proprioception. Hence, we recommend that rehabilitation and fall prevention for PD should focus on motor rather than on sensory aspects.

Short-Term Adaptation of Joint Position Sense Occurs during and after Sustained Vibration of Antagonistic Muscle Pairs

Proprioception is critical for the control of many goal-directed activities of daily living. While contributions from skin and joint receptors exist, the muscle spindle is thought to play an important role in allowing accurate judgments of limb position and movement to occur. The discharges elicited from muscle spindles can be degraded by simultaneous agonist-antagonist tendon vibration, causing proprioception to be distorted. Despite this, changes in limb perception that may result from sensory adaptation to this stimulus remain misunderstood. The purpose of this study was, therefore, to investigate short-term proprioceptive adaptation resulting from vibration of antagonistic muscle pairs. We measured elbow joint position sense in 21 healthy young adults while 80 Hz vibration was applied simultaneously to the distal tendons of the elbow flexor and extensor muscles. Matching errors were then analyzed during early and late adaptation phases to assess short-term adaptation to the vibration stimuli. Participants committed significant undershoot errors during the early adaptation phase, but were comparable to baseline measurements during the late adaptation phase. When we removed the vibration stimuli and conducted a second joint position matching task, matching variability increased significantly, and participants committed overshoot errors. These results bring into question the efficacy of simultaneous agonist-antagonist tendon vibration to degrade proprioceptive acuity.

Vision of the active limb impairs bimanual motor tracking in young and older adults

Despite the intensive investigation of bimanual coordination, it remains unclear how directing vision toward either limb influences performance, and whether this influence is affected by age. To examine these questions, we assessed the performance of young and older adults on a bimanual tracking task in which they matched motor-driven movements of their right hand (passive limb) with their left hand (active limb) according to in-phase and anti-phase patterns. Performance in six visual conditions involving central vision, and/or peripheral vision of the active and/or passive limb was compared to performance in a no vision condition. Results indicated that directing central vision to the active limb consistently impaired performance, with higher impairment in older than young adults. Conversely, directing central vision to the passive limb improved performance in young adults, but less consistently in older adults. In conditions involving central vision of one limb and peripheral vision of the other limb, similar effects were found to those for conditions involving central vision of one limb only. Peripheral vision alone resulted in similar or impaired performance compared to the no vision (NV) condition. These results indicate that the locus of visual attention is critical for bimanual motor control in young and older adults, with older adults being either more impaired or less able to benefit from a given visual condition.

Degradation of mouse locomotor pattern in the absence of proprioceptive sensory feedback

Mammalian locomotor programs are thought to be directed by the actions of spinal interneuron circuits collectively referred to as "central pattern generators." The contribution of proprioceptive sensory feedback to the coordination of locomotor activity remains less clear. We have analyzed changes in mouse locomotor pattern under conditions in which proprioceptive feedback is attenuated genetically and biomechanically. We find that locomotor pattern degrades upon elimination of proprioceptive feedback from muscle spindles and Golgi tendon organs. The degradation of locomotor pattern is manifest as the loss of interjoint coordination and alternation of flexor and extensor muscles. Group Ia/II sensory feedback from muscle spindles has a predominant influence in patterning the activity of flexor muscles, whereas the redundant activities of group Ia/II and group Ib afferents appear to determine the pattern of extensor muscle firing. These findings establish a role for proprioceptive feedback in the control of fundamental aspects of mammalian locomotor behavior.

Differential regulation of AChR clustering in the polar and equatorial region of murine muscle spindles

Intrafusal fibers of muscle spindles are innervated in the central region by afferent sensory axons and at both polar regions by efferent γ-motoneurons. We previously demonstrated that both neuron-muscle contact sites contain cholinergic synapse-like specialisation, including aggregates of the nicotinic acetylcholine receptor (AChR). In this study we tested the hypothesis that agrin and its receptor complex (consisting of LRP4 and the tyrosine kinase MuSK) are involved in the aggregation of AChRs in muscle spindles, similar to their role at the neuromuscular junction. We show that agrin, MuSK and LRP4 are concentrated at the contact site between the intrafusal fibers and the sensory- and γ-motoneuron, respectively, and that they are expressed in the cell bodies of proprioceptive neurons in dorsal root ganglia. Moreover, agrin and LRP4, but not MuSK, are expressed in γ-motoneuron cell bodies in the ventral horn of the spinal cord. In agrin- and in MuSK-deficient mice, AChR aggregates are absent from the polar regions. In contrast, the subcellular concentration of AChRs in the central region where the sensory neuron contacts the intrafusal muscle fiber is apparently unaffected. Skeletal muscle-specific expression of miniagrin in agrin(-/-) mice in vivo is sufficient to restore the formation of γ-motoneuron endplates. These results show that agrin and MuSK are major determinants during the formation of γ-motoneuron endplates but appear dispensable for the aggregation of AChRs at the central region. Our results therefore suggest different molecular mechanisms for AChR clustering within two domains of intrafusal fibers.

Virtual reality training improves balance function

Virtual reality is a new technology that simulates a three-dimensional virtual world on a computer and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These findings suggest that virtual reality training can activate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.

Neck proprioception shapes body orientation and perception of motion

This review article deals with some effects of neck muscle proprioception on human balance, gait trajectory, subjective straight-ahead (SSA), and self-motion perception. These effects are easily observed during neck muscle vibration, a strong stimulus for the spindle primary afferent fibers. We first remind the early findings on human balance, gait trajectory, SSA, induced by limb, and neck muscle vibration. Then, more recent findings on self-motion perception of vestibular origin are described. The use of a vestibular asymmetric yaw-rotation stimulus for emphasizing the proprioceptive modulation of motion perception from the neck is mentioned. In addition, an attempt has been made to conjointly discuss the effects of unilateral neck proprioception on motion perception, SSA, and walking trajectory. Neck vibration also induces persistent aftereffects on the SSA and on self-motion perception of vestibular origin. These perceptive effects depend on intensity, duration, side of the conditioning vibratory stimulation, and on muscle status. These effects can be maintained for hours when prolonged high-frequency vibration is superimposed on muscle contraction. Overall, this brief outline emphasizes the contribution of neck muscle inflow to the construction and fine-tuning of perception of body orientation and motion. Furthermore, it indicates that tonic neck-proprioceptive input may induce persistent influences on the subject's mental representation of space. These plastic changes might adapt motion sensitiveness to lasting or permanent head positional or motor changes.

Associations between Proprioceptive Neural Pathway Structural Connectivity and Balance in People with Multiple Sclerosis

Mobility and balance impairments are a hallmark of multiple sclerosis (MS), affecting nearly half of patients at presentation and resulting in decreased activity and participation, falls, injuries, and reduced quality of life. A growing body of work suggests that balance impairments in people with mild MS are primarily the result of deficits in proprioception, the ability to determine body position in space in the absence of vision. A better understanding of the pathophysiology of balance disturbances in MS is needed to develop evidence-based rehabilitation approaches. The purpose of the current study was to (1) map the cortical proprioceptive pathway in vivo using diffusion-weighted imaging and (2) assess associations between proprioceptive pathway white matter microstructural integrity and performance on clinical and behavioral balance tasks. We hypothesized that people with MS (PwMS) would have reduced integrity of cerebral proprioceptive pathways, and that reduced white matter microstructure within these tracts would be strongly related to proprioceptive-based balance deficits. We found poorer balance control on proprioceptive-based tasks and reduced white matter microstructural integrity of the cortical proprioceptive tracts in PwMS compared with age-matched healthy controls (HC). Microstructural integrity of this pathway in the right hemisphere was also strongly associated with proprioceptive-based balance control in PwMS and controls. Conversely, while white matter integrity of the right hemisphere’s proprioceptive pathway was significantly correlated with overall balance performance in HC, there was no such relationship in PwMS. These results augment existing literature suggesting that balance control in PwMS may become more dependent upon (1) cerebellar-regulated proprioceptive control, (2) the vestibular system, and/or (3) the visual system.

Motor unit firing pattern, synchrony and coherence in a deafferented patient

The firing of spinal motoneurons (MNs) is controlled continuously by inputs from muscle, joint and skin receptors. Besides altering MN synaptic drive, the removal of these inputs is liable to alter the synaptic noise and, thus, the variability of their tonic activity. Sensory afferents, which are a major source of common and/or synchronized inputs shared by several MNs, may also contribute to the coupling in the time and frequency domains (synchrony and coherence, respectively) observed when cross-correlation and coherence analyses are applied to the discharges of MN pairs. Surprisingly, no consistent changes in firing frequency, nor in synchrony and coherence were reported to affect the activity of 3 pairs of motor units (MUs) tested in a case of sensory polyradiculoneuropathy (SPRNP), leading to an irreversible loss of large diameter sensory afferents (Farmer et al., 1993). Such a limited sample, however, precludes a definite conclusion about the actual impact that a chronic loss of muscle and cutaneous afferents may have on the firing properties of human MUs. To address this issue, the firing pattern of 92 MU pairs was analyzed at low contraction force in a case of SPRNP leading similarly to a permanent loss of proprioceptive inputs. Compared with 8 control subjects, MNs in this patient tended to discharge with slightly shorter inter-spike intervals but with greater variability. Synchronous firing tended to occur more frequently with a tighter coupling in the patient. There was no consistent change in coherence in the 15–30 Hz frequency range attributed to the MN corticospinal drive, but a greater coherence was observed below 5 Hz and between 30 and 60 Hz in the patient. The possible origins of the greater irregularity in MN tonic discharges, the tighter coupling of the synchronous firing and the changes in coherence observed in the absence of proprioceptive inputs are discussed.

Information theoretic analysis of proprioceptive encoding during finger flexion in the monkey sensorimotor system

There is considerable debate over whether the brain codes information using neural firing rate or the fine-grained structure of spike timing. We investigated this issue in spike discharge recorded from single units in the sensorimotor cortex, deep cerebellar nuclei, and dorsal root ganglia in macaque monkeys trained to perform a finger flexion task. The task required flexion to four different displacements against two opposing torques; the eight possible conditions were randomly interleaved. We used information theory to assess coding of task condition in spike rate, discharge irregularity, and spectral power in the 15- to 25-Hz band during the period of steady holding. All three measures coded task information in all areas tested. Information coding was most often independent between irregularity and 15-25 Hz power (60% of units), moderately redundant between spike rate and irregularity (56% of units redundant), and highly redundant between spike rate and power (93%). Most simultaneously recorded unit pairs coded using the same measure independently (86%). Knowledge of two measures often provided extra information about task, compared with knowledge of only one alone. We conclude that sensorimotor systems use both rate and temporal codes to represent information about a finger movement task. As well as offering insights into neural coding, this work suggests that incorporating spike irregularity into algorithms used for brain-machine interfaces could improve decoding accuracy.

Perceptual changes of interaction between hand and object in an experimental phantom hand

The authors examined whether the wrist and elbow were perceived as flexed when a stick was fixed to the hand while the joints were extended during anesthesia. Ten healthy participants lay on their back on a bed with their eyes closed, and a stick was fixed to their right hand. Surprisingly, while the perceived position of the wrist and elbow moved toward flexion from 10 to 40 min after the ischemic block, the stick fixed to the hand was also perceived as having moved toward flexion from 10 to 20 min after the block. Such coupling the change in the perceived stick position with the change in body image suggests a new type of hand-object illusion.

The effects of the CORE programme on pain at rest, movement-induced and secondary pain, active range of motion, and proprioception in female office workers with chronic low back pain: a randomized controlled trial

OBJECTIVE

To investigate the effects of the CORE programme on pain at rest, movement-induced pain, secondary pain, active range of motion, and proprioception deficits in female office workers with chronic low back pain.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation clinics.

SUBJECTS

A total of 53 participants with chronic low back pain were randomized into the CORE group and the control group.

INTERVENTION

CORE group participants underwent the 30-minute CORE programme, five times per week, for eight weeks, with additional use of hot-packs and transcutaneous electrical nerve stimulation, while the control group used only hot-packs and transcutaneous electrical nerve stimulation.

MAIN MEASURES

Participants were evaluated pretest, posttest, and two months after the intervention period to measure resting and movement-induced pain, pressure pain as secondary pain, active range of pain-free motion, and trunk proprioception.

RESULTS

Pain intensity at rest (35.6 ±5.9 mm) and during movement (39.4 ±9.1 mm) was significantly decreased in the CORE group following intervention compared with the control group. There were significant improvements in pressure pain thresholds (quadratus lumborum: 2.2 ±0.7 kg/cm(2); sacroiliac joint: 2.0 ±0.7 kg/cm(2)), active range of motion (flexion: 30.8 ±14.3°; extension: 6.6 ±2.5°), and proprioception (20° flexion: 4.3 ±2.4°; 10° extension: 3.1 ±2.0°) in the CORE group following intervention (all p < 0.05). These improvements were maintained at the two-month follow-up. The control group did not show significant improvements in any measured parameter.

CONCLUSION

The CORE programme is an effective intervention for reducing pain at rest and movement-induced pain, and for improving the active range of motion and trunk proprioception in female office workers with chronic low back pain.

Specification of sensory neurons occurs through diverse developmental programs functioning in the brain and spinal cord

BACKGROUND

Vertebrates possess two populations of sensory neurons located within the central nervous system: Rohon-Beard (RB) and mesencephalic trigeminal nucleus (MTN) neurons. RB neurons are transient spinal cord neurons whilst MTN neurons are the proprioceptive cells that innervate the jaw muscles. It has been suggested that MTN and RB neurons share similarities and may have a common developmental program, but it is unclear how similar or different their development is.

RESULTS

We have dissected RB and MTN neuronal specification in zebrafish. We find that RB and MTN neurons express a core set of genes indicative of sensory neurons, but find these are also expressed by adjacent diencephalic neurons. Unlike RB neurons, our evidence argues against a role for the neural crest during MTN development. We additionally find that neurogenin1 function is dispensable for MTN differentiation, unlike RB cells and all other sensory neurons. Finally, we demonstrate that, although Notch signalling is involved in RB development, it is not involved in the generation of MTN cells.

CONCLUSIONS

Our work reveals fundamental differences between the development of MTN and RB neurons and suggests that these populations are non-homologous and thus have distinct developmental and, probably, evolutionary origins.

Sensorimotor training during expression of the leg extension response (LER) in 1-day-old rats

In newborn rats, the leg extension response (LER) is a coordinated hyperextension of the hindlimbs that is shown in response to anogenital stimulation. Here we examined the influence of sensorimotor training on LER expression in postnatal day 1 rats. In Experiment 1, we examined if proprioceptive feedback facilitates LER expression. We did this by repeatedly stimulating the pup's anogenital region with a vibrotactile device, to experimentally evoke the LER, thus increasing LER-relevant hindlimb proprioceptive feedback during training. In trained subjects, the LER was evoked every 4 min for 15 trials, followed by a final LER test. Results indicated that proprioceptive feedback on its own did not alter later expression of the LER. In Experiment 2, we examined the effect of both proprioceptive and cutaneous feedback on LER expression, through the use of a range of motion (ROM) restriction during training. During ROM restriction, a Plexiglas plate was placed beneath the pup at 50% of limb length. After the 15th training trial, a final LER test occurred with no ROM restriction in place. Compared to controls, pups that experienced ROM restriction exhibited a significantly shorter LER duration, and smaller hip and ankle angles during the LER test (indicating greater limb flexion). Together these findings show that concurrent proprioceptive and cutaneous feedback, but not proprioceptive feedback alone, has persistent effects on expression of this newborn action pattern.

Impact of altered lower limb proprioception produced by tendon vibration on adaptation to split-belt treadmill walking

It has been proposed that proprioceptive input is essential to the development of a locomotor body schema that is used to guide the assembly of successful walking. Proprioceptive information is used to signal the need for, and promotion of, locomotor adaptation in response to environmental or internal modifications. The purpose of this investigation was to determine if tendon vibration applied to either the hamstrings or quadriceps of participants experiencing split-belt treadmill walking modified lower limb kinematics during the early adaptation period. Modifications in the adaptive process in response to vibration would suggest that the sensory-motor system had been unsuccessful in down weighting the disruptive proprioceptive input resulting from vibration. Ten participants experienced split-belt walking, with and without vibration, while gait kinematics were obtained with a 12-camera collection system. Bilateral hip, knee, and ankle joint angles were calculated and the first five strides after the split were averaged for each subject to create joint angle waveforms for each of the assessed joints, for each experimental condition. The intralimb variables of stride length, percent stance time, and relative timing between various combinations of peak joint angles were assessed using repeated measures MANOVA. Results indicate that vibration had very little impact on the split-belt walking adaptive process, although quadriceps vibration did significantly reduce percent stance time by 1.78% relative to the no vibration condition. The data suggest that the perceptual-motor system was able to down weight the disrupted proprioceptive input such that the locomotor body schema was able to effectively manage the lower limb patterns of motion necessary to adapt to the changing belt speed. Complementary explanations for the current findings are also discussed.

Relationship between visuospatial neglect and kinesthetic deficits after stroke

BACKGROUND

After stroke, visuospatial and kinesthetic (sense of limb motion) deficits are common, occurring in approximately 30% and 60% of individuals, respectively. Although both types of deficits affect aspects of spatial processing necessary for daily function, few studies have investigated the relationship between these 2 deficits after stroke.

OBJECTIVE

We aimed to characterize the relationship between visuospatial and kinesthetic deficits after stroke using the Behavioral Inattention Test (BIT) and a robotic measure of kinesthetic function.

METHODS

Visuospatial attention (using the BIT) and kinesthesia (using robotics) were measured in 158 individuals an average of 18 days after stroke. In the kinesthetic matching task, the robot moved the participant's stroke-affected arm at a preset direction, speed, and magnitude. Participants mirror-matched the robotic movement with the less/unaffected arm as soon as they felt movement in their stroke affected arm.

RESULTS

We found that participants with visuospatial inattention (neglect) had impaired kinesthesia 100% of the time, whereas only 59% of participants without neglect were impaired. For those without neglect, we observed that a higher percentage of participants with lower but passing BIT scores displayed impaired kinesthetic behavior (78%) compared with those participants who scored perfect or nearly perfect on the BIT (49%).

CONCLUSIONS

The presence of visuospatial neglect after stroke is highly predictive of the presence of kinesthetic deficits. However, the presence of kinesthetic deficits does not necessarily always indicate the presence of visuospatial neglect. Our findings highlight the importance of assessment and treatment of kinesthetic deficits after stroke, especially in patients with visuospatial neglect.

Evaluation of upper limb sense of position in healthy individuals and patients after stroke

The aims of this study were to develop and evaluate reliability of a quantitative assessment tool for upper limb sense of position on the horizontal plane. We evaluated 15 healthy individuals (controls) and 9 stroke patients. A robotic device passively moved one arm of the blindfolded participant who had to actively move his/her opposite hand to the mirror location in the workspace. Upper-limb's position was evaluated by a digital camera. The position of the passive hand was compared with the active hand's 'mirror' position. Performance metrics were then computed to measure the mean absolute errors, error variability, spatial contraction/expansion, and systematic shifts. No significant differences were observed between dominant and non-dominant active arms of controls. All performance parameters of the post-stroke group differed significantly from those of controls. This tool can provide a quantitative measure of upper limb sense of position, therefore allowing detection of changes due to rehabilitation.

Postural response to vibration of triceps surae, but not quadriceps muscles, differs between people with and without knee osteoarthritis

Although proprioceptive impairments are reported in knee osteoarthritis (OA), there has been little investigation of the underlying causes. Muscle spindles make an important contribution to proprioception. This study investigated whether function of quadriceps, triceps surae, and tibialis anterior muscle spindles is altered in individuals with knee OA. Thirty individuals with knee OA (17 females, 66 ± 7 [mean ± SD] years) and 30 healthy asymptomatic controls (17 females, 65 ± 8 years) stood comfortably and blindfolded on a force plate. Mechanical vibration (60 Hz) was applied bilaterally over the quadriceps, triceps surae, or tibialis anterior muscles for the middle 15 s (Vibration) of a 45 s trial (preceded and followed by 15 s Baseline and Recovery periods). Two trials were recorded for each muscle site. Mean anterior-posterior displacement of centre of pressure was analysed. Although there were no differences between groups for trials with vibration applied to the quandriceps or tibialis anterior, participants with knee OA were initially perturbed more by triceps surae vibration and accommodated less to repeated exposure than controls. This indicates that people with knee OA have less potential to detect or compensate for disturbed input to triceps surae, possibly due to an inability to compensate using muscles spindles in the quadriceps muscle.

Clinical evaluation of motion and position sense in the upper extremities of the elderly using motion analysis system

The purpose of this study was to measure kinesthetic accuracy in healthy older adults by using arm position and motion matching tests. We investigated the effect of task type, joint angle, and matching arm results on kinesthetic accuracy in the upper extremities of 17 healthy right-handed older adults. Blinded subjects were asked to match positions and motions at four reference joint angles: 1) shoulder flexion, 0°–60°; 2) elbow flexion, 90°–135°; 3) wrist extension, 0°–50° in the sagittal plane; and 4) shoulder abduction, 0°–60° in the frontal plane. The absolute difference in angular displacement between the reference and matching arms was calculated to determine kinesthetic accuracy. Results showed that subjects were more accurate at matching motion than position tasks (P=0.03). Shoulder and elbow joints were more sensitive than wrist joints in perceiving passive positions and motions (P<0.05). The effect of the matching arm was found only when matching the joint angles of shoulder abduction and wrist extension (P<0.01). These results are comparable to findings of other studies that used machine-generated kinesthetic stimuli. The manual measurement of kinesthetic accuracy could be effective as a preliminary screening tool for therapists in clinical settings.

Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis

BACKGROUND

Clinicians commonly examine posture and movement in people with the belief that correcting dysfunctional movement may reduce pain. If dysfunctional movement is to be accurately identified, clinicians should know what constitutes normal movement and how this differs in people with low back pain (LBP). This systematic review examined studies that compared biomechanical aspects of lumbo-pelvic movement in people with and without LBP.

METHODS

MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2014 for relevant studies. Studies had to compare adults with and without LBP using skin surface measurement techniques to measure lumbo-pelvic posture or movement. Two reviewers independently applied inclusion and exclusion criteria, and identified and extracted data. Standardised mean differences and 95% confidence intervals were estimated for group differences between people with and without LBP, and where possible, meta-analyses were performed. Within-group variability in all measurements was also compared.

RESULTS

The search identified 43 eligible studies. Compared to people without LBP, on average, people with LBP display: (i) no difference in lordosis angle (8 studies), (ii) reduced lumbar ROM (19 studies), (iii) no difference in lumbar relative to hip contribution to end-range flexion (4 studies), (iv) no difference in standing pelvic tilt angle (3 studies), (v) slower movement (8 studies), and (vi) reduced proprioception (17 studies). Movement variability appeared greater for people with LBP for flexion, lateral flexion and rotation ROM, and movement speed, but not for other movement characteristics. Considerable heterogeneity exists between studies, including a lack of detail or standardization between studies on the criteria used to define participants as people with LBP (cases) or without LBP (controls).

CONCLUSIONS

On average, people with LBP have reduced lumbar ROM and proprioception, and move more slowly compared to people without LBP. Whether these deficits exist prior to LBP onset is unknown.

Feasibility of visual instrumented movement feedback therapy in individuals with motor incomplete spinal cord injury walking on a treadmill

Background: Incomplete spinal cord injury (iSCI) leads to motor and sensory deficits. Even in ambulatory persons with good motor function an impaired proprioception may result in an insecure gait. Limited internal afferent feedback (FB) can be compensated by provision of external FB by therapists or technical systems. Progress in computational power of motion analysis systems allows for implementation of instrumented real-time FB. The aim of this study was to test if individuals with iSCI can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy.

Methods: Individuals with chronic iSCI had to complete 6 days (1 day per week) of treadmill-based FB training with a 2 weeks pause after 3 days of training. Each day consists of an initial gait analysis followed by 2 blocks with FB/no-FB. During FB the deviation of the mean knee angle during swing from a speed matched reference (norm distance, ND) is visualized as a number. The task consists of lowering the ND, which was updated after every stride. Prior to the tests in patients the in-house developed FB implementation was tested in healthy subjects with an artificial movement task.

Results: Four of five study participants benefited from FB in the short and medium term. Decrease of mean ND was highest during the first 3 sessions (from 3.93 ± 1.54 to 2.18 ± 1.04). After the pause mean ND stayed in the same range than before. In the last 3 sessions the mean ND decreased slower (2.40 ± 1.18 to 2.20 ± 0.90). Direct influences of FB ranged from 60 to 15% of reduction in mean ND compared to initial gait analysis and from 20 to 1% compared to no-FB sessions.

Conclusions: Instrumented kinematic real-time FB may serve as an effective adjunct to established gait therapies in normalizing the gait pattern after incomplete spinal cord injury. Further studies with larger patient groups need to prove long term learning and the successful transfer of newly acquired skills to activities of daily living.

The co-constitution of the self and the world: action and proprioceptive coupling

This article proposes a theoretical reflection on the conditions for the constitution of a distinction between the self and the world by a cognitive system. The main hypothesis is the following: proprioception, as a sensory system that is habitually dedicated essentially to experience of the body, is conceived here as a coupling which is necessary for the dual and concomitant constitution of a bodily self and of a distal perceptual field. After recalling the singular characteristics of proprioceptive coupling, three lines of thought are developed. The first, which is notably inspired by research on sensory substitution, aims at emphasizing the indispensable role of action in the context of such perceptual learning. In a second part, this hypothesis is tested against opposing arguments. In particular, we shall discuss, in the context of what Braitenberg called a synthetic psychology, the emergence of oriented behaviors in simple robots that can be regulated by sensory regulations which are strictly external, since these robots do not have any form of "proprioception." In the same vein, this part also provides the opportunity to discuss the argument concerning a bijective relation between action and proprioception; it has been argued by others that because of this strict bijection it is not possible for proprioception to be the basis for the constitution of an exteriority. The third part, which is more prospective, suggests that it is important to take the measure of the phylogenetic history of this exteriority, starting from unicellular organisms. Taking into account the literature which attests the existence of proprioception even amongst the most elementary living organisms, this leads us to propose that the coupling of proprioception to action is very primitive, and that the role we propose for it in the co-constitution of an exteriority and self is probably already at work in the simplest living organisms.

Effect of spinal manipulation on the development of history-dependent responsiveness of lumbar paraspinal muscle spindles in the cat

We determined whether spinal manipulation could prevent and/or reverse the decrease and increase in paraspinal muscle spindle responsiveness caused respectively by lengthening and shortening histories of the lumbar muscles. Single unit spindle activity from multifidus and longissimus muscles was recorded in the L6 dorsal root in anesthetized cats. Muscle history was created and spinal manipulation delivered (thrust amplitude: 1.0mm, duration: 100ms) using a feedback-controlled motor attached to the L6 spinous process. Muscle spindle discharge to a fixed vertebral position (static test) and to vertebral movement (dynamic test) was evaluated following the lengthening and shortening histories. For the static test, changes in muscle spindle responsiveness were significantly less when spinal manipulation followed muscle history (p<0.01), but not when spinal manipulation preceded it (p>0.05). For the dynamic test, spinal manipulation did not significantly affect the history-induced change in muscle spindle responsiveness. Spinal manipulation may partially reverse the effects of muscle history on muscle spindle signaling of vertebral position.

Robot-assisted vs. sensory integration training in treating gait and balance dysfunctions in patients with multiple sclerosis: a randomized controlled trial

Background: Extensive research on both healthy subjects and patients with central nervous damage has elucidated a crucial role of postural adjustment reactions and central sensory integration processes in generating and “shaping” locomotor function, respectively. Whether robotic-assisted gait devices might improve these functions in Multiple sclerosis (MS) patients is not fully investigated in literature.

Purpose: The aim of this study was to compare the effectiveness of end-effector robot-assisted gait training (RAGT) and sensory integration balance training (SIBT) in improving walking and balance performance in patients with MS.

Methods: Twenty-two patients with MS (EDSS: 1.5–6.5) were randomly assigned to two groups. The RAGT group (n = 12) underwent end-effector system training. The SIBT group (n = 10) underwent specific balance exercises. Each patient received twelve 50-min treatment sessions (2 days/week). A blinded rater evaluated patients before and after treatment as well as 1 month post treatment. Primary outcomes were walking speed and Berg Balance Scale. Secondary outcomes were the Activities-specific Balance Confidence Scale, Sensory Organization Balance Test, Stabilometric Assessment, Fatigue Severity Scale, cadence, step length, single and double support time, Multiple Sclerosis Quality of Life-54.

Results: Between groups comparisons showed no significant differences on primary and secondary outcome measures over time. Within group comparisons showed significant improvements in both groups on the Berg Balance Scale (P = 0.001). Changes approaching significance were found on gait speed (P = 0.07) only in the RAGT group. Significant changes in balance task-related domains during standing and walking conditions were found in the SIBT group.

Conclusion: Balance disorders in patients with MS may be ameliorated by RAGT and by SIBT.

Effects of proprioceptive disruption on lumbar spine repositioning error in a trunk forward bending task

BACKGROUND

Various inputs of proprioception have been identified and shown to influence low back proprioception sense.

OBJECTIVE

To investigate the effect of disrupting proprioception on lumbar spine repositioning error during forward bending.

METHOD

Healthy-subjects (n=28) and patients with non-specific chronic low-back pain (n=10) aged between 20-50 years. Subjects performed 5 repetitions of a lumbar repositioning task targeting 30° of trunk-forward-bending from a seated-position with different proprioceptive disturbances administered to the low back. Video analysis of skin reflective markers measured lumbar spine range-of-motion. A control-task was performed without any proprioceptive disturbance, while the remaining 4 tasks were electro-stimulation, vibration, taping and sitting on an unstable surface.

RESULTS

The healthy group showed significantly altered repositioning error when compared with the control task (p=0.004): control-task vs. taping-task, vibration-task and unstable-sitting. In the NS-CLBP group, one motor-task showed significant difference in control-task vs. taping-task (p=0.004). Comparison between the NS-CLBP and matched-healthy groups revealed that the NS-CLBP subjects had larger repositioning-error (p=0.009) for control, taping and vibration tasks.

CONCLUSIONS

Proprioceptive disturbances had the most significant effect in increasing repositioning-error among healthy subjects. The between-groups analysis confirmed evidence consistent with the literature of greater repositioning-error in people with NS-CLBP than healthy subjects.

Proprioception: where are we now? A commentary on clinical assessment, changes across the life course, functional implications and future interventions

Proprioception, the sense of where one is in space, is essential for effective interaction with the environment. A lack of or reduction in proprioceptive acuity has been directly correlated with falls and with reduced functional independence in older people. Proprioceptive losses have also been shown to negatively correlate with functional recovery post stroke and play a significant role in other conditions such as Parkinson's disease. However, despite its central importance to many geriatric syndromes, the clinical assessment of proprioception has remained remarkably static. We look at approaches to the clinical assessment of proprioception, changes in proprioception across the life course, functional implications of proprioception in health and disease and the potential for targeted interventions in the future such as joint taping, and proprioception-specific rehabilitation and footwear.

Elbow joint position sense after total elbow arthroplasty

BACKGROUND

Multiple human experiments have shown that articular lesions can have a negative effect on proprioception. The influence of total elbow arthroplasty on joint position sense has not been reported so far. The purpose of the study was to evaluate proprioception, defined as a joint position sense, after total elbow arthroplasty.

METHODS

The study included 16 patients with unilateral semiconstrained linked total elbow arthroplasty and 21 healthy volunteers. The evaluation included measurement of active and passive reproduction of joint position sense of both elbows after surgery and the control groups. Reference angles included extension to 50° and 70° and flexion to 110°. We also assessed function of the elbow in arthroplasty group using the Mayo Elbow Performance Score, the Disability of the Arm, Shoulder and Hand score, and a visual analog scale for pain level.

RESULTS

The average value of error of passive reproduction of joint position for elbows after arthroplasty was significantly inferior for all evaluated positions compared with the contralateral elbow and with the control group, respectively, at 110° flexion: 4.3°, 2.7°, and 3.2°; at 70° extension: 4.9°, 2.9°, and 2.7°; and at 50° extension: 6.3°, 3.8°, and 3.8°. The average value of error of active reproduction of joint position for the arthroplasty group was also significantly inferior, respectively, at 110° flexion: 3.5°, 1.9° and 2°; and at 50° extension: 4.4°, 3.3°, and 3°.

CONCLUSION

Proprioception in elbows that undergo total arthroplasty is significantly inferior compared with the contralateral site of the patient and in the healthy control group.

Postural control in strabismic children: importance of proprioceptive information

OBJECTIVE

To examine the effect of proprioceptive information during postural control in strabismic children.

METHODS

Postural stability was recorded with a platform (Techno Concept®) in 12 strabismic children aged from 4.9 to 10 years and data were compared to that of 12 control age-matched children. Two postural positions were performed: Romberg and Tandem. Two postural conditions: without and with foam pad. We analyzed the surface area, the length, the mean speed of the center of pressure (CoP) and the effect of proprioceptive information.

RESULTS

Strabismic children are more instable than control age-matched children. The surface, the length and the mean speed of CoP are significantly higher in strabismic children than in control age-matched children. Both groups are more instable in Tandem position than in Romberg position. Finally, strabismic children use more proprioceptive information than control age-matched children.

CONCLUSION

For both Romberg and Tandem position, strabismic children are more instable than control age-matched children. Strabismic children use proprioceptive information more than control age-matched children to control their posture.

SIGNIFICANCE

Proprioceptive inputs are important for control posture particularly for strabismic population.

Movement-based embodied contemplative practices: definitions and paradigms

Over the past decades, cognitive neuroscience has witnessed a shift from predominantly disembodied and computational views of the mind, to more embodied and situated views of the mind. These postulate that mental functions cannot be fully understood without reference to the physical body and the environment in which they are experienced. Within the field of contemplative science, the directing of attention to bodily sensations has so far mainly been studied in the context of seated meditation and mindfulness practices. However, the cultivation of interoceptive, proprioceptive and kinesthetic awareness is also said to lie at the core of many movement-based contemplative practices such as Yoga, Qigong, and Tai Chi. In addition, it likely plays a key role in the efficacy of modern somatic therapeutic techniques such as the Feldenkrais Method and the Alexander Technique. In the current paper we examine how these practices are grounded in the concepts of embodiment, movement and contemplation, as we look at them primarily through the lens of an enactive approach to cognition. Throughout, we point to a series of challenges that arise when Western scientists study practices that are based on a non-dualistic view of mind and body.

Early vestibular processing does not discriminate active from passive self-motion if there is a discrepancy between predicted and actual proprioceptive feedback

Most of our sensory experiences are gained by active exploration of the world. While the ability to distinguish sensory inputs resulting of our own actions (termed reafference) from those produced externally (termed exafference) is well established, the neural mechanisms underlying this distinction are not fully understood. We have previously proposed that vestibular signals arising from self-generated movements are inhibited by a mechanism that compares the internal prediction of the proprioceptive consequences of self-motion to the actual feedback. Here we directly tested this proposal by recording from single neurons in monkey during vestibular stimulation that was externally produced and/or self-generated. We show for the first time that vestibular reafference is equivalently canceled for self-generated sensory stimulation produced by activation of the neck musculature (head-on-body motion), or axial musculature (combined head and body motion), when there is no discrepancy between the predicted and actual proprioceptive consequences of self-motion. However, if a discrepancy does exist, central vestibular neurons no longer preferentially encode vestibular exafference. Specifically, when simultaneous active and passive motion resulted in activation of the same muscle proprioceptors, neurons robustly encoded the total vestibular input (i.e., responses to vestibular reafference and exafference were equally strong), rather than exafference alone. Taken together, our results show that the cancellation of vestibular reafference in early vestibular processing requires an explicit match between expected and actual proprioceptive feedback. We propose that this vital neuronal computation, necessary for both accurate sensory perception and motor control, has important implications for a variety of sensory systems that suppress self-generated signals.

Reliability and relative weighting of visual and nonvisual information for perceiving direction of self-motion during walking

Direction of self-motion during walking is indicated by multiple cues, including optic flow, nonvisual sensory cues, and motor prediction. I measured the reliability of perceived heading from visual and nonvisual cues during walking, and whether cues are weighted in an optimal manner. I used a heading alignment task to measure perceived heading during walking. Observers walked toward a target in a virtual environment with and without global optic flow. The target was simulated to be infinitely far away, so that it did not provide direct feedback about direction of self-motion. Variability in heading direction was low even without optic flow, with average RMS error of 2.4°. Global optic flow reduced variability to 1.9°-2.1°, depending on the structure of the environment. The small amount of variance reduction was consistent with optimal use of visual information. The relative contribution of visual and nonvisual information was also measured using cue conflict conditions. Optic flow specified a conflicting heading direction (±5°), and bias in walking direction was used to infer relative weighting. Visual feedback influenced heading direction by 16%-34% depending on scene structure, with more effect with dense motion parallax. The weighting of visual feedback was close to the predictions of an optimal integration model given the observed variability measures.

Multimodal integration of self-motion cues in the vestibular system: active versus passive translations

The ability to keep track of where we are going as we navigate through our environment requires knowledge of our ongoing location and orientation. In response to passively applied motion, the otolith organs of the vestibular system encode changes in the velocity and direction of linear self-motion (i.e., heading). When self-motion is voluntarily generated, proprioceptive and motor efference copy information is also available to contribute to the brain's internal representation of current heading direction and speed. However to date, how the brain integrates these extra-vestibular cues with otolith signals during active linear self-motion remains unknown. Here, to address this question, we compared the responses of macaque vestibular neurons during active and passive translations. Single-unit recordings were made from a subgroup of neurons at the first central stage of sensory processing in the vestibular pathways involved in postural control and the computation of self-motion perception. Neurons responded far less robustly to otolith stimulation during self-generated than passive head translations. Yet, the mechanism underlying the marked cancellation of otolith signals did not affect other characteristics of neuronal responses (i.e., baseline firing rate, tuning ratio, orientation of maximal sensitivity vector). Transiently applied perturbations during active motion further established that an otolith cancellation signal was only gated in conditions where proprioceptive sensory feedback matched the motor-based expectation. Together our results have important implications for understanding the brain's ability to ensure accurate postural and motor control, as well as perceptual stability, during active self-motion.

The role of differential delays in integrating transient visual and proprioceptive information

Many actions involve limb movements toward a target. Visual and proprioceptive estimates are available online, and by optimally combining (Ernst and Banks, 2002) both modalities during the movement, the system can increase the precision of the hand estimate. The notion that both sensory modalities are integrated is also motivated by the intuition that we do not consciously perceive any discrepancy between the felt and seen hand's positions. This coherence as a result of integration does not necessarily imply realignment between the two modalities (Smeets et al., 2006). For example, the two estimates (visual and proprioceptive) might be different without either of them (e.g., proprioception) ever being adjusted after recovering the other (e.g., vision). The implication that the felt and seen positions might be different has a temporal analog. Because the actual feedback from the hand at a given instantaneous position reaches brain areas at different times for proprioception and vision (shorter for proprioception), the corresponding instantaneous unisensory position estimates will be different, with the proprioceptive one being ahead of the visual one. Based on the assumption that the system integrates optimally and online the available evidence from both senses, we introduce a temporal mechanism that explains the reported overestimation of hand positions when vision is occluded for active and passive movements (Gritsenko et al., 2007) without the need to resort to initial feedforward estimates (Wolpert et al., 1995). We set up hypotheses to test the validity of the model, and we contrast simulation-based predictions with empirical data.

Distribution of sensory nerve endings around the human sinus tarsi: a cadaver study

The aim of this study was to analyse the pattern of sensory nerve endings and blood vessels around the sinus tarsi. The superficial and deep parts of the fat pads at the inferior extensor retinaculum (IER) as well as the subtalar joint capsule inside the sinus tarsi from 13 cadaver feet were dissected. The distribution of the sensory nerve endings and blood vessels were analysed in the resected specimens as the number per cm(2) after staining with haematoxylin-eosin, S100 protein, low-affinity neurotrophin receptor p75, and protein gene product 9.5 using the classification of Freeman and Wyke. Free nerve endings were the predominant sensory ending (P < 0.001). Ruffini and Golgi-like endings were rarely found and no Pacini corpuscles were seen. Significantly more free nerve endings (P < 0.001) and blood vessels (P = 0.01) were observed in the subtalar joint capsule than in the superficial part of the fat pad at the IER. The deep part of the fat pad at the IER had significantly more blood vessels than the superficial part of the fat pad at the IER (P = 0.012). Significantly more blood vessels than free nerve endings were seen in all three groups (P < 0.001). No significant differences in distribution were seen in terms of right or left side, except for free nerve endings in the superficial part of the fat pad at the IER (P = 0.003). A greater number of free nerve endings correlated with a greater number of blood vessels. The presence of sensory nerve endings between individual fat cells supports the hypothesis that the fat pad has a proprioceptive role monitoring changes and that it is a source of pain in sinus tarsi syndrome due to the abundance of free nerve endings.

Lateralization of spatial information processing in response monitoring

The current study aims at identifying how lateralized multisensory spatial information processing affects response monitoring and action control. In a previous study, we investigated multimodal sensory integration in response monitoring processes using a Simon task. Behavioral and neurophysiologic results suggested that different aspects of response monitoring are asymmetrically and independently allocated to the hemispheres: while efference-copy-based information on the motor execution of the task is further processed in the hemisphere that originally generated the motor command, proprioception-based spatial information is processed in the hemisphere contralateral to the effector. Hence, crossing hands (entering a “foreign” spatial hemifield) yielded an augmented bilateral activation during response monitoring since these two kinds of information were processed in opposing hemispheres. Because the traditional Simon task does not provide the possibility to investigate which aspect of the spatial configuration leads to the observed hemispheric allocation, we introduced a new “double crossed” condition that allows for the dissociation of internal/physiological and external/physical influences on response monitoring processes. Comparing behavioral and neurophysiologic measures of this new condition to those of the traditional Simon task setup, we could demonstrate that the egocentric representation of the physiological effector's spatial location accounts for the observed lateralization of spatial information in action control. The finding that the location of the physical effector had a very small influence on response monitoring measures suggests that this aspect is either less important and/or processed in different brain areas than egocentric physiological information.

The neural encoding of self-generated and externally applied movement: implications for the perception of self-motion and spatial memory

The vestibular system is vital for maintaining an accurate representation of self-motion. As one moves (or is moved) toward a new place in the environment, signals from the vestibular sensors are relayed to higher-order centers. It is generally assumed the vestibular system provides a veridical representation of head motion to these centers for the perception of self-motion and spatial memory. In support of this idea, evidence from lesion studies suggests that vestibular inputs are required for the directional tuning of head direction cells in the limbic system as well as neurons in areas of multimodal association cortex. However, recent investigations in monkeys and mice challenge the notion that early vestibular pathways encode an absolute representation of head motion. Instead, processing at the first central stage is inherently multimodal. This minireview highlights recent progress that has been made towards understanding how the brain processes and interprets self-motion signals encoded by the vestibular otoliths and semicircular canals during everyday life. The following interrelated questions are considered. What information is available to the higher-order centers that contribute to self-motion perception? How do we distinguish between our own self-generated movements and those of the external world? And lastly, what are the implications of differences in the processing of these active vs. passive movements for spatial memory?

A noninvasive biomechanical treatment as an additional tool in the rehabilitation of an acute anterior cruciate ligament tear: A case report

Objectives:

Conservative treatments for anterior cruciate ligament (ACL) tears may have just as good an outcome as invasive treatments. These include muscle strengthening and neuromuscular proprioceptive exercises to improve joint stability and restore motion to the knee. The Purpose of the current work presents was to examine the feasibility of a novel non-invasive biomechanical treatment to improve the rehabilitation process following an ACL tear. This is a single case report that presents the effect of this therapy in a patient with a complete ACL rupture who chose not to undergo reconstructive surgery.

Methods:

A 29-year old female athlete with an acute indirect injury to the knee who chose not to undergo surgery was monitored. Two days after injury the patient began AposTherapy. A unique biomechanical device was specially calibrated to the patient’s feet. The therapy program was initiated, which included carrying out her daily routine while wearing the device. The subject underwent a gait analysis at baseline and follow-up gait analyses at weeks 1, 2, 4, 8, 12 and 26.

Results:

A severe abnormal gait was seen immediately after injury, including a substantial decrease in gait velocity, step length and single limb support. In addition, limb symmetry was substantially compromised following the injury. After 4 weeks of treatment, patient had returned to normal gait values and limbs asymmetry reached the normal range.

Conclusions:

The results of this case report suggest that this conservative biomechanical therapy may have helped this patient in her rehabilitation process. Further research is needed in order to determine the effect of this therapy for patients post ACL injuries.

A unifying modeling of plant shoot gravitropism with an explicit account of the effects of growth

Gravitropism, the slow reorientation of plant growth in response to gravity, is a major determinant of the form and posture of land plants. Recently a universal model of shoot gravitropism, the AC model, was presented, in which the dynamics of the tropic movement is only determined by the conflicting controls of (1) graviception that tends to curve the plants toward the vertical, and (2) proprioception that tends to keep the stem straight. This model was found to be valid for many species and over two orders of magnitude of organ size. However, the motor of the movement, the elongation, was purposely neglected in the AC model. If growth effects are to be taken into account, it is necessary to consider the material derivative, i.e., the rate of change of curvature bound to expanding and convected organ elements. Here we show that it is possible to rewrite the material equation of curvature in a compact simplified form that directly expresses the curvature variation as a function of the median elongation and of the distribution of the differential growth. By using this extended model, called the ACĖ model, growth is found to have two main destabilizing effects on the tropic movement: (1) passive orientation drift, which occurs when a curved element elongates without differential growth, and (2) fixed curvature, when an element leaves the elongation zone and is no longer able to actively change its curvature. By comparing the AC and ACĖ models to experiments, these two effects are found to be negligible. Our results show that the simplified AC mode can be used to analyze gravitropism and posture control in actively elongating plant organs without significant information loss.