The role of muscle receptors in the detection of movements

Spinal mechanisms may provide a combination of intermittent and continuous control of human posture: predictions from a biologically based neuromusculoskeletal model

Several models have been employed to study human postural control during upright quiet stance. Most have adopted an inverted pendulum approximation to the standing human and theoretical models to account for the neural feedback necessary to keep balance. The present study adds to the previous efforts in focusing more closely on modelling the physiological mechanisms of important elements associated with the control of human posture. This paper studies neuromuscular mechanisms behind upright stance control by means of a biologically based large-scale neuromusculoskeletal (NMS) model. It encompasses: i) conductance-based spinal neuron models (motor neurons and interneurons); ii) muscle proprioceptor models (spindle and Golgi tendon organ) providing sensory afferent feedback; iii) Hill-type muscle models of the leg plantar and dorsiflexors; and iv) an inverted pendulum model for the body biomechanics during upright stance. The motor neuron pools are driven by stochastic spike trains. Simulation results showed that the neuromechanical outputs generated by the NMS model resemble experimental data from subjects standing on a stable surface. Interesting findings were that: i) an intermittent pattern of muscle activation emerged from this posture control model for two of the leg muscles (Medial and Lateral Gastrocnemius); and ii) the Soleus muscle was mostly activated in a continuous manner. These results suggest that the spinal cord anatomy and neurophysiology (e.g., motor unit types, synaptic connectivities, ordered recruitment), along with the modulation of afferent activity, may account for the mixture of intermittent and continuous control that has been a subject of debate in recent studies on postural control. Another finding was the occurrence of the so-called “paradoxical” behaviour of muscle fibre lengths as a function of postural sway. The simulations confirmed previous conjectures that reciprocal inhibition is possibly contributing to this effect, but on the other hand showed that this effect may arise without any anticipatory neural control mechanism.

The control of upright stance is a challenging task since the objective is to maintain the equilibrium of an intrinsically unstable biomechanical system. Somatosensory information is used by the central nervous system to modulate muscle contraction, which prevents the body from falling. While the visual and vestibular systems also provide important additional sensory information, a human being with only somatosensory inputs is able to maintain an upright stance. In this study, we used a biologically-based large-scale neuromusculoskeletal model driven only by somatosensory feedback to investigate human postural control from a neurophysiological point of view. No neural structures above the spinal cord were included in the model. The results showed that the model based on a spinal control of posture can reproduce several neuromechanical outcomes previously reported in the literature, including an intermittent muscle activation. Since this intermittent muscular recruitment is an emergent property of this spinal-like controller, we argue that the so-called intermittent control of upright stance might be produced by an interplay between spinal cord properties and modulated sensory inflow.

7-Nitroindazole enhances c-Fos expression in spinal neurons in rats realizing operant movements

The expression of c-Fos and NADPH-diaphorase reactivity (NADPH-dr) in the cervical spinal cord was studied in adult male Wistar rats that realized operant reflexes after inhibition of neuronal nitric oxide synthase. Fos-immunoreactive neurons were visualized immunohistochemically in the C6/C7 spinal segments in the control, realized operant movements animals, and/or 7-nitroindazole (7-NI) injected rats. The mean numbers of immunoreactive interneurons and motoneurons (per section) were significantly greater in the Nucleus proprius (+240%) and motor nuclei (+600%) in rats of the 7-NI-pretreated and operant reflex realized group than in the isolated operant reflex realized group. Our study showed intensive staining of NADPH-dr axon terminals on the somata and initial parts of dendrites of motoneurons in experimental rats when the disodium salt of malic acid was added to the staining solution. Suppression of NO release is associated with potentiation of neuronal activation induced by descending supraspinal and proprioceptive signaling within the spinal cord.

Computationally efficient modeling of proprioceptive signals in the upper limb for prostheses: a simulation study

Accurate models of proprioceptive neural patterns could 1 day play an important role in the creation of an intuitive proprioceptive neural prosthesis for amputees. This paper looks at combining efficient implementations of biomechanical and proprioceptor models in order to generate signals that mimic human muscular proprioceptive patterns for future experimental work in prosthesis feedback. A neuro-musculoskeletal model of the upper limb with 7 degrees of freedom and 17 muscles is presented and generates real time estimates of muscle spindle and Golgi Tendon Organ neural firing patterns. Unlike previous neuro-musculoskeletal models, muscle activation and excitation levels are unknowns in this application and an inverse dynamics tool (static optimization) is integrated to estimate these variables. A proprioceptive prosthesis will need to be portable and this is incompatible with the computationally demanding nature of standard biomechanical and proprioceptor modeling. This paper uses and proposes a number of approximations and optimizations to make real time operation on portable hardware feasible. Finally technical obstacles to mimicking natural feedback for an intuitive proprioceptive prosthesis, as well as issues and limitations with existing models, are identified and discussed.

Cognitive-motor interactions of the basal ganglia in development

Neural circuits linking activity in anatomically segregated populations of neurons in subcortical structures and the neocortex throughout the human brain regulate complex behaviors such as walking, talking, language comprehension, and other cognitive functions associated with frontal lobes. The basal ganglia, which regulate motor control, are also crucial elements in the circuits that confer human reasoning and adaptive function. The basal ganglia are key elements in the control of reward-based learning, sequencing, discrete elements that constitute a complete motor act, and cognitive function. Imaging studies of intact human subjects and electrophysiologic and tracer studies of the brains and behavior of other species confirm these findings. We know that the relation between the basal ganglia and the cerebral cortical region allows for connections organized into discrete circuits. Rather than serving as a means for widespread cortical areas to gain access to the motor system, these loops reciprocally interconnect a large and diverse set of cerebral cortical areas with the basal ganglia. Neuronal activity within the basal ganglia associated with motor areas of the cerebral cortex is highly correlated with parameters of movement. Neuronal activity within the basal ganglia and cerebellar loops associated with the prefrontal cortex is related to the aspects of cognitive function. Thus, individual loops appear to be involved in distinct behavioral functions. Damage to the basal ganglia of circuits with motor areas of the cortex leads to motor symptoms, whereas damage to the subcortical components of circuits with non-motor areas of the cortex causes higher-order deficits. In this report, we review some of the anatomic, physiologic, and behavioral findings that have contributed to a reappraisal of function concerning the basal ganglia and cerebellar loops with the cerebral cortex and apply it in clinical applications to attention deficit/hyperactivity disorder (ADHD) with biomechanics and a discussion of retention of primitive reflexes being highly associated with the condition.

Enhanced proprioceptive acuity at the knee in the competitive athlete

STUDY DESIGN

Controlled laboratory study: cross-sectional.

OBJECTIVE

To determine if proprioception, measured by the threshold to detection of passive motion (TDPM), differed in individuals who regularly participate in moderate-intensity exercise for fitness as compared to individuals involved in high-intensity skilled exercise.

BACKGROUND

Previous research has been equivocal as to whether exercise training is associated with superior proprioceptive acuity, in particular, exercise that includes dynamic postural challenges such as cutting and pivoting.

METHODS

Two groups of 25 healthy individuals (18-32 years old) were recruited. One group consisted of individuals who performed moderate-activity level exercises for 5 to 10 hours per week. Participants in the other group performed high-activity level exercises, including high-speed cutting and pivoting activities, at least 10 hours per week. Proprioception was determined using TDPM, in which the knee was slowly extended or flexed at an angular velocity of 0.5°/s or less from a starting position of 40° of knee flexion.

RESULTS

Individuals participating in competitive, high-intensity skilled exercise demonstrated better acuity (average of both limbs) of TDPM (mean ± SD, 0.81° ± 0.38°; P<.001) than those participating in moderate-intensity exercise for fitness (1.53° ± 0.58°). A low but statistically significant association (r = -0.38, P = .006) was found between weekly duration of exercise and proprioceptive threshold as measured by TDPM.

CONCLUSION

These results suggest that perceptual thresholds of passive movement may be enhanced, depending on activity level and associated postural challenge, and that higher level and increased amount of exercise may promote enhanced neurosensory processing in these individuals. Consequently, high-intensity skilled training may deserve further emphasis in orthopaedic rehabilitation.

The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force

This is a review of the proprioceptive senses generated as a result of our own actions. They include the senses of position and movement of our limbs and trunk, the sense of effort, the sense of force, and the sense of heaviness. Receptors involved in proprioception are located in skin, muscles, and joints. Information about limb position and movement is not generated by individual receptors, but by populations of afferents. Afferent signals generated during a movement are processed to code for endpoint position of a limb. The afferent input is referred to a central body map to determine the location of the limbs in space. Experimental phantom limbs, produced by blocking peripheral nerves, have shown that motor areas in the brain are able to generate conscious sensations of limb displacement and movement in the absence of any sensory input. In the normal limb tendon organs and possibly also muscle spindles contribute to the senses of force and heaviness. Exercise can disturb proprioception, and this has implications for musculoskeletal injuries. Proprioceptive senses, particularly of limb position and movement, deteriorate with age and are associated with an increased risk of falls in the elderly. The more recent information available on proprioception has given a better understanding of the mechanisms underlying these senses as well as providing new insight into a range of clinical conditions.

Age-related changes in the joint position sense of the human hand

Age-related changes in lower limb joint position sense and their contributions to postural stability are well documented. In contrast, only a few studies have investigated the effect of age on proprioceptive hand function. Here, we introduce a novel test for measuring joint position sense in the fingers of the human hand. In a concurrent matching task, subjects had to detect volume differences between polystyrene balls grasped with their dominant (seven test stimuli: 126-505 cm(3)) and their nondominant hand (three reference stimuli: 210, 294, and 505 cm(3)). A total of 21 comparisons were performed to assess the number of errors, the weight of errors (ie, the volume difference between test and reference stimuli), and the direction of errors (ie, over- or underestimation of test stimulus). The test was applied to 45 healthy subjects aged 21 to 79 years. Our results revealed that all variables changed significantly with age, with the number of errors showing the strongest increase. We also assessed tactile acuity (two-point discrimination thresholds) and sensorimotor performance (pegboard performance) in a subset of subjects, but these scores did not correlate with joint position sense performance, indicating that the test reveals specific information about joint position sense that is not captured with pure sensory or motor tests. The average test-retest reliability assessed on 3 consecutive days was 0.8 (Cronbach's alpha). Our results demonstrate that this novel test reveals age-related decline in joint position sense acuity that is independent from sensorimotor performance.

Biomechanical and neurophysiological mechanisms related to postural control and efficiency of movement: a review

Understanding postural control requires considering various mechanisms underlying a person's ability to stand, to walk, and to interact with the environment safely and efficiently. The purpose of this paper is to summarize the functional relation between biomechanical and neurophysiological perspectives related to postural control in both standing and walking based on movement efficiency. Evidence related to the biomechanical and neurophysiological mechanisms is explored as well as the role of proprioceptive input on postural and movement control.

7-Nitroindazole potentiates c-fos expression induced by muscle tendon vibration in the spinal cord

INTRODUCTION

Expression of c-fos initiated by muscle proprioceptive signaling was studied in rats after inhibition of neuronal nitric oxide synthase (nNOS) with administration of 7-nitroindazole (7-NI).

METHODS

Fos-immunoreactive (Fos-ir) neurons were visualized immunohistochemically in the lumbar cord after vibration of the Achilles tendon and/or 7-NI systemic injections.

RESULTS

The total number of Fos-ir interneurons and motoneurons (per slice) was significantly greater in the 7-NI-pretreated and tendon-vibrated (7-NI + Tv) group than in the isolated tendon vibration group (Tv group). The greatest increases in the number of Fos-ir neurons were found in the L4 (+100%) and L5 (+105%) segments (P < 0.05).

CONCLUSIONS

Suppression of NO release after introduction of 7-NI was associated with potentiation of Fos immunoreactivity induced by muscle proprioceptive signaling within distinctive regions of the spinal cord.

Hoffmann reflex is increased after 14 days of daily repeated Achilles tendon vibration for the soleus but not for the gastrocnemii muscles

In a previous study, Achilles tendon vibrations were enough to improve the triceps surae (TS) activation capacities and also to slightly increase TS Hoffmann reflex (H-reflex) obtained by summing up soleus (Sol) and gastrocnemii (GM and GL) EMGs. The purpose of the present study was to analyze separately Sol and GM or GL reflexes to account for different effects of the vibrations on the reflex excitability of the slow soleus and of the gastrocnemii muscles. A control group (n = 13) and a vibration group (n = 16) were tested in pre-test and post-test conditions. The Achilles tendon vibration program consisted of 1 h of daily vibration (frequency: 50 Hz) applied during 14 days. Maximal Sol, GM and GL H-reflexes, and M-waves were recorded, and their H(max)/M(max) ratios gave the index of reflex excitability. After the vibration protocol, only Sol H(max)/M(max) was enhanced (p < 0.001). The enhanced Sol reflex excitability after vibration is in favor of a decrease in the pre-synaptic inhibition due to the repeated vibrations and the high solicitation of the reflex pathway. Those results of a short period of vibration applied at rest may be limited to the soleus because of its high density in muscle spindles and slow motor units, both structures being very sensitive to vibrations.

THE USE OF NONPARAMETRIC METHODS OF STATIONARY POINT PROCESSES IN THE STUDY OF COMPLEX INTERACTIONS IN THE NEUROMUSCULAR SYSTEM

In this paper we study the complex interactions involved in the incoming stimulus, from a gamma (γ) and/or an alpha (α) motoneuron, and the outgoing response from the muscle spindle transmitted by the Ia sensory afferent neuron to the spinal cord. The most interesting case is the γ and α coactivation to the function of the muscle spindle, while the effect from a single (γ or α) motoneuron is also presented as a comparison. The mathematical background of this analysis is based on the theory of stationary point processes. A kernel type method of estimating second- and third-order conditional densities is used. Under certain conditions the asymptotic distributions of these estimates are Normal and the construction of 95% approximate confidence intervals is feasible. The application of these asymptotic results to the system of the muscle spindle enables us to detect and interpret its excitatory and/or inhibitory behavior.

Effects of training on the estimation of muscular moment in submaximal exercise

The purpose of this study was to observe the effects of a submaximal isometric training program on estimation capacity at 25, 50, and 75% of maximal contraction in isometric action and at two angular velocities. The second purpose was to study the variability of isometric action. To achieve these purposes, participants carried out an isokinetic extension movement of the dominant lower limb during six test sessions and nine training sessions. Following the training program, estimation capacity in the different actions did not improve. However an improvement in performance was observed with a reduction in the variability of submaximal isometric actions. The proprioceptors activated in isometric action seemed to adapt to the training program itself which would promote better adaptation by a greater solicitation of internal feedback.

Bilateral transfer in active and passive guidance-reproduction based bimanual tasks: effect of proprioception and handedness

Recently, bilateral movement training based on robot-assisted rehabilitation systems has been attracting a lot of attention as a post-stroke motor rehabilitation protocol. Since humans generate coordinated motions based on their motor and sensory systems, investigation of the innate properties of human motor or sensory systems may provide insight into planning of effective bilateral movement training. In this study, we investigate the effects of proprioception and handedness on the movement of the contra-lateral upper limb, under both active and passive guidance conditions of the robot manipulators. Active and passive guidance-reproduction based bimanual tasks were used in this study; in these the subject is asked to hold both the right and left knobs installed at the end-effectors of two robot manipulators. The results indicate that better reproducing performance was obtained when the proprioceptive input was acquired from the active guidance condition.

Psychological stress alters ultrastructure and energy metabolism of masticatory muscle in rats

To investigate the effects of psychological stress on the masticatory muscles of rats, a communication box was applied to induce the psychological stress (PS) in rats. The successful establishment of psychological stimulation was confirmed by elevated serum levels of adrenocorticotropic hormone (ACTH) and changed behaviors in the elevated plusmaze apparatus. The energy metabolism of the bilateral masseter muscles was tested via chemocolorimetric analysis, whereas muscle ultrastructure was assessed by electron microscopy. In comparison to the control group, the PS group showed evidence of swollen mitochondria with cristae loss and reduced matrix density in the masticatory muscles after three weeks of stimulation; after five weeks of stimulation, severe vacuolar changes to the mitochondria were observed. Increased vascular permeability of the masticatory muscle capillaries was found in the five-week PS rats. In addition, there was decreased activity of Na⁺-K⁺ATPase and Ca²⁺-ATPase and a simultaneous increase in the activity of lactate dehydrogenase and lactic acid in the masticatory muscles of PS rats. Together, these results indicate that psychological stress induces alterations in the ultrastructure and energy metabolism of masticatory muscles in rats.

Choosing the optimal trigger point for analysis of movements after stroke based on magnetoencephalographic recordings

The aim of this study was to select the optimal procedure for analysing motor fields (MF) and motor evoked fields (MEF) measured from brain injured patients. Behavioural pretests with patients have shown that most of them cannot stand measurements longer than 30 minutes and they also prefer to move the hand with rather short breaks between movements. Therefore, we were unable to measure the motor field (MF) optimally. Furthermore, we planned to use MEF to monitor cortical plasticity in a motor rehabilitation procedure. Classically, the MF analysis refers to rather long epochs around the movement onset (M-onset). We shortened the analysis epoch down to a range from 1000 milliseconds before until 500 milliseconds after M-onset to fulfil the needs of the patients. Additionally, we recorded the muscular activity (EMG) by surface electrodes on the extensor carpi ulnaris and flexor carpi ulnaris muscles. Magnetoencephalographic (MEG) data were recorded from 9 healthy subjects, who executed horizontally brisk extension and flexion in the right wrist. Significantly higher MF dipole strength was found in data based on EMG-onset than in M-onset based data. There was no difference in MEF I dipole strength between the two trigger latencies. In conclusion, we recommend averaging in respect to the EMG-onset for the analysis of both components MF as well as MEF.

Warming-up before sporting activity improves knee position sense

OBJECTIVE

To evaluate the effects of a warm-up program on knee joint position sense in karatekas.

DESIGN

Repeated measures design.

SETTING

Research laboratory.

PARTICIPANTS

Ten young amateur karatekas (17.6 +/- 4.0 years of age).

MAIN OUTCOME MEASURES

Knee joint position sense evaluated before and immediately after a warm-up program through active repositioning in open kinetic chain (OKC) and closed kinetic chain (CKC).

RESULTS

At baseline testing no differences were observed between OKC and CKC in absolute (4.1 +/- 1.6 degrees vs. 3.4 +/- 2.0 degrees) and relative angular errors (2.4 +/- 3.4 degrees vs. 2.1 +/- 3.5 degrees). After the warm-up program, a significant decrease in absolute angular error was observed only in CKC (from 3.4 +/- 2.0 degrees to 1.8 +/- 0.5, p < 0.05). Additionally, in CKC the subjects reduced the relative angular error to approximately zero (from 2.1 +/- 3.5 degrees to -0.01 +/- 1.6 degrees) and decreased the variability of the responses, expressed by the decrease in standard deviation of the relative errors.

CONCLUSIONS

The warm-up program enhanced knee joint position sense only in CKC. Since no effects were detected in OKC, the evaluation of the effects of warm-up on knee joint position sense using merely an OKC technique would underestimate the valuable role of warm-up.

Corticomotor excitability of wrist flexor and extensor muscles during active and passive movement

The excitability of the corticospinal projection to upper and lower limbs is constantly modulated during voluntary and passive movement; however a direct comparison during a comparable movement has not been reported. In the present study we used transcranial magnetic stimulation (TMS) to compare corticomotor excitability to the extensor and flexor carpi radialis (ECR/FCR) muscles of the forearm during voluntary rhythmic wrist movement (through 45 degrees of range), during a matched (for range and rhythm) passive movement of the wrist, and while the wrist was stationary (in mid-range). TMS was delivered when the wrist was in the neutral position. With passive and active movement, and for both FCR and ECR, corticomotor excitability was reduced during lengthening relative to shortening phases of movement. With active movement, this pattern was maintained and superimposed on an overall increase in excitability to both muscles that was greater for the ECR. The results favor a common pattern of excitability changes shared by extensor and flexor muscles as they undergo lengthening and shortening, which may be mediated by afferent input during both passive and active movement. This is combined with an overall increase in excitability associated with active movement that is greater for extensor muscles perhaps due to differences in the strength of the corticomotor projection to these muscles.

Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist

STUDY DESIGN

Narrative review. Recent years have brought new research findings on the subject of wrist joint proprioception, which entails an understanding of the wrist as part of a sensorimotor system where afferent information from nerve endings in the wrist joint affects the neuromuscular control of the joint. An understanding of proprioception is also essential to adequately rehabilitate patients after wrist injuries. The aim of this narrative review was to give the reader a background of proprioception as it relates to neuromuscular control and joint stability, what is presently known in relation to the wrist joint and how these findings may be applied to the field of wrist rehabilitation.

LEVEL OF EVIDENCE

5.

Neuromuscular function after arthroscopic partial meniscectomy

BACKGROUND

Quadriceps muscle strength, which is essential for the function and stability of the knee, has been found to be impaired even years after arthroscopic partial meniscectomy. However, the neuromuscular alterations that could account for such muscle weakness remain unclear.

QUESTIONS/PURPOSES

We investigated (1) the side-to-side asymmetries in quadriceps muscle strength 6 months after arthroscopic partial meniscectomy, (2) the physiologic mechanisms (neural versus muscular) underlying muscle weakness, and (3) the impact of quadriceps weakness on muscle control at submaximal force levels.

PATIENTS AND METHODS

We tested 14 volunteers (10 men, four women) with an average age of 44 +/- 9 years (range, 24-59 years) at 6 +/- 1 months after unilateral medial arthroscopic partial meniscectomy. We measured maximal voluntary strength and muscle activation during isometric, concentric, and eccentric contractions using isokinetic dynamometry and surface EMG, respectively. We assessed vastus lateralis muscle size and architecture using ultrasonography. We measured muscle control at submaximal force levels with a repositioning test (knee proprioception) and a low-force target-tracking task (steadiness, accuracy).

RESULTS

Isometric and concentric quadriceps strength and vastus lateralis EMG activity were lower on the involved than on the uninvolved side. Muscle architecture and muscle control did not differ between the involved and uninvolved sides.

CONCLUSIONS

Our results showed quadriceps weakness exists 6 months after arthroscopic partial meniscectomy. As suggested by the EMG results, this is likely attributable to neural impairments (activation failure) that affect muscle control at maximal but not submaximal force outputs.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Effects of fatigue due to contraction of evertor muscles on the ankle joint position sense in male soccer players

BACKGROUND

The high incidence of ankle sprains that occur later in matches suggests that fatigue may contribute to altered neuromuscular control of the ankle. Moreover, deficits in ankle joint position sense (JPS) were seen in patients with a history of recurrent ankle sprains. It has been hypothesized that ankle sprains may be related to altered ankle JPS as a consequence of fatigue.

PURPOSE

To evaluate if fatiguing contractions of evertor muscles alter the ankle JPS.

STUDY DESIGN

Controlled laboratory study.

METHODS

Thirty-six soccer players (age, 24.7 +/- 1.3 years; height, 183.7 +/- 8.2 cm; weight, 78.9 +/- 7.9 kg) were recruited. Subjects were asked to recognize 2 positions (15 degrees of inversion and maximal active inversion minus 5 degrees ) for 2 conditions: normal and fatigue. Muscular fatigue was induced in evertor muscles of the dominant leg by using isometric contractions. The average of the absolute and variable errors of 3 trials were recorded for both fatigue and nonfatigue conditions. A matched control group of 36 soccer players (age, 23.9 +/- 0.9 years; height, 181.2 +/- 6.9 cm; weight, 77.8 +/- 6.5 kg) was asked to recognize the same positions, before a soccer match and after 45 minutes of playing, and their same scores were recorded. Finally, results of the 2 groups were compared.

RESULTS

There was significant decrease in subjects' ability to recognize passive and active repositioning of their ankle after a fatigue protocol (P <.001). Passive and active JPS were reduced after playing (P <.001). There was no significant difference between 2 groups in the results of JPS before and after the intervention (P > .1).

CONCLUSION

The acuity of the ankle JPS is reduced subsequent to a fatigue protocol and after a soccer match.

CLINICAL RELEVANCE

Evaluation of athletes' ankle JPS before returning to physical activity may prevent further injuries.

The assessment of the cervical spine. Part 1: Range of motion and proprioception

Neck pain and headache of cervical origin are complaints affecting an increasing number of the general population. Mechanical factors such as sustained neck postures or movements and long-term "abnormal" physiologic loads on the neck are believed to affect the cervical structures and compromise neck function. A comprehensive assessment of neck function requires evaluation of its physical parameters such as range of motion, proprioception, strength and endurance/fatigue. The complicated structure of the cervical spine however, makes it difficult for any clinician to obtain reliable and valid results. The aim of the first part of this systematic critical review is to identify the factors influencing the assessment of range of motion and proprioception of the cervical spine.

Mechanical and neural stretch responses of the human soleus muscle at different walking speeds

During human walking, a sudden trip may elicit a Ia afferent fibre mediated short latency stretch reflex. The aim of this study was to investigate soleus (SOL) muscle mechanical behaviour in response to dorsiflexion perturbations, and to relate this behaviour to short latency stretch reflex responses. Twelve healthy subjects walked on a treadmill with the left leg attached to an actuator capable of rapidly dorsiflexing the ankle joint. Ultrasound was used to measure fascicle lengths in SOL during walking, and surface electromyography (EMG) was used to record muscle activation. Dorsiflexion perturbations of 6 deg were applied during mid-stance at walking speeds of 3, 4 and 5 km h(-1). At each walking speed, perturbations were delivered at three different velocities (slow: approximately 170 deg s(-1), mid: approximately 230 deg s(-1), fast: approximately 280 deg s(-1)). At 5 km h(-1), fascicle stretch amplitude was 34-40% smaller and fascicle stretch velocity 22-28% slower than at 3 km h(-1) in response to a constant amplitude perturbation, whilst stretch reflex amplitudes were unchanged. Changes in fascicle stretch parameters can be attributed to an increase in muscle stiffness at faster walking speeds. As stretch velocity is a potent stimulus to muscle spindles, a decrease in the velocity of fascicle stretch at faster walking speeds would be expected to decrease spindle afferent feedback and thus stretch reflex amplitudes, which did not occur. It is therefore postulated that other mechanisms, such as altered fusimotor drive, reduced pre-synaptic inhibition and/or increased descending excitatory input, acted to maintain motoneurone output as walking speed increased, preventing a decrease in short latency reflex amplitudes.

Trials needed to assess knee proprioception following stroke

BACKGROUND AND PURPOSE

This study explores the number of trials required to identify clinically significant impairments in knee joint position sense and movement sense following stroke.

METHOD

Proprioception was assessed in 33 stroke patients aged 37-87 years. Ten trials for each assessment were performed in sitting and supine positions using both verbal response techniques and contralateral limb matching.

RESULTS

Forty-six percent of participants were identified with a proprioceptive deficit. The trial where the first incorrect response occurred varied across individuals and testing positions. Performing only one trial detected proprioceptive impairments in less than 10% patients, and incorrect responses did not always occur in the first 5 trials. In sitting, no participant failed the assessment of knee joint position sense using the verbal response technique after only 6 trials. In supine, no participant failed the assessment of knee movement sense using the verbal response technique after only 6 trials. For the assessment of knee joint position sense in sitting using contralateral limb matching an estimated 9.4% of patients with a deficit would be missed if only 3 trials were used in preference to 5. For assessment of knee joint position sense in sitting, an estimated 18.8% of patients with deficits would be missed if only 3 trials were used rather than 10 trials.

CONCLUSIONS

Clinicians should perform at least 10 trials in either sitting or supine to quantify joint position sense and movement sense at the knee following stroke.

Combined effects of preceding muscle vibration and contraction on the tonic vibration reflex

As a result of intrafusal thixotropy, muscle contraction at a short length followed by passive lengthening enhances the subsequent tonic vibration reflex (TVR). We studied the effects of muscle vibration, contraction, and their combination on the subsequent TVR in the left biceps in 20 healthy men. The preceding vibration (20 or 80 Hz) conditioning at a short or long length was applied to the muscle belly with and without a contraction. After conditioning, distal tendon vibration (80 Hz) was used to elicit the TVR at the test length. The strength of the TVR was measured by surface electromyography. Conditioning with 80-Hz vibration at a short length followed by passive lengthening enhanced the subsequent TVR, which was greater in the presence than in the absence of a conditioning contraction. These results suggest that vibration and contraction work synergistically to develop intrafusal thixotropy.

The intrinsic stiffness of the in vivo lumbar spine in response to quick releases: implications for reflexive requirements

Torso muscles contribute both intrinsic and reflexive stiffness to the spine; recent modeling studies indicate that intrinsic stiffness alone is sometimes insufficient to maintain stability in dynamic situations. The purpose of this study was to experimentally test this idea by limiting muscular reflexive responses to sudden trunk perturbations. Nine healthy males lay on a near-frictionless apparatus and were subjected to quick trunk releases from the neutral position into flexion or right-side lateral bend. Different magnitudes of moment release were accomplished by having participants contract their musculature to create a range of moment levels. EMG was recorded from 12 torso muscles and three-dimensional lumbar spine rotations were monitored. A second-order linear model of the trunk was employed to estimate trunk stiffness and damping during each quick release. Participants displayed very limited reflex responses to the quick load release paradigms, and consequently underwent substantial trunk displacements (>50% flexion range of motion and >70% lateral bend range of motion in the maximum moment trials). Trunk stiffness increased significantly with significant increases in muscle activation, but was still unable to prevent the largest trunk displacements in the absence of reflexes. Thus, it was concluded that the intrinsic stiffness of the trunk was insufficient to adequately prevent the spine from undergoing potentially harmful rotational displacements. Voluntary muscular responses were more apparent than reflexive responses, but occurred too late and of too low magnitude to sufficiently make up for the limited reflexes.

Local subcutaneous and muscle pain impairs detection of passive movements at the human thumb

Activity in both muscle spindle endings and cutaneous stretch receptors contributes to the sensation of joint movement. The present experiments assessed whether muscle pain and subcutaneous pain distort proprioception in humans. The ability to detect the direction of passive movements at the interphalangeal joint of the thumb was measured when pain was induced experimentally in four sites: the flexor pollicis longus (FPL), the subcutaneous tissue overlying this muscle, the flexor carpi radialis (FCR) muscle and the subcutaneous tissue distal to the metacarpophalangeal joint of thumb. Tests were conducted when pain was at a similar subjective intensity. There was no significant difference in the ability to detect flexion or extension under any painful or non-painful condition. The detection of movement was significantly impaired when pain was induced in the FPL muscle, but pain in the FCR, a nearby muscle that does not act on the thumb, had no effect. Subcutaneous pain also significantly impaired movement detection when initiated in skin overlying the thumb, but not in skin overlying the FPL muscle in the forearm. These findings suggest that while both muscle and skin pain can disturb the detection of the direction of movement, the impairment is site-specific and involves regions and tissues that have a proprioceptive role at the joint. Also, pain induced in FPL did not significantly increase the perceived size of the thumb. Proprioceptive mechanisms signalling perceived body size are less disturbed by a relevant muscle nociceptive input than those subserving movement detection. The results highlight the complex relationship between nociceptive inputs and their influence on proprioception and motor control.

The distribution and abundance of muscle spindles

This commentary suggests that the distribution and abundance of muscle spindles in different muscles is related to their role as signallers of muscle fascicle length. Large muscles comprising many fascicles will therefore have more spindles than smaller muscles.

Shoulder joint position sense improves with external load

Joint position sense (JPS) is important in the maintenance of optimal movement coordination of limb segments in functional activities. Researchers have shown that the sensitivity of musculotendinous mechanoreceptors increases as muscle activation levels increase. In the present study, when 25 participants tried to replicate the same presented position, both vector and elevation angle repositioning errors decreased linearly as the external load increased up to 40% above unloaded shoulder torque. However, external load had no effect on plane repositioning error. The results indicated that JPS increased under conditions of increasing external load but only in the direction of the applied load. That finding indicates that JPS acuity improves as muscle activation levels increase.

Aging effects on joint proprioception: the role of physical activity in proprioception preservation

Throughout the human life span the functions of several physiological systems dramatically change, including proprioception. Impaired proprioception leads to less accurate detection of body position changes increasing the risk of fall, and to abnormal joint biomechanics during functional activities so, over a period of time, degenerative joint disease may result. Altered neuromuscular control of the lower limb and consequently poor balance resulting from changes in the proprioceptive function could be related to the high incidence of harmful falls that occur in old age subjects. There is evidence of proprioception deterioration with aging. Regular physical activity seems to be a beneficial strategy to preserve proprioception and prevent falls among older subjects. Some studies have demonstrated that the regular physical activity can attenuate age-related decline in proprioception. This paper reviews the evidence of age effects on joint proprioception. We will discuss the possible mechanisms behind these effects and the role of regular physical activity in the attenuation of age-related decline in proprioception.

Effect of cooling on thixotropic position-sense error in human biceps muscle

Muscle temperature affects muscle thixotropy. However, it is unclear whether changes in muscle temperature affect thixotropic position-sense errors. We studied the effect of cooling on thixotropic position-sense errors induced by short-length muscle contraction (hold-short conditioning) in the biceps of 12 healthy men. After hold-short conditioning of the right biceps muscle in a cooled (5.0 degrees C) or control (36.5 degrees C) environment, subjects perceived greater extension of the conditioned forearm at 5.0 degrees C. The angle differences between the two forearms following hold-short conditioning of the right biceps muscle in normal or cooled conditions were significantly different (-3.335 +/- 1.680 degrees at 36.5 degrees C vs. -5.317 +/- 1.096 degrees at 5.0 degrees C; P=0.043). Induction of a tonic vibration reflex in the biceps muscle elicited involuntary forearm elevation, and the angular velocities of the elevation differed significantly between arms conditioned in normal and cooled environments (1.583 +/- 0.326 degrees /s at 36.5 degrees C vs. 3.100 +/- 0.555 degrees /s at 5.0 degrees C, P=0.0039). Thus, a cooled environment impairs a muscle's ability to provide positional information, potentially leading to poor muscle performance.

Development of a BIONic muscle spindle for prosthetic proprioception

The replacement of proprioceptive function, whether for conscious sensation or feedback control, is likely to be an important aspect of neural prosthetic restoration of limb movements. Thus far, however, it has been hampered by the absence of unobtrusive sensors. We propose a method whereby fully implanted, telemetrically operated BIONs monitor muscle movement, and thereby detect changes in joint angle(s) and/or limb posture without requiring the use of secondary components attached to limb segments or external reference frames. The sensor system is designed to detect variations in the electrical coupling between devices implanted in neighboring muscles that result from changes in their relative position as the muscles contract and stretch with joint motion. The goal of this study was to develop and empirically validate mathematical models of the sensing scheme and to use computer simulations to provide an early proof of concept and inform design of the overall sensor system. Results from experiments using paired dipoles in a saline bath and finite element simulations have given insight into the current distribution and potential gradients exhibited within bounded anisotropic environments similar to a human limb segment and demonstrated an anticipated signal to noise ratio of at least 8:1 for submillimeter resolution of relative implant movement over a range of implant displacements up to 15 cm.

Muscle proprioceptive feedback and spinal networks

This review revolves primarily around segmental feedback systems established by muscle spindle and Golgi tendon organ afferents, as well as spinal recurrent inhibition via Renshaw cells. These networks are considered as to their potential contributions to the following functions: (i) generation of anti-gravity thrust during quiet upright stance and the stance phase of locomotion; (ii) timing of locomotor phases; (iii) linearization and correction for muscle nonlinearities; (iv) compensation for muscle lever-arm variations; (v) stabilization of inherently unstable systems; (vi) compensation for muscle fatigue; (vii) synergy formation; (viii) selection of appropriate responses to perturbations; (ix) correction for intersegmental interaction forces; (x) sensory-motor transformations; (xi) plasticity and motor learning. The scope will at times extend beyond the narrow confines of spinal circuits in order to integrate them into wider contexts and concepts.

Effect of static stretching of muscles surrounding the knee on knee joint position sense

BACKGROUND

Muscle stretching is widely used in sport training and in rehabilitation. Considering the important contribution of joint position sense (JPS) to knee joint stability and function, it is legitimate to question if stretching might alter the knee JPS.

OBJECTIVE

To evaluate if a stretch regimen consisting of three 30 s stretches alters the knee JPS.

DESIGN AND SETTING

A blinded, randomised design with a washout time of 24 h was used.

SUBJECTS

39 healthy students (21 women, 18 men) volunteered to participate in this study.

METHODS AND MAIN OUTCOME MEASURES

JPS was estimated by the ability to reproduce the two target positions (20 degrees and 45 degrees of flexion) in the dominant knee. The absolute angular error (AAE) was defined as the absolute difference between the target angle and the subject perceived angle of knee flexion. AAE values were measured before and immediately after the static stretch. Measurements were repeated three times. The static stretch comprised a 30 s stretch followed by a 30 s pause, three times for each muscle.

RESULTS

The AAE decreased significantly after the stretching protocols for quadriceps (3.5 (1.3) vs 0.7 (2.4); p<0.001), hamstring (3.6 (2.2) vs 1.6 (3.1); p = 0.016) and adductors (3.7 (2.8) vs 1.7 (2.4); p = 0.016) in 45 degrees of flexion, but no differences were found for values of the gastrocnemius and popliteus muscles in this angle and for the values of all muscles in 20 degrees of flexion (p>0.05).

CONCLUSION

The accuracy of the knee JPS in 45 degrees of flexion is improved subsequent to a static stretch regimen of quadriceps, hamstring and adductors in healthy subjects.

Age-related physiological and morphological changes of muscle spindles in rats

Age-related physiological and morphological changes of muscle spindles were examined in rats (male Fischer 344/DuCrj: young, 4-13 months; middle-aged, 20-22 months; old, 28-31 months). Single afferent discharges of the muscle spindles in gastrocnemius muscles were recorded from a finely split dorsal root during ramp-and-hold (amplitude, 2.0 mm; velocity, 2-20 mm s(-1)) or sinusoidal stretch (amplitude, 0.05-1.0 mm; frequency, 0.5-2 Hz). Respective conduction velocities (CVs) were then measured. After electrophysiological experimentation, the muscles were dissected. The silver-impregnated muscle spindles were teased and then analysed using a light microscope. The CV and dynamic response to ramp-and-hold stretch of many endings were widely overlapped in old rats because of the decreased CV and dynamic response of primary endings. Many units in old rats showed slowing of discharge during the release phase under ramp-and-hold stretch and continuous discharge under sinusoidal stretch, similarly to secondary endings in young and middle-aged rats. Morphological studies revealed that primary endings of aged rat muscle spindles were less spiral or non-spiral in appearance, but secondary endings appeared unchanged. These results suggest first that primary muscle spindles in old rats are indistinguishable from secondary endings when determined solely by previously used physiological criteria. Secondly, these physiological results reflect drastic age-related morphological changes in spindle primary endings.

Sensory-specific balance training in older adults: effect on position, movement, and velocity sense at the ankle

BACKGROUND AND PURPOSE

Age-related changes in proprioception contribute to impairments in postural control and increased fall risk in older adults. The purpose of this randomized controlled trial was to examine the effects of balance exercises on proprioception.

SUBJECTS

The participants were 36 older people and 24 younger people who were healthy.

METHODS

Older participants were randomly assigned to a balance exercise group (n=17) or a falls prevention education group (n=19). Baseline, postintervention, and 8-week follow-up measurements of 3 proprioceptive measures (threshold to perception of passive movement, passive joint position sense, and velocity discrimination) were obtained at the ankle. For comparative purposes, younger participants underwent a one-time assessment of the 3 proprioceptive measures.

RESULTS

Postintervention improvements in velocity discrimination were found in the balance exercise group when compared with values at baseline and in the falls prevention education group. Age-related differences found at baseline were reduced in the balance exercise group after intervention. Improvements were not maintained at the 8-week follow-up. Threshold to perception of passive movement and passive joint position sense did not change as a function of the exercise intervention.

DISCUSSION AND CONCLUSION

The results suggest that short-term improvements in velocity sense, but not movement and position sense, may be achieved following a balance exercise intervention.

Movement discrimination after intra-articular local anaesthetic of the ankle joint

BACKGROUND

The effect on clinical safety of dampening articular mechanoreceptor feedback at the ankle is unknown. Injection of the ankle joint for pain control may result in such dampening. Athletes receiving intra-articular local anaesthetic may therefore be at increased risk of sustaining ankle injuries, which are a common reason for missed sporting participation.

OBJECTIVE

To determine the effect of intra-articular local anaesthetic on movement discrimination at the ankle joint.

DESIGN

Prospective, randomised, double-blinded, placebo-controlled, cross-over trial.

SETTING

Australian Institute of Sport Medical Centre, Canberra, Australia.

PATIENTS

Twenty two healthy subjects (44 ankles) aged 18-26 were recruited for the three visits of the study.

INTERVENTIONS

Subjects were tested for their initial movement discrimination scores using the active movement extent discrimination apparatus (AMEDA). They then received ultrasound-guided intra-articular injections of local anaesthetic (2% lignocaine hydrochloride) or normal saline, on two separate later occasions, before further AMEDA assessment.

MAIN OUTCOME MEASURES

Change in movement discrimination scores after intra-articular injection of local anaesthetic or saline.

RESULTS

Movement discrimination scores were not significantly different from control ankles after injection of either local anaesthetic or saline into the ankle joint.

CONCLUSIONS

The intra-articular injection of neither 2 ml lignocaine nor an equivalent amount of normal saline resulted in significant effects on movement discrimination at the ankle joint. These results suggest that injections of local anaesthetic into the ankle joint are unlikely to significantly affect proprioception and thereby increase injury risk.

Retraining cervical joint position sense: the effect of two exercise regimes

This study compared the effects of conventional proprioceptive training and craniocervical flexion (C-CF) training on cervical joint position error (JPE) in people with persistent neck pain. The aim was to evaluate whether proprioceptive training was superior in improving proprioceptive acuity compared to another form of exercise, which has been shown to be effective in reducing neck pain. This may help to differentiate the mechanisms of effect of such interventions. Sixty-four female subjects with persistent neck pain and deficits in JPE were randomized into two exercise groups: proprioceptive training or C-CF training. Exercise regimes were conducted over a 6-week period, and all patients received personal instruction by an experienced physiotherapist once per week. A significant pre- to postintervention decrease in JPE, neck pain intensity, and perceived disability was identified for both the proprioceptive training group (p < 0.001) and the C-CF training group (p < 0.05). Patients who participated in the proprioceptive training demonstrated a greater reduction in JPE from right rotation compared to the C-CF training group (p < 0.05). No other significant differences were observed between the two groups. The results demonstrated that both proprioceptive training and C-CF training have a demonstrable benefit on impaired cervical JPE in people with neck pain, with marginally more benefit gained from proprioceptive training. The results suggest that improved proprioceptive acuity following intervention with either exercise protocol may occur through an improved quality of cervical afferent input or by addressing input through direct training of relocation sense.