The Ia afferent feedback of a given movement evokes the illusion of the same movement when returned to the subject via muscle tendon vibration

The functional role of conscious sensation of movement

This paper proposes a new framework for investigating neural signals sufficient for a conscious sensation of movement and their role in motor control. We focus on signals sufficient for proprioceptive awareness, particularly from muscle spindle activation and from primary motor cortex (M1). Our review of muscle vibration studies reveals that afferent signals alone can induce conscious sensations of movement. Similarly, studies employing peripheral nerve blocks suggest that efferent signals from M1 are sufficient for sensations of movement. On this basis, we show that competing theories of motor control assign different roles to sensation of movement. According to motor command theories, sensation of movement corresponds to an estimation of the current state based on afferent signals, efferent signals, and predictions. In contrast, within active inference architectures, sensations correspond to proprioceptive predictions driven by efferent signals from M1. The focus on sensation of movement provides a way to critically compare and evaluate the two theories. Our analysis offers new insights into the functional roles of movement sensations in motor control and consciousness.

Examination of foot sensations in children with generalized joint hypermobility

BACKGROUND

Generalized joint hypermobility (GJH) is a condition that can be observed in children and children with GJH may have problems such as clumsiness, proprioceptive sensory loss, balance and coordination disorders.

AIMS

To evaluate foot and ankle senses in children with GJH and compare them with their healthy peers.

STUDY DESIGN

A cross-sectional study.

SUBJECTS

Children aged 5-14 years with and without GJH were included in the study.

OUTCOME MEASURES

After assessing the joint hypermobility of the children with the Beighton Score, tactile, vibration, two-point discrimination, and proprioception senses were evaluated.

RESULTS

A total of 40 children (15 females, 25 males, mean age 9.43 years, SD ± 2.98 years, 20 with GJH and 20 without GJH) were included in the study. In children with GJH, foot sole tactile sense and ankle dorsiflexion and plantar flexion joint position sense were deficient in comparison with healthy controls (p < 0.05).

CONCLUSIONS

There were deficiencies in foot and ankle tactile and proprioceptive senses in children with GJH. Neurosensorimotor examination of balance and coordination should be performed and appropriate intervention programs should be planned accordingly in children with GJH.

Symbiotic electroneural and musculoskeletal framework to encode proprioception via neurostimulation: ProprioStim

Peripheral nerve stimulation in amputees achieved the restoration of touch, but not proprioception, which is critical in locomotion. A plausible reason is the lack of means to artificially replicate the complex activity of proprioceptors. To uncover this, we coupled neuromuscular models from ten subjects and nerve histologies from two implanted amputees to develop ProprioStim: a framework to encode proprioception by electrical evoking neural activity in close agreement with natural proprioceptive activity. We demonstrated its feasibility through non-invasive stimulation on seven healthy subjects comparing it with standard linear charge encoding. Results showed that ProprioStim multichannel stimulation was felt more natural, and hold promises for increasing accuracy in knee angle tracking, especially in future implantable solutions. Additionally, we quantified the importance of realistic 3D-nerve models against extruded models previously adopted for further design and validation of novel neurostimulation encoding strategies. ProprioStim provides clear guidelines for the development of neurostimulation policies restoring natural proprioception.

Proprioceptive manipulations in orthograde posture modulate postural control in low back pain patients: a pilot study

As we stand upright, perceptual afferences are crucial to successfully help generating postural motor commands. Non-Specific Low Back Pain patients frequently demonstrate a lack of proprioceptive acuity, often translating into postural control deficiencies. For the first time, to our knowledge, we studied the postural effects of proprioceptive manipulations in orthograde posture on Non-Specific Low Back Pain patients. Using static posturography recordings, we computed sway speed, speed variance, and the main direction of sway. We also addressed the patient’s subjective feedbacks after being manipulated. Five minutes after the proprioceptive manipulations, our results revealed decreased speed and speed variance outcomes, but the main direction of sway was not modulated. Furthermore, after the proprioceptive manipulations, the patients also self-reported improved clinical outcomes. These findings provide new knowledge opening new fields of research as well as potential treatment strategies in Low Back Pain patients.

Degree of muscle-and-tendon tonus effects on kinesthetic illusion in wrist joints toward advanced rehabilitation robotics

Due to increasing demand for rehabilitation and therapy for cerebrovascular diseases, patients require advanced development of medical rehabilitation robots. In our laboratory, we focus on the formation capability of the substitute neural path caused by brain plasticity using the kinesthetic illusion (KI), which is effective for therapies using robots. In KI, people perceive an illusionary limb movement without an actual movement when a vibration stimulus is applied to a limb’s tendons. In previous research, the optimal frequency that induces the maximum KI has a correlation factor of about 0.5 with the tendon’s natural frequency when a human subject is in a state of laxity. However, we do not know whether the above finding can be applied to actual rehabilitation because muscles and tendons are sometimes in tonus during rehabilitation, a state that varies the natural frequency. In this study, we investigate the correlation between the optimal and natural frequencies of tendon by systematically changing their tension to clarify the effects on the illusion induced by the muscle and the tendon when they are in tonus. We identified a negative correlation between the optimal and natural frequencies when they are in tonus, although a positive correlation appeared when they are in laxity. This result suggests that KI’s optimal frequency should be changed based on the degree of the tendon and muscle tonus. Therefore, our present findings provide a suitable vibration frequency that induces KI due to the degree of the tendon and muscle tonus during robot therapies.

Feasibility of generating 90 Hz vibrations in remote implanted magnets

Limb amputation not only reduces the motor abilities of an individual, but also destroys afferent channels that convey essential sensory information to the brain. Significant efforts have been made in the area of upper limb prosthetics to restore sensory feedback, through the stimulation of residual sensory elements. Most of the past research focused on the replacement of tactile functions. On the other hand, the difficulties in eliciting proprioceptive sensations using either haptic or (neural) electrical stimulation, has limited researchers to rely on sensory substitution. Here we propose the myokinetic stimulation interface, that aims at restoring natural proprioceptive sensations by exploiting the so-called tendon illusion, elicited through the vibration of magnets implanted inside residual muscles. We present a prototype which exploits 12 electromagnetic coils to vibrate up to four magnets implanted in a forearm mockup. The results demonstrated that it is possible to generate highly directional and frequency-selective vibrations. The system proved capable of activating a single magnet, out of many. Hence, this interface constitutes a promising approach to restore naturally perceived proprioception after an amputation. Indeed, by implanting several magnets in independent muscles, it would be possible to restore proprioceptive sensations perceived as coming from single digits.

Disentangling the percepts of illusory movement and sensory stimulation during tendon vibration in the EEG

Mechanical vibration of muscle tendons in specific frequencies - termed functional proprioceptive stimulation (FPS) - has the ability to induce the illusion of a movement which is congruent with a lengthening of the vibrated tendon and muscle. The majority of previous reports of the brain correlates of this illusion are based on functional neuroimaging. Contrary to the electroencephalogram (EEG) however, such technologies are not suitable for bedside or ambulant use. While a handful of studies have shown EEG changes during FPS, it remains underinvestigated whether these changes were due to the perceived illusion or the perceived vibration. Here, we aimed at disentangling the neural correlates of the illusory movement from those produced by the vibration sensation by comparing the neural responses to two vibration types, one that did and one that did not elicit an illusion. We recruited 40 naïve participants, 20 for the EEG experiment and 20 for a supporting behavioral study, who received functional tendon co-vibration on the biceps and triceps tendon at their left elbow, pseudo-randomly switching between the illusion and non-illusion trials. Time-frequency decomposition uncovered a strong and lasting event-related desynchronization (ERD) in the mu and beta band in both conditions, suggesting a strong somatosensory response to the vibration. Additionally, the analysis of the evoked potentials revealed a significant difference between the two experimental conditions from 310 to 990ms post stimulus onset. Training classifiers on the frequency-based and voltage-based correlates of illusion perception yielded above chance accuracies for 17 and 13 out of the 20 subjects respectively. Our findings show that FPS-induced illusions produce EEG correlates that are distinct from a vibration-based control and which can be classified reliably in a large number of participants. These results encourage pursuing EEG-based detection of kinesthetic illusions as a tool for clinical use, e.g., to uncover aspects of cognitive perception in unresponsive patients.

Proprioceptive Augmentation With Illusory Kinaesthetic Sensation in Stroke Patients Improves Movement Quality in an Active Upper Limb Reach-and-Point Task

Stroke patients often have difficulty completing motor tasks even after substantive rehabilitation. Poor recovery of motor function can often be linked to stroke-induced damage to motor pathways. However, stroke damage in pathways that impact effective integration of sensory feedback with motor control may represent an unappreciated obstacle to smooth motor coordination. In this study we investigated the effects of augmenting movement proprioception during a reaching task in six stroke patients as a proof of concept. We used a wearable neurorobotic proprioceptive feedback system to induce illusory kinaesthetic sensation by vibrating participants' upper arm muscles over active limb movements. Participants were instructed to extend their elbow to reach-and-point to targets of differing sizes at various distances, while illusion-inducing vibration (90 Hz), sham vibration (25 Hz), or no vibration was applied to the distal tendons of either their biceps brachii or their triceps brachii. To assess the impact of augmented kinaesthetic feedback on motor function we compared the results of vibrating the biceps or triceps during arm extension in the affected arm of stroke patients and able-bodied participants. We quantified performance across conditions and participants by tracking limb/hand kinematics with motion capture, and through Fitts' law analysis of reaching target acquisition. Kinematic analyses revealed that injecting 90 Hz illusory kinaesthetic sensation into the actively contracting (agonist) triceps muscle during reaching increased movement smoothness, movement directness, and elbow extension. Conversely, injecting 90 Hz illusory kinaesthetic sensation into the antagonistic biceps during reaching negatively impacted those same parameters. The Fitts' law analyses reflected similar effects with a trend toward increased throughput with triceps vibration during reaching. Across all analyses, able-bodied participants were largely unresponsive to illusory vibrational augmentation. These findings provide evidence that vibration-induced movement illusions delivered to the primary agonist muscle involved in active movement may be integrated into rehabilitative approaches to help promote functional motor recovery in stroke patients.

Feasibility Case Study for Treating a Patient with Sensory Ataxia Following a Stroke with Kinesthetic Illusion Induced by Visual Stimulation

Background: Sensory ataxia is a disorder of movement coordination caused by sensory deficits, especially in kinesthetic perception. Visual stimulus-induced kinesthetic illusion (KINVIS) is a method used to provide vivid kinesthetic perception without peripheral sensory input by using a video showing pre-recorded limb movements while the actual limb remains stationary. We examined the effects of KINVIS intervention in a patient with sensory ataxia. Case: The patient was a 59-year-old man with a severe proprioceptive deficit caused by left thalamic hemorrhage. During KINVIS intervention, a computer screen displayed a pre-recorded mirror image video of the patient’s unaffected hand performing flexion–extension movements as if it were attached to the patient’s affected forearm. Kinematics during the flexion–extension movements of the paretic hand were recorded before and after 20-min interventions. Transcranial magnetic stimulation was applied to the affected and non-affected hemispheres. The amplitude of the motor-evoked potential (MEP) at rest was recorded for the muscles of both hands. After the intervention, the total trajectory length and the rectangular area bounding the trajectory of the index fingertip decreased. The MEP amplitude of the paretic hand increased, whereas the MEP amplitude of the non-paretic hand was unchanged. Discussion: The changes in kinematics after the intervention suggested that KINVIS therapy may be a useful new intervention for sensory ataxia, a condition for which few effective treatments are currently available. Studies in larger numbers of patients are needed to clarify the mechanisms underlying this therapeutic effect.

A new method to elicit and measure movement illusions in stroke by means of muscle tendon vibration: the Standardized Kinesthetic Illusion Procedure (SKIP)

Purpose: Muscle tendon vibration (MTV) strongly activates muscle spindles and can evoke kinaesthetic illusions. Although potentially relevant for sensorimotor rehabilitation in stroke, MTV is scarcely used in clinical practice, likely because of the absence of standardised procedures to elicit and characterise movement illusions. This work developed and validated a Standardised Kinaesthetic Illusion Procedure (SKIP) to favour the use of MTV-induced illusions in clinical settings.Materials and methods: SKIP scores were obtained in 15 individuals with chronic stroke and 18 age- and gender-matched healthy counterparts. A further 13 healthy subjects were tested to provide more data with the general population. MTV was applied over the Achilles tendon and SKIP scoring system characterised the clearness and direction of the illusions of ankle dorsiflexion movements.Results: All healthy and stroke participants perceived movement illusions. SKIP scores on the paretic side were significantly lower compared to the non paretic and healthy. Illusions were less clear and sometimes in unexpected directions with the impaired ankle, but still possible to elicit in the presence of sensorimotor deficits.Conclusions: SKIP represents an ancillary and potentially useful clinical method to elicit and characterise illusions of movements induced by MTV. SKIP could be relevant to further assess the processing of proprioceptive afferents in stroke and their potential impact on motor control and recovery. It may be used to guide therapy and improve sensorimotor recovery. Future work is needed to investigate the metrological properties of our method (reliability, responsiveness, etc.), and also the neurophysiological underpinnings of MTV-induced illusions.

Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury

Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury but is less effective in humans. Here we hypothesized that this interspecies discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations and preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position. Consequently, continuous EES can only facilitate locomotion within a narrow range of stimulation parameters and is unable to provide meaningful locomotor improvements in humans without rehabilitation. Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motor neuron activity. This demonstrates the importance of stimulation protocols that preserve proprioceptive information to facilitate walking with EES.

The preload force affects the perception threshold of muscle vibration-induced movement illusions

The control and the execution of motor tasks are largely influenced by proprioceptive feedback, i.e. the information about the position and movement of the body. In 1972, it was discovered that a vibratory stimulation applied non-invasively to a muscle or a tendon induces a movement illusion consistent with the elongation of the vibrated muscle/tendon. Although this phenomenon was reported by several studies, it is still unclear how to reliably reproduce it because of the many different features of the stimulation altering the sensation (e.g. frequency, duration, location). By performing a psychophysical test, we analysed the effects of the stimulation point and the preload force on the minimum stimulation amplitude needed to elicit an illusion of movement. In particular, we stimulated two groups of healthy subjects on three target regions of the biceps brachii muscle (the distal tendon, the muscle belly and one of the proximal tendons) applying three preload force ranges (0.5–0.75N, 1–2N and 3–4N). Our results showed that the minimum stimulation amplitude eliciting a sensation is affected by the preload force. On the contrary, it did not change significantly among the three stimulated regions. Nevertheless, the reported vividness of the illusion of movement changed across the stimulated points decreasing while moving from the distal to the proximal tendons. Overall, these outcomes contribute to the scientific debate on the features that modulate the vibration-induced movement illusion proposing ways to increase the reliability of the procedure in basic and applied research studies.

Can somatosensory electrical stimulation relieve spasticity in post-stroke patients? A TMS pilot study

Evidence suggests that somatosensory electrical stimulation (SES) may decrease the degree of spasticity from neural drives, although there is no agreement between corticospinal modulation and the level of spasticity. Thus, stroke patients and healthy subjects were submitted to SES (3 Hz) for 30' on the impaired and dominant forearms, respectively. Motor evoked potentials induced by single-pulse transcranial magnetic stimulation were collected from two forearm muscles before and after SES. The passive resistance of the wrist joint was measured with an isokinetic system. We found no evidence of an acute carry-over effect of SES on the degree of spasticity.

Kinesthetic Senses

The kinesthetic senses are the senses of position and movement of the body, senses we are aware of only on introspection. A method used to study kinesthesia is muscle vibration, which engages afferents of muscle spindles to trigger illusions of movement and changed position. When vibrating elbow flexors, it generates sensations of forearm extension, when vibrating extensors, sensations of forearm flexion. Vibrating the elbow joint produces no illusion. Vibrating flexors and extensors together at the same frequency also produces no illusion, because what is perceived is the signal difference between antagonist muscles of each arm and between arms. The size of the illusion depends on how the muscle has been conditioned beforehand, due to a property of muscle called thixotropy. When measuring the illusion, blindfolded subjects may carry out a matching or pointing task. In pointing, signals from muscle spindles are less important than in matching. Afferent signals from kinesthetic receptors project to areas of somatosensory cortex to generate sensations of detection and location. This is referred to the body model, which provides information about size and shape of body parts. Kinesthesia, together with vision and touch, is associated with the sense of body ownership. All three can combine or each, on its own, can generate ownership. Related is the sense of agency, the sense of being responsible for one's own actions. In recent times, much progress has been made using neuroimaging techniques to identify the various areas of the brain likely to be responsible for generating these sensations. © 2017 American Physiological Society. Compr Physiol 8:1157-1183, 2018.

Muscle Vibration-Induced Illusions: Review of Contributing Factors, Taxonomy of Illusions and User’s Guide

Limb muscle vibration creates an illusory limb movement in the direction corresponding to lengthening of the vibrated muscle. Neck muscle vibration results in illusory motion of visual and auditory stimuli. Attributed to the activation of muscle spindles, these and related effects are of great interest as a tool in research on proprioception, for rehabilitation of sensorimotor function and for multisensory immersive virtual environments. However, these illusions are not easy to elicit in a consistent manner. We review factors that influence them, propose their classification in a scheme that links this area of research to perception theory, and provide practical suggestions to researchers. Local factors that determine the illusory effect of vibration include properties of the vibration stimulus such as its frequency, amplitude and duration, and properties of the vibrated muscle, such as contraction and fatigue. Contextual (gestalt) factors concern the relationship of the vibrated body part to the rest of the body and the environment. Tactile and visual cues play an important role, and so does movement, imagined or real. The best-known vibration illusions concern one’s own body and can be classified as ‘first-order’ due to a direct link between activity in muscle spindles and the percept. More complex illusions involve other sensory modalities and external objects, and provide important clues regarding the hidden role of proprioception, our ‘silent’ sense. Our taxonomy makes explicit this and other distinctions between different illusory effects. We include User’s Guide with tips for anyone wishing to conduct a vibration study.

Cutaneous afferent feedback from the posterior ankle contributes to proprioception

Cutaneous mechanoreceptors in skin surrounding joints can respond to the skin strain generated by movement, and thus provide proprioceptive cues. The objective of this experiment was to determine the contribution of skin feedback from the posterior ankle to position sense during passive movements. In 28 healthy adults (12 male), a topical anesthetized (n=14) or placebo cream (n=14) was applied to an area of skin on the posterior ankle that undergoes stretch and compression during ankle dorsi- and plantar-flexion. Position sense was assessed before and after anesthetization using a passive joint matching task (target angles: 6°, 12°, and 18° dorsiflexion and plantar flexion). Results showed that reducing skin feedback caused the perception that the ankles were aligned when the anesthetized ankle was relatively more dorsiflexed, suggesting that posterior ankle skin primarily signals the magnitude of skin stretch. Larger movement into dorsiflexion was likely necessary to provide enough stretch of muscle and surrounding intact skin to compensate for reduced signals from the anesthetized skin region. Reducing skin feedback also increased matching variability during larger movements. These findings suggest that skin feedback from the posterior ankle has a significant contribution to position sense during passive movement. Therefore, the sensitivity of skin surrounding the ankle could be important to consider in populations with reduced peripheral skin sensitivity as a result of ageing or neurological disorders.

Is the Frequency in Somatosensory Electrical Stimulation the Key Parameter in Modulating the Corticospinal Excitability of Healthy Volunteers and Stroke Patients with Spasticity?

Somatosensory electrical stimulation (SES) has been proposed as an approach to treat patients with sensory-motor impairment such as spasticity. However, there is still no consensus regarding which would be the adequate SES parameters to treat those deficits. Therefore, the aim of this study was to evaluate the effects of applying SES over the forearm muscles at four different frequencies of stimulation (3, 30, 150, and 300 Hz) and in two intervals of time (5′ and 30′) by means of transcranial magnetic stimulation and Hoffmann's reflex (H-reflex) in healthy volunteers (Experiments  I and II). A group of stroke patients (Experiment  III) was also preliminary evaluated to ascertain SES effects at a low frequency (3 Hz) applied for 30′ over the forearm spastic flexors muscles by measuring the wrist joint passive torque. Motor evoked potentials and the H-reflex were collected from different forearm and hand muscles immediately before and after SES and up to 5′ (Experiment  I) and 10′ (Experiments  I and II) later. None of the investigated frequencies of SES was able to operate as a key in switching modulatory effects in the central nervous system of healthy volunteers and stroke patients with spasticity.

Vibrotactile stimulation of fast-adapting cutaneous afferents from the foot modulates proprioception at the ankle joint

It has previously been shown that cutaneous sensory input from across a broad region of skin can influence proprioception at joints of the hand. The present experiment tested whether cutaneous input from different skin regions across the foot can influence proprioception at the ankle joint. The ability to passively match ankle joint position (17° and 7° plantar flexion and 7° dorsiflexion) was measured while cutaneous vibration was applied to the sole (heel, distal metatarsals) or dorsum of the target foot. Vibration was applied at two different frequencies to preferentially activate Meissner's corpuscles (45 Hz, 80 μm) or Pacinian corpuscles (255 Hz, 10 μm) at amplitudes ∼3 dB above mean perceptual thresholds. Results indicated that cutaneous input from all skin regions across the foot could influence joint-matching error and variability, although the strongest effects were observed with heel vibration. Furthermore, the influence of cutaneous input from each region was modulated by joint angle; in general, vibration had a limited effect on matching in dorsiflexion compared with matching in plantar flexion. Unlike previous results in the upper limb, we found no evidence that Pacinian input exerted a stronger influence on proprioception compared with Meissner input. Findings from this study suggest that fast-adapting cutaneous input from the foot modulates proprioception at the ankle joint in a passive joint-matching task. These results indicate that there is interplay between tactile and proprioceptive signals originating from the foot and ankle.

Functional impact of vibratory proprioceptive assistance in patients with facioscapulohumeral muscular dystrophy

INTRODUCTION

In this study we analyzed the effects of a rehabilitation method based on the use of vibratory proprioceptive assistance (VPA) in subjects with facioscapulohumeral muscular dystrophy.

METHODS

Eight subjects were given 1 month of mechanical vibratory treatment that consisted of 8 sessions of 40-min stimulation on the more affected side. During each session, illusory movements were induced as follows: sensations of extension or flexion of the forearm or elevation of the arm via vibration applied to the distal tendon of the biceps brachialis (BB), triceps brachialis (TB), or pectoralis major muscles (PM), respectively, and of elevation of the arm with extension or flexion of the forearm via vibration of PM+BB or PM+TB, respectively.

RESULTS

Treatment led to a significant increase in the amplitude of voluntary shoulder flexion, constant score, and self-rated health.

CONCLUSION

VPA may serve as a rehabilitation method for reducing the deleterious effects of decline in motor activities.

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

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

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.

Temporal features of human tendon vibration illusions

Muscle spindles provide information about the position and movement of our bodies. One method for investigating spindle signals is tendon vibration. Vibration of flexor tendons can produce illusions of extension, and vibration of extensor tendons can produce illusions of flexion. Here we estimate the temporal resolution and persistence of these illusions. In Experiments 1 and 2, sequences of alternating vibration of wrist flexor and extensor tendons produced position illusions that varied with alternation period. When vibrations alternated at 1 Hz or slower, perceived position at the end of the sequence depended on the last vibration. When vibrations alternated every 0.3 s, perceived position was independent of the last vibration. Experiment 2 verified and extended these results using more trials and concurrent electromyographic recording. Although tendon vibrations sometimes induce reflexive muscle activity, we found no evidence that such activity contributed to these effects. Experiment 3 investigated how long position sense is retained when not updated by current information from spindles. Our first experiments suggested that vibrating antagonistic tendons simultaneously could produce conflicting inputs, leaving position sense reliant on memory of position prior to vibration onset. We compared variability in position sense after different durations of such double vibration. After 12 s of double vibration, variability across trials exceeded levels predicted from vibrations of flexor or extensor tendons alone. This suggests that position sense memory had decayed too much to substitute for the current conflicting sensory information. Together, our results provide novel, quantitative insight into the temporal properties of tendon vibration illusions.

Functional changes in muscle afferent neurones in an osteoarthritis model: implications for impaired proprioceptive performance

Background

Impaired proprioceptive performance is a significant clinical issue for many who suffer osteoarthritis (OA) and is a risk factor for falls and other liabilities. This study was designed to evaluate weight-bearing distribution in a rat model of OA and to determine whether changes also occur in muscle afferent neurones.

Methodology/Principal Findings

Intracellular recordings were made in functionally identified dorsal root ganglion neurones in acute electrophysiological experiments on the anaesthetized animal following measurements of hind limb weight bearing in the incapacitance test. OA rats but not naïve control rats stood with less weight on the ipsilateral hind leg (P = 0.02). In the acute electrophysiological experiments that followed weight bearing measurements, action potentials (AP) elicited by electrical stimulation of the dorsal roots differed in OA rats, including longer AP duration (P = 0.006), slower rise time (P = 0.001) and slower maximum rising rate (P = 0.03). Depolarizing intracellular current injection elicited more APs in models than in naïve muscle afferent neurones (P = 0.01) indicating greater excitability. Axonal conduction velocity in model animals was slower (P = 0.04).

Conclusions/Significance

The present study demonstrates changes in hind limb stance accompanied by changes in the functional properties of muscle afferent neurones in this derangement model of OA. This may provide a possible avenue to explore mechanisms underlying the impaired proprioceptive performance and perhaps other sensory disorders in people with OA.

The effects of kinesthetic illusory sensation induced by a visual stimulus on the corticomotor excitability of the leg muscles

A novel method of visual stimulus, reported by Kaneko et al. [14], induced a vivid kinesthetic illusion and increased the corticomotor excitability of the finger muscles without any overt movement. To explore the effect of this method on the lower limbs, motor evoked potentials (MEP) were recorded from the left tibialis anterior (TA) and soleus muscles using transcranial magnetic stimulation (TMS). A computer screen that showed the moving image of an ankle movement was placed over the subject's leg, and its position was modulated to induce an illusory sensation that the subject's own ankle was moving (illusion condition). TMS was delivered at rest and at two different times during the illusion condition (ankle dorsiflexion phase: illusion-DF; ankle plantarflexion phase: illusion-PF). The MEP amplitude of the TA, which is the agonist muscle for ankle dorsiflexion, was significantly increased during the illusion-DF condition. This indicated that the visual stimulus showing the moving image of an ankle movement could induce a kinesthetic illusion and selectively increase the corticomotor excitability in an agonist muscle for an illusion, as was previously reported for an upper limb. The MEP amplitude of the soleus, which is the agonist muscle for ankle plantarflexion, increased during the illusion-PF condition, but not significantly. Because of the vividness of the illusory sensation was significantly greater during the illusion-DF condition than the illusion-PF condition, we concluded that the vividness of the illusory sensation had a crucial role in increasing corticomotor excitability.

Predicting Any Arm Movement Feedback to Induce Three-Dimensional Illusory Movements in Humans

Our sense of body posture and movement is mainly mediated by densely packed populations of tiny mechanoreceptors present in the muscles. Signals triggered in muscle spindles by our own actions contribute crucially to our consciousness of positions and movements by continuously feeding and updating dynamic sensorimotor maps. Deciphering the coding rules whereby the nervous system integrates this proprioceptive information perceptually could help to elucidate the mechanisms underlying kinesthesia. The aim of the present study was to test the validity of a “propriomimetic method” of predicting the proprioceptive streams emitted by each of the muscles involved in two- (2D) and three-dimensional (3D) arm movements. This method was based on the functional properties of muscle spindle populations previously recorded microneurographically in behaving humans. Ia afferent patterns mimicking those evoked when the “arm–forearm” ensemble is drawing straight lines, graphic symbols, and complex 3D figures were calculated. These simulated patterns were then delivered to the main elbow and shoulder muscle tendons of motionless volunteers via a set of vibrators. Results show that the simulated proprioceptive patterns applied induced, in passive subjects, illusory 2D and 3D arm movements, the trajectories of which were very similar to the expected ones. These simulated patterns can therefore be said to be a substitute for the Ia proprioceptive feedback evoked by any human arm movement and this method can certainly be extended to other musculoskeletal ensembles. The illusory movements induced when these proprioceptive patterns are applied to muscle groups via sets of vibrators may provide useful tools for sensorimotor rehabilitation purposes.

Regaining motor control in musician's dystonia by restoring sensorimotor organization

Professional musicians are an excellent model of long-term motor learning effects on structure and function of the sensorimotor system. However, intensive motor skill training has been associated with task-specific deficiency in hand motor control, which has a higher prevalence among musicians (musician's dystonia) than in the general population. Using a transcranial magnetic stimulation paradigm, we previously found an expanded spatial integration of proprioceptive input into the hand motor cortex [sensorimotor organization (SMO)] in healthy musicians. In musician's dystonia, however, this expansion was even larger. Whereas motor skills of musicians are likely to be supported by a spatially expanded SMO, we hypothesized that in musician's dystonia this might have developed too far and now disrupts rather than assists task-specific motor control. If so, motor control should be regained by reversing the excessive reorganization in musician's dystonia. Here, we test this hypothesis and show that a 15 min intervention with proprioceptive input (proprioceptive training) restored SMO in pianists with musician's dystonia to the pattern seen in healthy pianists. Crucially, task-specific motor control improved significantly and objectively as measured with a MIDI (musical instrument digital interface) piano, and the amount of behavioral improvement was significantly correlated to the degree of sensorimotor reorganization. In healthy pianists and nonmusicians, the SMO and motor performance remained essentially unchanged. These findings suggest that the differentiation of SMO in the hand motor cortex and the degree of motor control of intensively practiced tasks are significantly linked and finely balanced. Proprioceptive training restored this balance in musician's dystonia to the behaviorally beneficial level of healthy musicians.

A parietal-premotor network for movement intention and motor awareness

It is commonly assumed that we are conscious of our movements mainly because we can sense ourselves moving as ongoing peripheral information coming from our muscles and retina reaches the brain. Recent evidence, however, suggests that, contrary to common beliefs, conscious intention to move is independent of movement execution per se. We propose that during movement execution it is our initial intentions that we are mainly aware of. Furthermore, the experience of moving as a conscious act is associated with increased activity in a specific brain region: the posterior parietal cortex. We speculate that movement intention and awareness are generated and monitored in this region. We put forward a general framework of the cognitive and neural processes involved in movement intention and motor awareness.

Perceptual integration of illusory and imagined kinesthetic images

It is generally agreed that motor imagery involves kinesthetic sensations especially as far as first-person imagery is concerned. It was proposed to determine the extent to which motor imagery and vibration-induced illusory sensations of movement are integrated perceptually. Imagined and illusory hand movements were evoked both separately and in various combinations in 12 volunteers. After each trial, the participants were asked to draw the movement trajectory perceived. In all the subjects, propriomimetic vibration patterns applied to various wrist muscles induced spatially oriented or more complex illusory hand movements such as writing or drawing. Depending on the instructions, the subjects were also able to produce imagined hand movements in various directions and at two different velocities. When straight illusory and imagined movements were evoked simultaneously, all the subjects perceived a single movement trajectory, in which the direction and the velocity of the two ongoing sensations were exactly integrated. This perceptual integration also occurred in the case of more complex movements, such as writing and drawing, giving rise to the perception of original trajectories also combining the features of both motor images. Because these two kinesthetic images, the one intentionally and centrally induced and the other peripherally evoked, activate almost the same neural network including cortical sensory and motor areas, parietal regions, and the cerebellum, these results suggest that common processes may be involved in such a perceptual fusion. The nature of these common processes is discussed, and some fields of research in which these findings could potentially be applied are suggested.

A new vibrator to stimulate muscle proprioceptors in fMRI

Studying cognitive brain functions by functional magnetic resonance imaging (fMRI) requires appropriate stimulation devices that do not interfere with the magnetic fields. Since the emergence of fMRI in the 90s, a number of stimulation devices have been developed for the visual and auditory modalities. Only few devices, however, have been developed for the somesthesic modality. Here, we present a vibration device for studying somesthesia that is compatible with high magnetic field environments and that can be used in fMRI machines. This device consists of a poly vinyl chloride (PVC) vibrator containing a wind turbine and of a pneumatic apparatus that controls 1-6 vibrators simultaneously. Just like classical electromagnetic vibrators, our device stimulates muscle mechanoreceptors (muscle spindles) and generates reliable illusions of movement. We provide the fMRI compatibility data (phantom test), the calibration curve (vibration frequency as a function of air flow), as well as the results of a kinesthetic test (perceived speed of the illusory movement as a function of vibration frequency). This device was used successfully in several brain imaging studies using both fMRI and magnetoencephalography.

Inducing Any Virtual Two-Dimensional Movement in Humans by Applying Muscle Tendon Vibration

In humans, tendon vibration evokes illusory sensation of movement. We developed a model mimicking the muscle afferent patterns corresponding to any two-dimensional movement and checked its validity by inducing writing illusory movements through specific sets of muscle vibrators. Three kinds of illusory movements were compared. The first was induced by vibration patterns copying the responses of muscle spindle afferents previously recorded by microneurography during imposed ankle movements. The two others were generated by the model. Sixteen different vibratory patterns were applied to 20 motionless volunteers in the absence of vision. After each vibration sequence, the participants were asked to name the corresponding graphic symbol and then to reproduce the illusory movement perceived. Results showed that the afferent patterns generated by the model were very similar to those recorded microneurographically during actual ankle movements ( r = 0.82). The model was also very efficient for generating afferent response patterns at the wrist level, if the preferred sensory directions of the wrist muscle groups were first specified. Using recorded and modeled proprioceptive patterns to pilot sets of vibrators placed at the ankle or wrist levels evoked similar illusory movements, which were correctly identified by the participants in three quarters of the trials. Our proprioceptive model, based on neurosensory data recorded in behaving humans, should then be a useful tool in fields of research such as sensorimotor learning, rehabilitation, and virtual reality.

Cutaneous afferents provide a neuronal population vector that encodes the orientation of human ankle movements

The aim of this study was to analyse the directional coding of two-dimensional limb movements by cutaneous afferents from skin areas covering a multidirectional joint, the ankle. The activity of 89 cutaneous afferents was recorded in the common peroneal nerve, and the mean discharge frequency of each unit was measured during the outward phase of ramp and hold movements imposed in 16 different directions. Forty-two afferents responded to the movements in the following decreasing order (SA2, n = 24/27; FA2, n = 13/17; FA1, n = 3/24; SA1, n = 2/21). All the units activated responded to a specific range of directions, defining their 'preferred sector', within which their response peaked in a given direction, their 'preferred direction'. Based on the distribution of the preferred directions, two populations of afferents, and hence two skin areas were defined: the anterior and the external lateral parts of the leg. As the directional tuning of each population was cosine shaped, the neuronal population vector model was applied and found to efficiently describe the movement direction encoded by cutaneous afferents, as it has been previously reported for muscle afferents. The responses of cutaneous afferents were then considered with respect to those of the afferents from the underlying muscles, which were previously investigated, and an almost perfect matching of directional sensitivity was observed. It is suggested that the common movement-encoding characteristics exhibited by cutaneous and muscle afferents, as early as the peripheral level, may facilitate the central co-processing of their feedbacks subserving kinaesthesia.

Stance- and Locomotion-Dependent Processing of Vibration-Induced Proprioceptive Inflow From Multiple Muscles in Humans

We performed a whole-body mapping study of the effect of unilateral muscle vibration, eliciting spindle Ia firing, on the control of standing and walking in humans. During quiet stance, vibration applied to various muscles of the trunk-neck system and of the lower limb elicited a significant tilt in whole body postural orientation. The direction of vibration-induced postural tilt was consistent with a response compensatory for the illusory lengthening of the stimulated muscles. During walking, trunk-neck muscle vibration induced ample deviations of the locomotor trajectory toward the side opposite to the stimulation site. In contrast, no significant modifications of the locomotor trajectory could be detected when vibrating various muscles of the lower as well as upper limb. The absence of correlation between the effects of muscle vibration during walking and standing dismisses the possibility that vibration-induced postural changes can account for the observed deviations of the locomotor trajectory during walking. We conclude that the dissimilar effects of trunk-neck and lower limb muscle vibration during walking and standing reflect a general sensory-motor plan, whereby muscle Ia input is processed according to both the performed task and the body segment from which the sensory inflow arises.