Proprioception in musculoskeletal rehabilitation. Part 2: Clinical assessment and intervention

Joint position error after neck protraction-retraction movements in healthy office workers: a cross-sectional study

Since the upper cervical spine (UCS) has been regarded to be distinct from the lower cervical spine (LCS), joint position error (JPE) needs to be tested separately for both regions. The purpose of this study was to investigate the JPE after cervical protraction/retraction movements, involving opposite movements of extension and flexion for the UCS and LCS. These movements are frequently performed during office work. Cervical JPEs were tracked in thirty healthy office workers while performing four tests of cervical pro-retraction movements with variations in vision and movement direction, and assessed using the Kinect head tracker (Microsoft Corp), placed in front of each participant. The JPE was expressed in constant (CE), absolute (AE) and variable errors (VE). Multilevel linear models evaluated main and interaction effects of vision, movement direction, cervical region and sex. Slightly larger JPEs have been found in the UCS. Vision showed no effect on any outcome variable. No effect exceeded typical measurement errors reported for the Kinect head tracker. This study showed, that JPEs after pro-retraction movements of the head and neck may differ for UCS and LCS. The differences were small and not beyond measurement error reported for the Kinect.

Effects of 4 Weeks of Active Exergames Training on Muscular Fitness in Elderly Women

Gallardo-Meza, C, Simon, K, Bustamante-Ara, N, Ramirez-Campillo, R, García-Pinillos, F, Keogh, JWL, and Izquierdo, M. Effects of 4 weeks of active exergames training on muscular fitness in elderly women. J Strength Cond Res XX(X): 000-000, 2020-To analyze the effects of 4 weeks of an active exergames training program on muscular fitness in older women, 2 groups of community dwelling physically active subjects were formed by block-design randomization. One was deemed the control group (CG, n = 37; age 68.1 ± 3.3 years), and a second group completed 4 weeks of an active exergames training program (ExG, n = 35; age, 69.2 ± 3.7 years). Training included active exergames (Wii Fit Plus) performed on the Wii Balanceboard, 2 sessions per week. The exergames required mainly balance-related movements, such as leaning forward, leftward, and rightward, also requiring isometric squat positions and explosive leg extension. A supervisor-to-subject ratio method of 2:1 was used. An intensity-based individual progressive overload was applied. There were no significant (all p > 0.05, d = 0.01-0.07) baseline differences between-groups for all dependent variables. For the ExG, significant improvements were observed in static balance right leg test (Δ75.5%, d = 0.89), static balance left leg (Δ33.7%, d = 0.57), timed up-and-go test (Δ14.8%, d = 0.85) and sit-to-stand velocity test (Δ83.8%, d = 1.62). For the control group, trivial to small decrements in performance were observed across all tests (Δ -2.1 to -8.4%, d = -0.08 to 0.32). Group × time interactions were observed for the static balance right and left leg, timed up-and-go test, and the mean velocity achieved in the 5-repetition sit-to-stand test (all p < 0.001; d = 0.33-0.60). In conclusion, exergames training improves muscular fitness in older women. These results should be considered when designing appropriate and better exercise training programs for older women.

A novel staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex injury: A case report

STUDY DESIGN

Case report.

INTRODUCTION

Studies have highlighted the sensory innervations and stabilizing role of forearm muscles on wrist joint and implications to wrist sensorimotor rehabilitation. This case explored the novel incorporation of dart-throwing motion and proprioceptive neuromuscular facilitation in wrist sensorimotor rehabilitation.

PURPOSE OF THE STUDY

To describe and evaluate a staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex (TFCC) injury.

METHODS

The patient participated in the staged program for 9 sessions over a 3-month period. Treatment involved neuromuscular strengthening at the wrist and movement normalization of the upper extremity. Outcome measures were grip strength, visual analog scale, joint position sense, Quick Disabilities of the Arm, Shoulder and Hand, and patient-rated wrist evaluation.

RESULTS

The patient showed improvement in all outcome measures. Most outcomes exceeded the established minimal clinically important difference values.

DISCUSSION

The results suggest that dart-throwing motion and proprioceptive neuromuscular facilitation are beneficial in rehabilitation of TFCC injury.

CONCLUSIONS

This is the first study that incorporated dart-throwing motion and proprioceptive neuromuscular facilitation in the sensorimotor rehabilitation of TFCC injury and yielded promising results. There is a need to further evaluate the program in prospective randomized controlled trial recruiting a larger group of patients with TFCC injury.

The immediate effect of IASTM vs. Vibration vs. Light Hand Massage on knee angle repositioning accuracy and hamstrings flexibility: A pilot study

INTRODUCTION

The effectiveness of novel soft-tissue interventions relative to traditional ones requires further exploration. The purpose of this pilot study was to evaluate the immediate effect of Instrument Assisted Soft Tissue Mobilization (IASTM) compared to Vibration Massage or Light Hand Massage on hamstrings' flexibility and knee proprioception.

METHODS

16 healthy non-injured male participants (mean age 23.7 years, height 1.80 cms and body mass 77.7 kg) were randomly assigned to the following interventions: (a) 5min IASTM, (b) 5min Vibration Massage and (c) 8min Light Hand-Massage, sequentially delivered to all participants with an in-between 1-week time interval. A single application of each intervention was given over the hamstrings of their dominant leg (repeated measures under 3 different experimental conditions). An active knee angle reproduction proprioception test and the back-saver sit and reach flexibility test were performed before and immediately after each intervention. Reliability of outcomes was also assessed.

RESULTS

Reliability for flexibility (ICC_3,1 = 0.97-0.99/SEM = 0.83-1.52 cm) and proprioception (ICC_3,1 = 0.83-0.88/SEM = 1.63-2.02°) was very good. For flexibility, statistically significant immediate improvement (p < 0.001) was noted in all 3 groups (1.61-3.23 cm), with no between-group differences. For proprioception, improvement in the IASTM (2.12°), Vibration Massage (0.32°) and Light Hand-Massage (1.17°) conditions was not statistically significant; no between-group differences were also evident.

CONCLUSIONS

Our findings indicate that muscle flexibility was positively influenced immediately after a single intervention of IASTM, Vibration Massage or Light Hand Massage. Proprioception changes were not statistically significant either within or between groups. Further evaluation of those interventions in a larger population with hamstrings pathology is required.

Changes in Cervicocephalic Kinesthetic Sensibility, Widespread Pressure Pain Sensitivity, and Neck Pain After Cervical Thrust Manipulation in Patients With Chronic Mechanical Neck Pain: A Randomized Clinical Trial

OBJECTIVE

The purpose of the current randomized clinical trial was to examine the effects of cervical thrust manipulation or sham manipulation on cervicocephalic kinaesthetic sense, pain, pain-related disability, and pressure pain sensitivity in patients with mechanical neck pain.

METHODS

Fifty-four individuals with neck pain were randomly assigned to receive either a cervical manipulation (right or left) or a sham manipulation. Immediate outcomes included cervical kinesthetic sense as assessed by joint position sense error (JPSE) and pressure pain thresholds (PPTs). At 1 week, neck pain intensity (numerical pain rate scale) and neck pain-related disability (Neck Disability Index [NDI]) outcomes were also collected.

RESULTS

The mixed-model analysis of covariance revealed a significant group × time interaction in favor of the cervical thrust manipulation group for the JPSE on rotation and extension. There was also a significant interaction for changes in PPTs at C5 to C6 and tibialis anterior. At the 1-week follow-up, a significant interaction existed for neck-related disability but not for neck pain at rest, worst pain, or lowest pain experienced the preceding week.

CONCLUSIONS

Our results suggest that cervical spine thrust manipulation improves JPSE, PPT and NDI in participants with chronic mechanical neck pain. Furthermore, changes in JPSE and NDI were large and surpass published minimal detectable changes for these outcome measures. In addition, the effect sizes of PPTs were medium; however, only C5 to C6 zygapophyseal joint exceeded the minimal detectable change. In contrast, cervical thrust manipulation did not improve neck pain intensity at 1 week after the intervention.

Correlation of force sense error test measured by a pressure biofeedback unit and EMG activity of quadriceps femoris in healthy individuals

BACKGROUND

Our study developed a force sense error test (FSET) method for use on the quadriceps muscle, which could be employed in clinical practice to correlate the results of quadriceps muscle activity levels determined by surface electromyography (sEMG).

METHODS

Twenty-four healthy individuals were included in the study. A pressure biofeedback unit (PBU) placed under the knee joint, was used for force sense error test (FSET) evaluation. First, a maximum contraction value was determined with the PBU. Next, 50% and 65% of the maximum contraction value were used for the analysis. Concurrently, norm values for the quadriceps muscle activity levels were determined by sEMG. Simultaneously, quadriceps muscle activity levels were recorded while testing the FSET using the PBU. Each measurement was repeated in triplicate, and the average constant errors observed by the PBU were recorded in mmHg.

RESULTS

The FSET for both 50% and 65% of the normal mmHg value determined using the PBU positively correlated with activity change levels in the quadriceps muscle determined by sEMG (p < 0.05).

CONCLUSIONS

The relationship between the FSET measured using PBU and changes in the level of activity in the quadriceps muscle showed that a PBU can be used in clinical practice for proprioceptive evaluation of the knee region.

Immediate effects of isometric trunk stabilization exercises with suspension device on flexion extension ratio and strength in chronic low back pain patientss

BACKGROUND

Recent clinical research has supported the use of suspension devices in rehabilitation procedures both in practice and in theory. Although a longitudinal study has reported on the use of suspension devices among asymptomatic subjects, it is necessary to investigate the immediate effects of suspension exercises in patients with CLBP.

OBJECTIVE

The present study aims to investigate changes in neuromuscular activation after the prescription of suspension exercises in patients with CLBP. A secondary aim was to determine whether practical flexion and extension strength can be effectively enhanced.

METHODS

Before and after suspension exercise, flexion extension (FE) ratio and trunk strength of flexion and extension were measured. Patients performed two types of suspension exercises: supine bridge and forward leaning exercises. The paired t-test was used to compare the FE ratio and strength data. Pearson correlation coefficient was performed to study the correlation between measured variables.

RESULTS

Compared to the pre-exercise measurements, the flexion-extension ratio and trunk extension strength was significantly increased at the post-exercise measurement (p< 0.05). The FE ratio in the right lumbar erector spine muscle was significantly correlated with post-exercise trunk extension strength (p< 0.05).

CONCLUSIONS

For patients with chronic lower back pain, stimulation of the lumbar extensor muscle and of proprioception is effective both for strengthening lumbar extensors and for improving the flexion-extension ratio. Consequently, forward leaning and supine bridge exercises with a suspension device are beneficial for normalising neuromuscular control of the erector spinae muscles.

Bilateral Tactile Feedback-Enabled Training for Stroke Survivors Using Microsoft KinectTM

Rehabilitation and mobility training of post-stroke patients is crucial for their functional recovery. While traditional methods can still help patients, new rehabilitation and mobility training methods are necessary to facilitate better recovery at lower costs. In this work, our objective was to design and develop a rehabilitation training system targeting the functional recovery of post-stroke users with high efficiency. To accomplish this goal, we applied a bilateral training method, which proved to be effective in enhancing motor recovery using tactile feedback for the training. One participant with hemiparesis underwent six weeks of training. Two protocols, “contralateral arm matching” and “both arms moving together”, were carried out by the participant. Each of the protocols consisted of “shoulder abduction” and “shoulder flexion” at angles close to 30 and 60 degrees. The participant carried out 15 repetitions at each angle for each task. For example, in the “contralateral arm matching” protocol, the unaffected arm of the participant was set to an angle close to 30 degrees. He was then requested to keep the unaffected arm at the specified angle while trying to match the position with the affected arm. Whenever the two arms matched, a vibration was given on both brachialis muscles. For the “both arms moving together” protocol, the two arms were first set approximately to an angle of either 30 or 60 degrees. The participant was asked to return both arms to a relaxed position before moving both arms back to the remembered specified angle. The arm that was slower in moving to the specified angle received a vibration. We performed clinical assessments before, midway through, and after the training period using a Fugl-Meyer assessment (FMA), a Wolf motor function test (WMFT), and a proprioceptive assessment. For the assessments, two ipsilateral and contralateral arm matching tasks, each consisting of three movements (shoulder abduction, shoulder flexion, and elbow flexion), were used. Movements were performed at two angles, 30 and 60 degrees. For both tasks, the same procedure was used. For example, in the case of the ipsilateral arm matching task, an experimenter positioned the affected arm of the participant at 30 degrees of shoulder abduction. The participant was requested to keep the arm in that position for ~5 s before returning to a relaxed initial position. Then, after another ~5-s delay, the participant moved the affected arm back to the remembered position. An experimenter measured this shoulder abduction angle manually using a goniometer. The same procedure was repeated for the 60 degree angle and for the other two movements. We applied a low-cost Kinect to extract the participant’s body joint position data. Tactile feedback was given based on the arm position detected by the Kinect sensor. By using a Kinect sensor, we demonstrated the feasibility of the system for the training of a post-stroke user. The proposed system can further be employed for self-training of patients at home. The results of the FMA, WMFT, and goniometer angle measurements showed improvements in several tasks, suggesting a positive effect of the training system and its feasibility for further application for stroke survivors’ rehabilitation.

Throwing performance in water polo is related to in-water shoulder proprioception

Water polo players require a high level of upper-extremity strength, flexibility and coordination to achieve a peak level of throwing performance. Increased levels of shoulder proprioceptive acuity, strength and range of motion (ROM) have been previously associated with higher sporting performance. A coach-rating scale, used to quantify an athlete's kicking proficiency in soccer; was adapted in the current study to measure each coach's subjective expert opinion regarding athletes' throwing mechanics, velocity, and accuracy. To examine this hypothesis shoulder proprioception acuity of 18 water polo players was measured both in-water and on-land using an AMEDA apparatus and correlated with coach-rated throwing performance and clinical measures of shoulder strength and ROM. There was a moderate positive correlation between the in-water and the on-land proprioception acuity (r = 0.47, p < 0.05). The in-water score showing a strong positive correlation with coach rated throwing mechanics (r = 0.68, p < 0.05) and velocity (r = 0.75, p = 0.02), suggesting that superior proprioception acuity contributed to fast, mechanically-efficient throwing. These findings support the notion that in-water proprioceptive acuity is an important determinant of the throwing performance achieved by water polo athletes and its measurement may be a valuable adjunct to current athlete screening.

Comparative joint position error in patients with non-specific neck disorders and asymptomatic age-matched individuals

Background

Neck pain is a common complaint worldwide and ranked seventh in 2010 as the cause of ‘years lived with disability’ in Ghana. Proprioceptive dysfunction, measured by joint position error (JPE) tests, indicates an association with neck pain frequency, dizziness and balance problems in patients.

Objectives

To examine proprioceptive deficits of the neck using a laser pointer attached to the head.

Methods

Twenty patients within the age group 21–60 years, with at least five points on the neck disability index (NDI), and 20 age- and sex-matched controls with less than five points on the NDI were recruited for this study. The JPE was determined wearing a headlight laser pointer directed towards a Cartesian coordinate system adjusted to x/y = 0/0, placed on a wall after returning from left and right rotation, flexion and extension. From starting in an upright sitting position, facing the Cartesian coordinate system, each participant performed five repetitions for each movement direction. The mean of five repetitions for each movement direction was calculated as absolute error (AE), constant error (CE) and variable error (VE).

Results

Control participants showed larger JPE values for nearly all AE, CE and VE. After repositioning from flexion controls showed an approximately 0.6 ° larger median JPE, and the opposite for extension, with median differences between 1 ° and 2 °.

Conclusion

The results of this study do not reveal any meaningful differences between patients with mild disabled neck movement compared with controls.

Clinical implications

Joint position error testing does not seem useful for patients with mild neck disability.

Postural control skills, proprioception, and risk of fall in long-term survivor patients treated with knee rotationplasty

Knee A1 rotationplasty is a particular type of limb salvage surgery alternative to hip disarticulation and high transfemoral amputation for skeletally immature children with bone cancers in the distal femur. Notwithstanding optimal functional outcomes, long-term survivor patients often report frequent falls, and a sense of instability during gait, particularly on uneven terrain. This study aimed to assess the postural control, the proprioception, and the risk of fall in these patients, which have not been explored before. Eighteen long-term survivor patients participated in the study. The mean follow-up from surgery was 23 years, mean age 32 years. Patients were assessed using a specific instrumental device (Delos Postural Proprioceptive System) both for the static double-stance and the single-stance test in the open eyes and closed eyes conditions. The double-stance test showed postural instability values within the normal range for healthy individuals, whereas in the single-stance test stability index, when assessed in the average of both lower limbs, values were lower than the literature findings for older individuals. However, when separating the operated from the nonoperated limb performance, standing on the operated limb was very unstable, with a low stability index and a low degree of autonomy, indicating a certain risk of falling, whereas standing on the nonoperated limb had a performance close to normal or even superior. In conclusion, knee rotationplasty patients had very good postural control when standing on both limbs, whereas single stance on the operated limb was compromised, with particular involvement of the proprioceptive component. This may determine a higher risk of falling than their normal-age counterparts and rehabilitation intervention for prevention is indicated.

Intra and interrater reliability and clinical feasibility of a simple measure of cervical movement sense in patients with neck pain

BACKGROUND

Pattern tracing tasks can be used to assess cervical spine movement sense (CMS). A simple clinical measure of CMS (tracing fixed figure-of-eight (F8) and zigzag (ZZ) patterns with a head mounted laser) has been proposed and assessed in asymptomatic subjects. It is important to determine if examiner ratings of the traces are reliable and feasible for clinical use in those with neck pain. We therefore examined the intra- and inter-rater reliability of rating video recordings of the CMS tasks, and the feasibility of undertaking the tests in clinic by comparing slow motion versus real-time video ratings.

METHODS

Cross-sectional study examining neck pain subjects from a physiotherapy clinic. F8 and ZZ patterns traced with a head-mounted laser pointer at two velocities (accurate; accurate & fast) were videoed and later examined. Time (total time taken to complete the pattern), error frequency (number of deviations) and error magnitude (sum of deviations multiplied by distance from the central line) were measured. Two assessors independently evaluated the laser tracing videos in slow motion; a third rated the videos in real time. Intraclass correlation coefficients (ICC) and standard error of measurements (SEM) were calculated for intra- and inter-tester reliability, and feasibility.

RESULTS

Twenty neck pain patient (13 women) videos were assessed. Intra-and inter-rater reliability was substantial to almost-perfect (ICC 0.76-1.00; SEM < 0.01-2.50). Feasibility was moderate to almost-perfect (ICC 0.54-1; SEM <  0.01-2.98).

CONCLUSIONS

Video (slow motion) ratings of time and errors for F8 and ZZ movement patterns in neck pain subjects showed high intra and inter-rater reliability. Achieving reliable ratings in clinic (real-time) appears feasible. Synthesising our results, the most reliable and feasible CMS ratings appear to be when the subject uses accurate rather than accurate and fast execution. The ZZ movement pattern may be superior to F8 in terms of rating. Time and error frequency for tracing F8 and ZZ as accurately as possible in determining CMS appears promising for use in clinic. Future research directions were identified.

Physical therapy examination and management of a 48-year-old male with vertigo, cephalalgia, and cervicalgia secondary to unilateral vestibular hypofunction

PURPOSE

This case report presents evidence-based physical therapy assessments and interventions for a patient with unilateral vestibular hypofunction (UVH). UVH is the result of peripheral vestibular dysfunction in the inner ear. Case Description : The patient was a 48-year-old male with symptoms of dizziness, cephalalgia, and cervicalgia. The examination and treatment were focused on impaired cervical proprioception, which is a vital component of balance training in addition to visual, vestibular, and somatosensory re-education for patients with dizziness. Toward the end of the physical therapy episode of care, the patient was medically diagnosed with Chiari malformation, a congenital cerebellar tonsillar herniation. Outcomes : The patient made significant strides on the Dizziness Handicap Inventory, Ten Meter Walk Test, Single Leg Stance, Balance Error Scoring System, Fukuda Stepping Test, Cervical Joint Position Error Sense Test, Convergence Distance, Global Rate of Change, and cervical range of motion assessments. The patient did not demonstrate comparable improvements on the Dynamic Visual Acuity Test. Conclusion : This case report demonstrates a physical therapy program for a patient with peripheral UVH-related symptoms. This approach may also be applicable for patients with the central cause of dizziness such as Chiari malformation. Future directions for research and clinical practice are also suggested in this report.

Inter- and intrarater reliability of two proprioception tests using clinical applicable measurement tools in subjects with and without knee osteoarthritis

BACKGROUND

The therapeutic value of proprioceptive-based exercises in knee osteoarthritis (KOA) management warrants investigation of proprioceptive testing methods easily accessible in clinical practice.

OBJECTIVE

To estimate inter- and intrarater reliability of the knee joint position sense (KJPS) test and knee force sense (KFS) test in subjects with and without KOA.

DESIGN

Cross-sectional test-retest design.

METHOD

Two blinded raters performed independently repeated measures of the KJPS and KFS test, using an analogue inclinometer and handheld dynamometer, respectively, in eight KOA patients (12 symptomatic knees) and 26 healthy controls (52 asymptomatic knees). Intraclass correlation coefficients (ICCs; model 2,1), standard error of measurement (SEM) and minimal detectable change with 95% confidence bounds (MDC₉₅) were calculated.

RESULTS

For KJPS, results showed good to excellent test-retest agreement (ICCs 0.70-0.95 in KOA patients; ICCs 0.65-0.85 in healthy controls). A 2° measurement error (SEM 1°) was reported when measuring KJPS in multiple test positions and calculating mean repositioning error. Testing KOA patients pre and post therapy a repositioning error larger than 4° (MDC₉₅) is needed to consider true change. Measuring KFS using handheld dynamometry showed poor to fair interrater and poor to excellent intrarater reliability in subjects with and without KOA.

CONCLUSIONS

Measuring KJPS in multiple test positions using an analogue inclinometer and calculating mean repositioning error is reliable and can be used in clinical practice. We do not recommend the use of the KFS test to clinicians. Further research is required to establish diagnostic accuracy and validity of our KJPS test in larger knee pain populations.

Pinch aperture proprioception: reliability and feasibility study

[Purpose] To establish the reliability and feasibility of a novel pinch aperture device to measure proprioceptive joint position sense. [Subjects and Methods] Reliability of the pinch aperture device was assessed in 21 healthy subjects. Following familiarization with a 15° target position of the index finger and thumb, subjects performed 5 trials in which they attempted to actively reproduce the target position without visual feedback. This procedure was repeated at a testing session on a separate date, and the between-session intraclass correlation coefficient (ICC) was calculated. In addition, extensor tendon vibration was applied to 19 healthy subjects, and paired t-tests were conducted to compare performance under vibration and no-vibration conditions. Pinch aperture proprioception was also assessed in two individuals with known diabetic neuropathy. [Results] The pinch aperture device demonstrated excellent reliability in healthy subjects (ICC 0.88, 95% confidence interval 0.70-0.95). Tendon vibration disrupted pinch aperture proprioception, causing subjects to undershoot the target position (18.1 ± 2.6° vs. 14.8° ± 0.76, p<0.001). This tendency to undershoot the target position was also noted in individuals with diabetic neuropathy. [Conclusion] This study describes a reliable, feasible, and functional means of measuring finger proprioception. Further research should investigate the assessment and implications of pinch aperture proprioception in neurological and orthopedic populations.

Shoulder proprioception: How is it measured and is it reliable? A systematic review

STUDY DESIGN

Systematic review.

INTRODUCTION

Constituents of proprioception include our awareness of the position (joint position sense [JPS]) and motion (kinesthesia) of our limbs in space. Proprioceptive deficits are associated with musculoskeletal disorders but remain a challenge to quantify, particularly at the shoulder.

PURPOSE OF THE STUDY

To report the psychometric values of validity, reliability, and responsiveness for shoulder JPS and/or kinesthesia protocols.

METHODS

A review of 5 databases was conducted from inception to July 2016 for studies reporting a psychometric property of a shoulder proprioception protocol. The included studies were evaluated using the QualSyst checklist and COSMIN 4-point scale.

RESULTS

Twenty-one studies were included, yielding 407 participants and 553 evaluated shoulders (n). The included studies support excellent methodological scores using the QualSyst checklist (88.1 ± 9.9%) and good psychometric scores with the COSMIN for reliability (71.1%) and moderate-to-low quality score (50%) for criterion validity. Weighted average intraclass correlation coefficients (ICCs) for intrarater reliability were highest for passive JPS and kinesthesia, ICC = 0.92 ± 0.07 (n = 214) and ICC = 0.92 ± 0.04 (n = 74), respectively. The most reliable movement and tool are internal rotation at 90° of abduction, ICC = 0.88 ± 0.01 (n = 53), and the dynamometer, ICC = 0.92 ± 0.88 (n = 225). Only 2 studies quantify an aspect of validity and no responsiveness indices were reported among the included studies.

CONCLUSION

Based on the results of the included studies, the evaluation of shoulder proprioception is most reliable when using a passive protocol with an isokinetic dynamometer for internal rotation at 90° of shoulder abduction. Standardized protocols addressing the psychometric properties of shoulder proprioception measures are needed.

LEVEL OF EVIDENCE

Level 1a: systematic review.

ATLETAS DE TAEKWONDO TÊM MELHOR CONTROLE POSTURAL DO QUE ATLETAS DE HANDEBOL E FUTEBOL AMERICANO

RESUMO Introdução: O controle postural é um pré-requisito importante para o desempenho do atleta no esporte. Além disso, o sistema de controle postural contribui para a prevenção de lesões. Déficits nesse sistema podem levar a instabilidade corporal e sobrecarga das estruturas musculoesqueléticas, gerando disfunção e dor. Objetivos: A proposta deste estudo foi avaliar o controle postural em três diferentes modalidades esportivas: taekwondo, handebol e futebol americano. Métodos: Todos os atletas executaram o teste de equilíbrio unipodal sobre uma plataforma de força nos membros inferiores direito e esquerdo. Foram realizados três testes de trinta segundos cada, com os olhos abertos. A média dos três testes foi utilizada para mensurar os parâmetros de controle postural, centro de pressão e velocidade dos deslocamentos anteroposteriores e mediolaterais. Resultados: Diferenças significativas foram observadas entre os três grupos em todos os parâmetros analisados (P = <0,04). A análise post hoc revelou que os atletas de taekwondo tiveram melhor controle postural (P = < 0,035) dos membros inferiores em comparação com as outras duas modalidades. Não foram observadas diferenças significativas entre o handebol e o futebol americano. Conclusão: Os atletas do taekwondo têm melhor controle postural durante o teste de equilíbrio unipodal do que os atletas do handebol e do futebol americano.

A new clinical test for sensorimotor function of the hand - development and preliminary validation

BACKGROUND

Sensorimotor disturbances of the hand such as altered neuromuscular control and reduced proprioception have been reported for various musculoskeletal disorders. This can have major impact on daily activities such as dressing, cooking and manual work, especially when involving high demands on precision and therefore needs to be considered in the assessment and rehabilitation of hand disorders. There is however a lack of feasible and accurate objective methods for the assessment of movement behavior, including proprioception tests, of the hand in the clinic today. The objective of this observational cross- sectional study was to develop and conduct preliminary validation testing of a new method for clinical assessment of movement sense of the wrist using a laser pointer and an automatic scoring system of test results.

METHODS

Fifty physiotherapists performed a tracking task with a hand-held laser pointer by following a zig-zag pattern as accurately as possible. The task was performed with left and right hand in both left and right directions, with three trials for each hand movement. Each trial was video recorded and analysed with a specifically tailored image processing pipeline for automatic quantification of the test. The main outcome variable was Acuity, calculated as the percent of the time the laser dot was on the target line during the trial.

RESULTS

The results showed a significantly better Acuity for the dominant compared to non-dominant hand. Participants with right hand pain within the last 12 months had a significantly reduced acuity (p < 0.05), and although not significant there was also a similar trend for reduced Acuity also for participants with left hand pain. Furthermore, there was a clear negative correlation between Acuity and Speed indicating a speed-accuracy trade off commonly found in manual tasks. The repeatability of the test showed acceptable intra class correlation (ICC_2.1) values (0.68-0.81) and standard error of measurement values ranging between 5.0-6.3 for Acuity.

CONCLUSIONS

The initial results suggest that the test may be a valid and feasible test for assessment of the movement sense of the hand. Future research should include assessments on different patient groups and reliability evaluations over time and between testers.

Evaluation of Static and Dynamic Balance Tests in Single and Dual Task Conditions in Participants With Nonspecific Chronic Low Back Pain

Objective

The purpose of this study was to investigate static and dynamic balance tests in single, dual cognitive, and dual manual task conditions in participants with and without nonspecific chronic low back pain.

Methods

In this case control study, 40 patients (age range 18-50 years) with nonspecific chronic low back pain for at least 3 months and 40 healthy participants matched for age, weight, height, and sex participated in this study. Balance performance was evaluated using static (One Leg Stance) and dynamic (Modified Star Excursion Balance Test, 10-m walk test, and Timed Up and Go) balance tests. All tests were performed in three conditions: single task (balance only), dual cognitive task (balance and counting numbers backward), and dual manual task (balance and carrying a cup of water).

Results

The results indicated that different balance tests were impaired in dual task conditions compared with single task in each group. Cognitive and balance performances were not significantly different between nonspecific chronic low back pain and healthy participants in all clinical balance tests.

Conclusion

It seems that the static and dynamic balance performance under dual task conditions (excluding the Modified Star Excursion Balance Test) was impaired in each group. Dual tasking did not differ between nonspecific chronic low back pain participants with low level of pain and disability compared with healthy participants.

Eye stabilization reflexes in traumatic and non-traumatic chronic neck pain patients

BACKGROUND

Many chronic neck pain patients experience problems with vision. These problems are possibly induced by deviations of the eye stabilization reflexes. It is not known whether these eye reflex alterations occur both in traumatic and non-traumatic neck pain patients.

OBJECTIVE

To investigate if the cervico-ocular reflex (COR) and the vestibulo-ocular reflex (VOR) are changed in tertiary care patients with prolonged, chronic neck pain with various origin of complaints.

DESIGN

Cross sectional study.

METHODS

Ninety-one chronic neck pain patients were subdivided into three groups by origin of complaints, and compared with healthy controls. COR and VOR gains were measured with an infrared eye tracking device with the subject sitting on a rotating chair in a darkened room and with the head fixed.

RESULTS

Neck pain patients had a higher COR gain (median 0.41, IQR 0.289) compared with healthy controls (median 0.231, IQR 0.179). The mean COR gain did not differ between the three patient groups (Whiplash Associated Disorders 0.444 (SD 0.221); traumatic 0.397 (SD0.205); non-traumatic 0.468 (SD0.236)). There was no difference in VOR gain between the groups.

CONCLUSION

Chronic neck pain patients, who already received primary care, still have an elevated cervico-ocular reflex. The origin of complaints did not seem to be associated with this deviant oculomotor behavior.

Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability

STUDY DESIGN

Case report.

INTRODUCTION

Previously published studies demonstrate the importance of the sensory innervation of the carpal ligaments and the implication for the sensorimotor control of the wrist. In addition, this case considers key rehabilitation concepts to include the dart-throwing motion and the stabilizing effect of the forearm muscles.

PURPOSE OF THE STUDY

To describe the rehabilitation program for a patient with chronic wrist pain, diagnosed with a partial tear of the dorsal intercarpal ligament and a sprain of the scapholunate ligament of the right wrist.

METHODS

The patient participated in a staged treatment plan over a 3-month period (20 sessions), which began with a focus on proprioceptive awareness and joint position sense retraining. The treatment progressed to strengthening of specific muscles to enhance stability of the wrist joint. The patient completed the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation on initial evaluation, re-evaluation at ninth session, and discharge at 20th session.

RESULTS

Raw scores in the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation improved from 33 and 61.5 on initial evaluation to 18 and 17.5 on discharge, respectively.

CONCLUSIONS

Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. The effectiveness of proprioceptive retraining needs to be evaluated in a well-designed randomized controlled trial recruiting this patient population.

LEVEL OF EVIDENCE

5.

Elastic Tape Improved Shoulder Joint Position Sense in Chronic Hemiparetic Subjects: A Randomized Sham-Controlled Crossover Study

Background

Elastic tape has been widely used in clinical practice in order to improve upper limb (UL) sensibility. However, there is little evidence that supports this type of intervention in stroke patients.

Objective

To verify the effect of elastic tape, applied to the paretic shoulder, on joint position sense (JPS) during abduction and flexion in subjects with chronic hemiparesis compared to sham tape (non-elastic tape). Furthermore, to verify if this potential effect is correlated to shoulder subluxation measurements and sensorimotor impairment.

Methods

A crossover and sham-controlled study was conducted with post-stroke patients who were randomly allocated into two groups: 1) those who received Sham Tape (ST) first and after one month they received Elastic Tape (ET); 2) those who received Elastic Tape (ET) first and after one month they received Sham Tape (ST). The JPS was evaluated using a dynamometer. The absolute error for shoulder abduction and flexion at 30° and 60° was calculated. Sensorimotor impairment was determined by Fugl-Meyer, and shoulder subluxation was measured using a caliper.

Results

Thirteen hemiparetic subjects (average time since stroke 75.23 months) participated in the study. At baseline (before interventions), the groups were not different for abduction at 30° (p = 0.805; p = 0.951), and 60° (p = 0.509; p = 0.799), or flexion at 30° (p = 0.872; p = 0.897) and 60° (p = 0.853; p = 0.970). For the ET group, differences between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° p<0.010) and 60° (p<0.010) were observed. For the ST group, differences were also observed between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° (p<0.010,) and 60° (p<0.010). Potential effects were only correlated with shoulder subluxation during abduction at 30° (p = 0.001, r = -0.92) and 60° (p = 0.020, r = -0.75).

Conclusion

Elastic tape improved shoulder JPS of subjects with chronic hemiparesis regardless of the level of UL sensorimotor impairment. However, this improvement was influenced by the subluxation degree at abduction.

Joint position sense - There׳s an app for that

Traditionally, proprioception has been assessed with a passive model, in which an external apparatus moves a body segment. Recently, protocols have been developed based on active movements, which are more representative of functional activities. However, even these approaches require expensive testing equipment and the necessity of a visit to a research lab, as there are no commercially available mobile instruments that allow for the assessment of proprioception outside of a laboratory setting. The objective of this study was to demonstrate the validity and feasibility of using a mobile device (iPod Touch) to assess joint position. We conducted a concurrent validity study in the lab (n=9) and a field based study (n=79). The field based study was conducted at the 2012 American Society of Biomechanics meeting in Gainesville, Florida. The results of both studies demonstrate good agreement with our established protocol using a magnetic tracking device, with angular errors decreasing with increasing shoulder flexion angles. The studies demonstrate the validity and feasibility of using mobile devices for assessing motion-based parameters, both inside and outside of a laboratory setting.

Robot-aided assessment of lower extremity functions: a review

The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice.

Torque steadiness and muscle activation are bilaterally impaired during shoulder abduction and flexion in chronic post-stroke subjects

OBJECTIVE

To characterize sensorimotor control and muscle activation in the shoulder of chronic hemiparetic during abduction and flexion in maximal and submaximal isometric contractions. Furthermore, to correlate submaximal sensorimotor control with motor impairment and degree of shoulder subluxation.

METHODS

Thirteen chronic hemiparetic post-stroke age-gender matched with healthy were included. Isometric torques were assessed using a dynamometer. Electromyographic activity of the anterior and middle deltoid, upper trapezius, pectoralis major and serratus anterior muscles were collected. Variables were calculated for torque: peak, time to target, standard deviation (SD), coefficient of variation (CV), and standard error (RMSE); for muscle activity: maximum and minimum values, range and coefficient of activation. Motor impairment was determined by Fugl-Meyer and shoulder subluxation was measured with a caliper.

RESULTS

Paretic and non-paretic limbs reduced peak and muscle activation during maximal isometric contraction. Paretic limb generated lower force when compared with non-paretic and control. Paretic and non-paretic presented higher values of SD, CV, RMSE, and CV for prime mover muscles and minimum values for all muscles during steadiness. No correlation was found between sensorimotor control, motor impairment and shoulder subluxation.

CONCLUSION

Chronic hemiparetic presented bilateral deficits in sensorimotor and muscle control during maximal and submaximal shoulder abduction and flexion.

Introduction to Equine Physical Therapy and Rehabilitation

Physical therapy (physiotherapy, or PT) can be broadly defined as the restoration of movement and function and includes assessment, treatment, and rehabilitation. This review outlines the history, definition, and regulation of PT, followed by the core scientific principles of PT. Because musculoskeletal physiotherapy is the predominant subdiscipline in equine PT, encompassing poor performance, back pain syndromes, other musculoskeletal disorders, and some neuromuscular disorders, the sciences of functional biomechanics, neuromotor control, and the sensorimotor system in the spine, pelvis, and peripheral joints are reviewed. Equine PT also may involve PT assessment and treatment of riders.

The effects of an 8-week stabilization exercise program on lumbar movement sense in patients with low back pain

Background

Lumbar stabilization exercises have gained popularity and credibility in patients with non-acute low back pain. Previous research provides more support to strength/resistance and coordination/stabilisation programs. Some authors also suggest adding strength/resistance training following motor control exercises. However, the effect of such a lumbar stabilization program on lumbar proprioception has never been tested so far. The present study investigated the effects of an 8-week stabilization exercise program on lumbar proprioception in patients with low back pain (LBP) and assessed the 8-week test-retest reliability of lumbar proprioception in control subjects.

Methods

Lumbar proprioception was measured before and after an 8-week lumbar stabilization exercise program for patients with LBP. Control subjects participated in the same protocol but received no treatment.

Results

The lumbar proprioception measure showed moderate reliability. Patients with LBP and control subjects demonstrated no differences in lumbar proprioception at baseline. Participants from both groups showed better proprioception following the 8-week interval, demonstrating the presence of learning between testing days.

Conclusions

The improvement of lumbar proprioception seen in both groups was ascribed to motor learning of the test itself. The effect of lumbar stabilization exercises on lumbar proprioception remains unknown because the LBP group did not show lumbar proprioception impairments.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-0875-4) contains supplementary material, which is available to authorized users.

Effects of postural specific sensorimotor training in patients with chronic low back pain: study protocol for randomised controlled trial

Background

Sensorimotor training (SMT) is popularly applied as a preventive or rehabilitative exercise method in various sports and rehabilitation settings. Yet, there is only low-quality evidence on its effect on pain and function. This randomised controlled trial will investigate the effects of a theory-based SMT in rehabilitation of chronic (>3 months) non-specific low back pain (CNLBP) patients.

Methods/Design

A pilot study with a parallel, single-blinded, randomised controlled design. Twenty adult patients referred to the clinic for CNLBP treatment will be included, randomised, and allocated to one of two groups. Each group will receive 9 x 30 minutes of standard physiotherapy (PT) treatment. The experimental group will receive an added 15 minutes of SMT. For SMT, proprioceptive postural exercises are performed on a labile platform with adjustable oscillation to provoke training effects on different entry levels. The active comparator group will perform 15 minutes of added sub-effective low-intensity endurance training. Outcomes are assessed on 4 time-points by a treatment blinded tester: eligibility assessment at baseline (BL) 2–4 days prior to intervention, pre-intervention assessment (T0), post-intervention assessment (T1), and at 4 weeks follow-up (FU). At BL, an additional healthy control group (n = 20) will be assessed to allow cross-sectional comparison with symptom-free participants. The main outcomes are self-reported pain (Visual Analogue Scale) and functional status (Oswestry Disability Index). For secondary analysis, postural control variables after an externally perturbed stance on a labile platform are analysed using a video-based marker tracking system and a pressure plate (sagittal joint-angle variability and centre of pressure confidence ellipse). Proprioception is measured as relative cervical joint repositioning error during a head-rotation task. Effect sizes and mixed-model MANOVA (2 groups × 4 measurements for 5 dependent variables) will be calculated.

Discussion

This is the first attempt to systematically investigate effects of a theory-based sensorimotor training in patients with CNLBP. It will provide analysis of several postural segments during a dynamic task for quantitative analysis of quality and change of the task performance in relation to changes in pain and functional status.

Trial registration

Trial registry number on cliniclatrials.gov is NCT02304120, first registered on 17 November 2014.

The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury

Balance control improvement is one of the most important goals in sports and exercise. Better balance is strongly positively associated with enhanced athletic performance and negatively associated with lower limb sports injuries. Proprioception plays an essential role in balance control, and ankle proprioception is arguably the most important. This paper reviews ankle proprioception and explores synergies with balance control, specifically in a sporting context. Central processing of ankle proprioceptive information, along with other sensory information, enables integration for balance control. When assessing ankle proprioception, the most generalizable findings arise from methods that are ecologically valid, allow proprioceptive signals to be integrated with general vision in the central nervous system, and reflect the signal-in-noise nature of central processing. Ankle proprioceptive intervention concepts driven by such a central processing theory are further proposed and discussed for the improvement of balance control in sport.