Proprioceptive performance of bilateral upper and lower limb joints: side-general and site-specific effects

Normative values and the influence of sex, hand dominance, and direction of movement on active wrist joint position sense in young healthy adults

BACKGROUND

Active wrist joint position sense (JPS) is a feasible method for determining wrist proprioception. However, the normative values and factors affecting wrist JPS are not known.

OBJECTIVES

To identify normative values of active wrist JPS in young healthy adults and explore the influence of sex, hand dominance and direction of wrist movement.

DESIGN

Cross-sectional study.

METHOD

JPS of 100 individuals aged 18-40 years, (male: female = 51:49) were measured at two wrist positions (20° flexion/extension) using the active wrist JPS test. Absolute error (in degrees) was calculated and summarized using descriptive measures. Kruskal-Wallis analysis of variance was performed to determine the differences in JPS error based on sex, dominance and direction of wrist movement.

RESULTS

Mean absolute JPS flexion error on the dominant side was 3.47°(SD = 3.91°), and non-dominant side was 3.26°(SD = 3.23°). Mean absolute JPS extension error on the dominant side was 3.35°(SD = 3.43°), and non-dominant side was 4.59°(SD = 4.82°). Compared to males, females had more absolute error for flexion and extension on the dominant side. No significant difference was found in the absolute error between the dominant and non-dominant sides or between flexion and extension.

CONCLUSION

These normative values of active JPS in young healthy adults can help clinicians while assessing proprioceptive impairments of the wrist. Differences in JPS errors due to sex were found, but not due to dominance or direction of movement. These findings can guide future research on mechanisms involved in wrist JPS.

Stroke rehabilitation: from diagnosis to therapy

Stroke remains a significant global health burden, necessitating comprehensive and innovative approaches in rehabilitation to optimize recovery outcomes. This paper provides a thorough exploration of rehabilitation strategies in stroke management, focusing on diagnostic methods, acute management, and diverse modalities encompassing physical, occupational, speech, and cognitive therapies. Emphasizing the importance of early identification of rehabilitation needs and leveraging technological advancements, including neurostimulation techniques and assistive technologies, this manuscript highlights the challenges and opportunities in stroke rehabilitation. Additionally, it discusses future directions, such as personalized rehabilitation approaches, neuroplasticity concepts, and advancements in assistive technologies, which hold promise in reshaping the landscape of stroke rehabilitation. By delineating these multifaceted aspects, this manuscript aims to provide insights and directions for optimizing stroke rehabilitation practices and enhancing the quality of life for stroke survivors.

Heart rate-related physiological changes induced by classical music-elicited emotions do not underlie alterations in healthy adults' ankle joint target-matching strategy

Emotions have the potential to modulate human voluntary movement by modifying muscle afferent discharge which in turn may affect kinesthetic acuity. We examined if heart rate (HR)-related physiological changes induced by music-elicited emotions would underlie alterations in healthy young adults' ankle joint target-matching strategy quantified by joint position sense (JPS). Participants (n = 40, 19 females, age = 25.9 ± 2.9 years) performed ipsilateral-, and contralateral ankle target-matching tasks with their dominant and non-dominant foot using a custom-made foot platform while listening to classical music pieces deemed to evoke happy, sad, or neutral emotions (each n = 10). Participants in the 4th group received no music during the task. Absolute (ABS), constant (CONST), and variable (VAR) target-matching errors and HR-related data were analyzed. Participants performed the contralateral target-matching task with smaller JPS errors when listening to sad vs. happy music (ABS: p < 0.001, d = 1.6; VAR: p = 0.010, d = 1.2) or neutral (ABS: p < 0.001, d = 1.6; VAR: p < 0.001, d = 1.4) music. The ABS (d = 0.8) and VAR (d = 0.3) JPS errors were lower when participants performed the task with their dominant vs. non-dominant foot. JPS errors were also smaller during the ipsilateral target-matching task when participants (1) listened to sad vs. neutral (ABS: p = 0.007, d = 1.2) music, and (2) performed the target-matching with their dominant vs. non-dominant foot (p < 0.001, d = 0.4). Although emotions also induced changes in some HR-related data during the matching conditions, i.e., participants who listened to happy music had lower HR-related values when matching with their non-dominant vs. dominant foot, these changes did not correlate with JPS errors (all p > 0.05). Overall, our results suggest that music-induced emotions have the potential to affect target-matching strategy and HR-related metrics but the changes in HR-metrics do not underlie the alteration of ankle joint target-matching strategy in response to classical music-elicited emotions.

A novel proprioceptive rehabilitation program: A pilot randomized controlled trail as an approach to address proprioceptive deficits in patients with diabetic polyneuropathy

BACKGROUND

Diabetic polyneuropathy (DPN) is a notable microvascular complication of DM, affecting 16%-66% globally. DPN often leads to proprioceptive deficits in the lower limbs (LL), leading to impaired functional performance. However, evidence supporting proprioceptive rehabilitation programs (PRP) for DPN remains scarce.

AIMS

This pilot study aims to evaluate the effectiveness of a novel 12-week PRP on LL static and dynamic proprioception and shed light on the potential benefits of PRP for DPN population.

METHODS

Randomized Controlled Trail was conducted among 30 DPN patients (age 53.25±7.72 years, BMI 24.01±1.41 and DM duration 9.48±6.45 years), randomly allocated to intervention (n = 15) or control (n = 15) groups. The intervention group received PRP 3 times/week for 12 weeks. The control group received no exercise. Both groups received regular diabetic care. Static and dynamic proprioception of both LL were assessed at baseline, 6 weeks and 12 weeks. Position-reposition test was used to assess ankle joint position sense by obtaining difference between target and reproduced angles. Error in detecting knee angle and speed were obtained by performing Lower Limb Matching and Sense of Movement tests respectively to assess dynamic proprioception.

RESULTS

Two-way ANOVA and paired comparisons revealed, no significant improvement in proprioceptive deficits at 6 weeks (p>0.05), but significant improvement was achieved at 12-weeks (p<0.05) in the intervention group. Mean errors in Pposition re-position(R:p<0.001, L;p<0.001) and Lower limb matching (R:p<0.001, L;p<0.001) tests reduced by 5° and 10° respectively, indicating a70% improvement in the intervention group. Error of detecting speed reduced only on right side by 0.041ms-1 accounting for a 42% improvement. No improvements were observed in the control group.

CONCLUSIONS

Novel 12-week PRP may yield a significant reduction in LL proprioceptive deficits among DPN patients. Future RCTs with larger samples should compare the effectiveness of this PRP compared with conventional rehabilitation programs.

A multichannel investigation of proprioceptive accuracy

Proprioceptive accuracy (PAc), i.e., the acuity of perception of the state of different parts of the motor system, shows substantial intraindividual differences, and is often considered a general ability. However, it is questionable whether there is an association between accuracies measured with different tests at different body sites. PAc with respect to both knee and elbow joints (joint position reproduction) and the flexors of the upper arms (weight discrimination) was measured in 87 young healthy individuals with regular physical activity across multiple indices. Expected and perceived performance was also assessed for each behavioral task. Frequentist and Bayesian analysis largely supported the idea that PAc with respect to various parts of the motor system are unrelated. No dominant-subdominant differences for actual performance were found; however, PAc for the dominant and subdominant limb were associated in many cases. Finally, perceived performance was related to expected but not to actual performance for all three proprioceptive modalities. In conclusion, actual accuracy of perception of the actual state of a part (i.e., joint, muscle) of the motor system cannot be generalized to other parts. Perceived accuracy, dominantly shaped by expectations, is independent from actual accuracy.

Lower Limb Proprioception in Low Back Pain and Its Relationship With Voluntary Postural Control

This study aimed to investigate whether patients with low back pain (LBP) had impaired lower limb proprioception and its association with somatosensory acuity. Thirty patients with LBP and 30 asymptomatic people volunteered, using Sway Discrimination Apparatus tests to assess somatosensory acuity during voluntary anteroposterior and mediolateral postural sway. Results showed significantly reduced somatosensory acuity in mediolateral sway in LBP patients (p = 0.005) with ankle, knee, and hip proprioception showing significantly impairment compared to asymptomatic controls (all p ≤ 0.012). Regression analysis showed that ankle and hip proprioception were significantly associated with somatosensory perception (0.001 ≤ p ≤ 0.026, 0.067 ≤ R2≤ 0.235). Overall, findings suggested a global deterioration of lower limb proprioception in LBP patients, with ankle and hip proprioception playing crucial role in somatosensory perception.

Knee osteoarthritis patients assessed during walking for ankle inversion movement discrimination sensitivity

Background: Knee osteoarthritis (KOA) is a common musculoskeletal condition that affects dynamic balance control and increases the risk of falling during walking. However, the mechanisms underlying this are still unclear. Diminished ankle proprioception during walking has been found to be related to fear of falling in older adults, with a gender difference in incidence of falling. This study aimed to determine 1) whether ankle inversion proprioceptive acuity during walking is impaired in patients with KOA; and 2) whether there is any difference between genders. Methods: Thirty-two patients with KOA (F:M = 17:15, Median age = 52.5, BMI = 22.3 ± 3.0) and 34 healthy controls without KOA (HC) (F:M = 17:17; median age = 49.0, BMI = 22.5 ± 2.7) were recruited. In patients with KOA, ankle inversion proprioceptive acuity was measured on the affected side using the ankle inversion discrimination apparatus for walking (AIDAW), whilst HC were assessed on a randomly selected side. Two-way (2*2) analysis of variance (ANOVA) was performed to determine the main effects and interaction between gender and KOA condition. Results: Two-way ANOVA showed a significant KOA main effect (F = 26.6, p < 0.001, ƞp 2 = 0.3) whereby AIDAW scores during walking for individuals with KOA were significantly lower than those without KOA (KOA vs. HC: 0.746 ± 0.057 vs. 0.807 ± 0.035). There was neither a gender main effect nor interaction (both p > 0.05). Conclusion: Individuals with KOA demonstrated lower ankle proprioception scores during walking compared to their healthy counterparts, with a similar level of impairment in ankle proprioceptive acuity between male and female patients. A low score may contribute to an increased risk of falling in the KOA population. The current findings suggest the need for global concern about lower limb proprioception in the clinical management of KOA.

Relationship between pain and proprioception among individuals with rotator cuff-related shoulder pain

BACKGROUND

Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood.

PURPOSE

This study aimed to investigate the relationship between shoulder pain and proprioception.

STUDY DESIGN

This was a cross-sectional comparative study.

METHODS

Twenty-two participants with RCRSP (mean age 27.6 ± 4.8 years) and 22 matched pain-free participants (23.4 ± 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t-tests and Spearman rank correlations.

RESULTS

Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = -0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = -0.31 [-0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 ± 1.2 cm vs 5.5 ± 1.5 cm; superior 3.8 ± 2.1 cm vs 5.7 ± 2.9 cm; superior-lateral nondominant targets 4.3 ± 2.2 cm vs 6.1 ± 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]).

CONCLUSIONS

Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain.

Voluntary postural sway control and mobility in adults with low back pain

Introduction

Low back pain (LBP) is associated with altered somatosensory perception, which is involved in both involuntary and voluntary control of posture. Currently, there is a lack of methods and tools for assessing somatosensory acuity in patients with LBP. The purpose of this study was (1) to assess the reliability of the sway discrimination apparatus (SwayDA) (2) to evaluate the differences in somatosensory acuity between patients with LBP and pain-free individuals, and (3) to examine relationships between somatosensory acuity, severity of LBP, and mobility in patients with LBP.

Methods

Twenty participants (10 patients with LBP and 10 matched asymptomatic controls) were recruited in a test-retest reliability test. Another 56 participants were recruited for this study with 28 individuals presenting with LBP and a further twenty-eight being asymptomatic. The SwayDA was custom-built to measure somatosensory perception during voluntary anterior-posterior (SwayDA-AP), medial-lateral to the dominant side (SwayDA-ML-D), and non-dominant side (SwayDA-ML-ND) postural sway control. Participants also completed mobility tests, including 10 times and 1-min sit-to-stand tests (10-STS, 1 m-STS). The area under the receiver operating characteristic curve (AUC) was calculated to quantify somatosensory acuity in discriminating different voluntary postural sway extents.

Results

The ICC (2.1) for the SwayDA-AP, SwayDA-ML-D, and SwayDA-ML-ND were 0.741, 0.717, and 0.805 with MDC95 0.071, 0.043, and 0.050. Patients with LBP demonstrated significantly lower SwayDA scores (tSwayDA-AP = -2.142, p = 0.037; tSwayDA-ML-D = -2.266, p = 0.027) than asymptomatic controls. The AUC values of the SwayDA-AP test were significantly correlated with ODI (rSwayDA-AP-ODI = -0.391, p = 0.039). Performances on the 1 m-STS and the 10-STS were significantly correlated with the AUC scores from all the SwayDA tests (-0.513 ≤ r ≤ 0.441, all p < 0.05).

Discussion

The SwayDA tests evaluated showed acceptable reliability in assessing somatosensory acuity during voluntary postural sway. Somatosensory acuity was diminished in patients with LBP compared to asymptomatic controls. In patients with LBP, lower somatosensory acuity was associated with increased LBP-related disability. Future research could focus on investigating the factors contributing to the decreased somatosensory perception and mobility in individuals with LBP.

Bilateral Transfer of a Visuomotor Task in Different Workspace Configurations

Bilateral transfer occurs when a learned behavior transfers from one (group of) effectors(s) to another. Researchers investigating bilateral transfer of a visuomotor adaptation task between limbs used across workspaces have observed divergent results. This study assessed whether bilateral transfer of a visuomotor adaptation task changes with workspace configuration manipulation. Ninety-six right-handed young adults were assigned to one of three workspace locations, i.e., ipsilateral, contralateral, and central. Within each workspace were two retention groups (RRR/LLL) and two bilateral transfer groups (RLR/LRL). Performance before and after training was collected to determine direct and after-effects. We observed an asymmetric transfer of pathlength (left to right) but no ensuing after-effect. However, the transfer of movement time and normalized jerk was symmetric in the contralateral workspace. These findings showed differences in the pattern of bilateral transfer asymmetry in the different workspace configurations, which was parameter specific.

Reference value of knee position sense in weight-bearing and non-weight-bearing conditions

BACKGROUND

Our study aimed to identify age-related changes in knee proprioception to provide reference values for weight-bearing (WB) and non-weight-bearing (NWB) conditions and to identify factors (age, WB condition, dominance, and sex) that can affect knee proprioception.

METHODS

A total of 84 healthy adult men and women were recruited. Active knee joint position sense (JPS) was measured using a digital inclinometer for knee proprioception. The participants performed the required movements actively, with verbal feedback from the examiner, slowly moving to the target angles (30° and 50°) and maintaining them for 5 s before returning to the starting position. Afterward, without assistance from the examiner, the participants actively moved back to the same angle, and the examiner confirmed the angles. This procedure was repeated twice for each target angle, and the average values were used as the data. The participants were barefoot, wearing shorts, and closed their eyes while the measurements were obtained. The measurements were first obtained on the dominant side under the NWB conditions. When a change in posture was needed during the measurement, the participants sat in a resting position for 2 min.

RESULTS

Except for age, all other factors (WB condition, dominance, sex) were not statistically significant. Age showed a significant difference in knee JPS, except for the non-dominant side at 30° and the dominant side at 50° in the NWB condition.

CONCLUSION

This study indicates that the WB condition, dominant side, and sex need not be considered when measuring and assessing knee JPS. Age shows a negative correlation with knee joint position sense, and the reference values presented in this study can be used as objective target values during the rehabilitation process.

The effect of compression and combined compression-tactile stimulation on lower limb somatosensory acuity

Background

Lower limb somatosensation and proprioception are important for maintaining balance. Research has shown that compression garments or exposure to textured surfaces, can enhance somatosensation however, little is known about the effect of combined compression and texture on somatosensory acuity in the lower limb. This study aimed to assess the effects of combined compression socks with a plantar textured sole, on lower limb somatosensory acuity.

Methods

Thirty participants completed a somatosensory acuity task (active movement extent discrimination apparatus; AMEDA) under three conditions: barefoot (control condition), standard knee-high compression sock (compression sock), and knee-high compression sock with internal rubber nodules situated on the sole (textured-compression sock). Somatosensory acuity was assessed between the different sock conditions for the (i) entire group, (ii) high performers, and (iii) low performers. It was hypothesized that low performers would see gains wearing either sock, but the greatest improvement would be in the textured-compression sock condition.

Results

AMEDA scores were not significantly different between conditions when the entire group was analyzed (p = 0.078). The low performers showed an improvement in somatosensory acuity when wearing the compression sock (p = 0.037) and the textured compression sock (p = 0.024), when compared to barefoot, but there was no difference between the two sock conditions (p > 0.05). The high performers did not show any improvement (p > 0.05 for all).

Conclusion

These findings demonstrate that additional sensory feedback may be beneficial to individuals with lower baseline somatosensory acuity but is unlikely to provide benefit for those with higher somatosensory acuity.

Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI.

METHODS

Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale.

RESULTS

Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI.

CONCLUSIONS

The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.

When proprioceptive feedback enhances visual perception of self-body movement: rehabilitation perspectives

Introduction

Rehabilitation approaches take advantage of vision's important role in kinesthesia, using the mirror paradigm as a means to reduce phantom limb pain or to promote recovery from hemiparesis. Notably, it is currently applied to provide a visual reafferentation of the missing limb to relieve amputees' pain. However, the efficiency of this method is still debated, possibly due to the absence of concomitant coherent proprioceptive feedback. We know that combining congruent visuo-proprioceptive signals at the hand level enhances movement perception in healthy people. However, much less is known about lower limbs, for which actions are far less visually controlled in everyday life than upper limbs. Therefore, the present study aimed to explore, with the mirror paradigm, the benefit of combined visuo-proprioceptive feedback from the lower limbs of healthy participants.

Methods

We compared the movement illusions driven by visual or proprioceptive afferents and tested the extent to which adding proprioceptive input to the visual reflection of the leg improved the resulting movement illusion. To this end, 23 healthy adults were exposed to mirror or proprioceptive stimulation and concomitant visuo-proprioceptive stimulation. In the visual conditions, participants were asked to voluntarily move their left leg in extension and look at its reflection in the mirror. In the proprioceptive conditions, a mechanical vibration was applied to the hamstring muscle of the leg hidden behind the mirror to simulate an extension of the leg, either exclusively or concomitantly, to the visual reflection of the leg in the mirror.

Results

(i) Visual stimulation evoked leg movement illusions but with a lower velocity than the actual movement reflection on the mirror; (ii) proprioceptive stimulation alone provided more salient illusions than the mirror illusion; and (iii) adding a congruent proprioceptive stimulation improved the saliency, amplitude, and velocity of the illusion.

Conclusion

The present findings confirm that visuo-proprioceptive integration occurs efficiently when the mirror paradigm is coupled with mechanical vibration at the lower limbs, thus providing promising new perspectives for rehabilitation.

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.

The measurement of proprioceptive accuracy: A systematic literature review

BACKGROUND

Proprioceptive accuracy refers to the individual's ability to perceive proprioceptive information, that is, the information referring to the actual state of the locomotor system, which originates from mechanoreceptors located in various parts of the locomotor system and from tactile receptors located in the skin. Proprioceptive accuracy appears to be an important aspect in the evaluation of sensorimotor functioning; however, no widely accepted standard assessment exists. In this systematic review, our goal was to identify and categorize different methods that are used to assess different aspects of proprioceptive accuracy.

METHODS

A literature search was conducted in 5 different databases (PubMed, SPORTDiscus, PsycINFO, ScienceDirect, and SpringerLink).

RESULTS

Overall, 1139 scientific papers reporting 1346 methods were included in this review. The methods assess 8 different aspects of proprioception: (a) the perception of joint position, (b) movement and movement extent, (c) trajectory, (d) velocity, and the sense of (e) force, (f) muscle tension, (g) weight, and (h) size. They apply various paradigms of psychophysics (i.e., the method of adjustment, constant stimuli, and limits).

CONCLUSION

As the outcomes of different tasks with respect to various body parts show no associations (i.e., proprioceptive accuracy is characterized by site-specificity and method-specificity), the appropriate measurement method for the task needs to be chosen based on theoretical considerations and/or ecological validity.

Right hemisphere brain lateralization for knee proprioception among right-limb dominant individuals

Introduction

Studies indicate that brain response during proprioceptive tasks predominates in the right hemisphere. A right hemisphere lateralization for proprioception may help to explain findings that right-limb dominant individuals perform position matching tasks better with the non-dominant left side. Evidence for proprioception-related brain response and side preference is, however, limited and based mainly on studies of the upper limbs. Establishing brain response associated with proprioceptive acuity for the lower limbs in asymptomatic individuals could be useful for understanding the influence of neurological pathologies on proprioception and locomotion.

Methods

We assessed brain response during an active unilateral knee joint position sense (JPS) test for both legs of 19 right-limb dominant asymptomatic individuals (females/males = 12/7; mean ± SD age = 27.1 ± 4.6 years). Functional magnetic resonance imaging (fMRI) mapped brain response and simultaneous motion capture provided real-time instructions based on kinematics, accurate JPS errors and facilitated extraction of only relevant brain images.

Results

Significantly greater absolute (but not constant nor variable) errors were seen for the dominant right knee (5.22° ± 2.02°) compared with the non-dominant left knee (4.39° ± 1.79°) (P = 0.02). When limbs were pooled for analysis, significantly greater responses were observed mainly in the right hemisphere for, e.g., the precentral gyrus and insula compared with a similar movement without position matching. Significant response was also observed in the left hemisphere for the inferior frontal gyrus pars triangularis. When limbs were assessed independently, common response was observed in the right precentral gyrus and superior frontal gyrus. For the right leg, additional response was found in the right middle frontal gyrus. For the left leg, additional response was observed in the right rolandic operculum. Significant positive correlations were found between mean JPS absolute errors for the right knee and simultaneous brain response in the right supramarginal gyrus (r = 0.464, P = 0.040).

Discussion

Our findings support a general right brain hemisphere lateralization for proprioception (knee JPS) of the lower limbs regardless of which limb is active. Better proprioceptive acuity for the non-dominant left compared with the dominant right knee indicates that right hemisphere lateralization may have meaningful implications for motor control.

Effects of compression running pants and treadmill running stages on knee proprioception and fatigue-related physiological responses in half-marathon runners

Background: Knee injury is common in half-marathon runners, however, the effect of compression running pants on fatigue and knee proprioception remains unclear. Objectives: The study aims to investigate whether wearing compression running pants (CRP) and treadmill running stages affect knee proprioception and fatigue-related physiological responses during half-marathon running. Methods: Eighteen half-marathon runners completed two self-paced 21 km treadmill running trials, once wearing CRP and once wearing loose running shorts (LRS). For each 21 km run, RPE, heart rate, blood lactic acid, and knee flexion proprioception were assessed before starting, and after each 7 km stage. Results: Data analysis revealed no difference between CRP and LRS conditions in heart rate, RPE, or blood lactic acid. Repeated measures ANOVA showed a significant garment condition main effect whereby wearing CRP was associated with higher knee proprioceptive acuity (p = 0.006). Polynomial trend analysis showed a significant linear downwards trend in proprioceptive acuity across the four measurement occasions (p = 0.048). Stage analysis showed that wearing CRP was associated with better knee proprioception at running distances of 14 km (p = 0.007, 95%CI = -0.054, -0.010) and 21 km (p = 0.016, 95%CI = -0.051, -0.006). Conclusion: Compression running pants provide an overall positive effect on knee proprioception, particularly after 14 km and 21km, which may reduce the probability of knee injury. CRP had no significant effect on physiological measures in half-marathon running.

Ankle Proprioception in Male and Female Surfers and the Implications of Motor Experience and Lower-Body Strength

ABSTRACT

Dowse, RA, Secomb, JL, Bruton, M, Parsonage, J, Ferrier, B, Waddington, G, and Nimphius, S. Ankle proprioception in male and female surfers and the implications of motor experience and lower-body strength. J Strength Cond Res 36(12): 3497-3504, 2022-The primary objectives were to evaluate if the active movement extent discrimination apparatus (AMEDA) condition (i.e., front foot and back foot plantarflexion, dorsiflexion, inversion, and eversion) and the level of competition explained ankle movement discrimination scores and, thereafter, examined the contribution of surf experience, physical capacity, and ability to proprioception. It was also considered important to re-evaluate the surf experience, anthropometric characteristics, physical capacities, and abilities of male and female surfers. Twenty-six male ( n = 12, surf experience = 18 ± 8 years) and female surfers ( n = 14, surf experience = 9 ± 6 years) completed a pre-exercise medical questionnaire, anthropometric assessment, 8 AMEDA assessments, countermovement jump, squat jump, and isometric midthigh pull assessment. The AMEDA condition and level of competition did not have a statistically significant main effect on ankle movement discrimination scores; however, the effect of the gender/sex was significant ( p = 0.044). Surf experience ( p = 0.029) and lower-body isometric strength ( p = 0.029) had a statistically significant but small main effect on ankle movement discrimination scores. The results also confirmed that there were significant differences in surf experience, anthropometric characteristics, physical capacity, and jumping ability between male and female surfers. As surf experience and physical capacity were only able to explain a small magnitude of ankle movement discrimination scores, it is suggested that ankle proprioception in surfers may be related to both the volume and quality of the motor experience attained, which may be augmented by environmental and sociocultural factors.

Ankle Inversion Proprioception Impairment in Persons with Chronic Ankle Instability Is Task-Specific

While investigators have often compared ankle proprioception between groups with and without chronic ankle instability (CAI), findings have been inconsistent. Possibly this is because ankle proprioceptive impairment in this population is task-specific. Thus, we aimed to compare ankle inversion proprioception in individuals with and without CAI in two task conditions: (i) when standing (not challenging) and (ii) when on a step-down landing (minimally-challenging). Ankle inversion proprioception was measured in both conditions for 38 recreational sport player volunteers with CAI (n = 19) and without CAI (n = 19). We used the Active Movement Extent Discrimination Apparatus (AMEDA) for the standing condition and the Ankle Inversion Discrimination Apparatus-Landing (AIDAL) for step-down landing. From analysis of variance (ANOVA) tests, CAI and non-CAI participants performed equally well on the AMEDA when standing; but the CAI group performed significantly worse than the non-CAI group on the AIDAL step-down landing task (p = 0.03). Within the non-CAI group, the AIDAL proprioceptive scores, as area under the receiver operating characteristics curve (AUC), were significantly higher than their AMEDA AUC scores (p = 0.03), while there was no significant difference between AIDAL and AMEDA AUC scores in the CAI group. Cumberland Ankle Instability Tool CAIT scores were significantly correlated with AIDAL scores (Spearman's rho = 0.391, p = 0.015), but not with the AMEDA scores; and there was no significant correlation between the AIDAL and AMEDA scores. Thus, an ankle inversion proprioceptive deficit was evident for persons with CAI on the step-down AIDAL, and in a dose-response way, but not evident on the standing AMEDA, suggesting that ankle proprioceptive impairment is task-specific. Selected proprioceptive tests must present some minimal degree of challenge to the ankle joint in a functional task in order to differentiate CAI from non-CAI participants.

A Reliability of Active and Passive Knee Joint Position Sense Assessment Using the Luna EMG Rehabilitation Robot

Joint position sense (JPS) is the awareness of joint location in space, indicating accuracy and precision of the movement. Therefore, the aim of the present study is to determine the reliability of active and passive JPS assessment regarding the knee joint. This was carried out using the Luna EMG rehabilitation robot. Further analysis assessed whether the examination of only the dominant site is justified and if there are differences between sites. The study comprised 24 healthy male participants aged 24.13 ± 2.82 years, performing sports at a recreational level. Using the Luna EMG rehabilitation robot, JPS tests were performed for the right and left knees during flexion and extension in active and passive mode, in two separate sessions with a 1-week interval. Both knee flexion and extension in active and passive modes demonstrated high reliability (ICC = 0.866-0.982; SEM = 0.63-0.31). The mean JPS angle error did not differ significantly between the right and left lower limbs (p < 0.05); however, no between-limb correlation was noted (r = 0.21-0.34; p > 0.05). The Bland-Altman plots showed that the between-limb bias was minimal, with relatively wide limits of agreement. Therefore, it was concluded that the Luna EMG rehabilitation robot is a reliable tool for active and passive knee JPS assessment. In our study, JPS angle error did not differ significantly between left and right sides; however, the slight asymmetry was observed (visible in broad level of agreement exceeding 5° in Bland-Altman plots), what may suggest that in healthy subjects, e.g., active athletes, proprioception should always be assessed on both sides.

The impact of unexpected platform perturbation on ankle proprioception ability in static and dynamic starting positions

AIMS

To examine the relationship between ankle proprioception and the ability to maintain balance with increased magnitudes of unexpected perturbations; and to compare the participants' ability to maintain balance following perturbations when starting from static and dynamic positions.

METHODS

Sixty physical education students (average 24.6 years) were tested for proprioception ability (AUC scores) and balance challenges presented on a perturbation treadmill. The degree at which participants lost postural balance was recorded in seven starting positions: standing-eyes-open (SO), standing-eyes-closed (SC), tandem-dominant (TD), tandem non-dominant, (TND) single-leg lateral side perturbation (SLP), single-leg medial side perturbation (SMP), and walking. Perturbation scores were analysed divided by tertiles. Multidimensional Unfolding SPSS Statistics 25 (PREFSCAL) was used to examine the relationships between data sets.

RESULTS

AUC scores of both dominant and non-dominant legs were significantly correlated with SO (r = 0.316; r = 0.445), SC (r = 0.364; r = 0.413), TD (r = 0.346; r = 0.308), and walking (r = 0.265; r = 0.439), respectively. In the dominant-leg, AUC scores of individuals with below-median SO scores were significantly worse compared to those with median SO scores (p = .046). In the non-dominant leg, individuals with above-median SC had significantly better AUC scores compared to those with lower-than-median SC (p = .008). Those with median and above-median SO and walking achieved better AUC scores than those with below-median (SO: p = .049, p = .004; walking: p = .016, p < .001, respectively). In dimension I, the SLP and SMP were located opposite one another; in dimension II, the TD and TND were located at the upper side, whereas SC, SO and walking were at the lowest side.

CONCLUSIONS

AUC scores were significantly correlated with the level at which postural balance was lost, whereby the better the proprioception ability, the better the ability to maintain balance. As such, the ability to maintain balance is harder in tandem positions than in standing and walking positions. This ability differed when perturbations were to the lateral or medial sides.

Biosignal processing methods to explore the effects of side-dominance on patterns of bi- and unilateral standing stability in healthy young adults

We examined the effects of side-dominance on the laterality of standing stability using ground reaction force, motion capture (MoCap), and EMG data in healthy young adults. We recruited participants with strong right (n = 15) and left (n = 9) hand and leg dominance (side-dominance). They stood on one or two legs on a pair of synchronized force platforms for 50 s with 60 s rest between three randomized stance trials. In addition to 23 CoP-related variables, we also computed six MoCap variables representing each lower-limb joint motion time series. Moreover, 39 time- and frequency-domain features of EMG data from five muscles in three muscle groups were analyzed. Data from the multitude of biosignals converged and revealed concordant patterns: no differences occurred between left- and right-side dominant participants in kinetic, kinematic, or EMG outcomes during bipedal stance. Regarding single leg stance, larger knee but lower ankle joint kinematic values appeared in left vs right-sided participants during non-dominant stance. Left-vs right-sided participants also had lower medial gastrocnemius EMG activation during non-dominant stance. While right-side dominant participants always produced larger values for kinematic data of ankle joint and medial gastrocnemius EMG activation during non-dominant vs dominant unilateral stance, this pattern was the opposite for left-sided participants, showing larger values when standing on their dominant vs non-dominant leg, i.e., participants had a more stable balance when standing on their right leg. Our results suggest that side-dominance affects biomechanical and neuromuscular control strategies during unilateral standing.

Assessing bilateral ankle proprioceptive acuity in stroke survivors: An exploratory study

Background

Bilateral proprioception deficits were reported in stroke survivors. However, whether bilateral proprioception deficits exist in the ankle joint after stroke was unclear. Ankle proprioception is a significant predictor of balance dysfunction after stroke, and previous studies to date are lacking appropriate evaluation methods.

Objectives

We want to determine whether the active movement extent discrimination apparatus (AMEDA) is a reliable tool for assessing ankle proprioceptive acuity in stroke survivors and the presence of deficits in ankle proprioception on the affected and unaffected sides in patients after stroke.

Methods

Bilateral ankle proprioception was assessed in 20 stroke patients and 20 age-matched healthy controls using AMEDA. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC).

Results

The ICC in the affected and unaffected sides was 0.713 and 0.74, respectively. Analysis of variance revealed significant deficits in ankle proprioception in subacute stroke survivors vs. healthy controls (F = 2.719, p = 0.045). However, there were no significant differences in proprioception acuity scores between the affected and unaffected sides in patients after stroke (F = 1.14, p = 0.331).

Conclusions

Stroke survivors had bilateral deficits in ankle proprioceptive acuity during active movements compared with age-matched healthy controls, underscoring the need to evaluate these deficits on both sides of the body and develop effective sensorimotor rehabilitation methods for this patient population. The AMEDA can reliably determine bilateral ankle proprioceptive acuity in stroke survivors.

Joint Specificity and Lateralization of Upper Limb Proprioceptive Perception

Proprioception is the sense of position and movement of body segments. The widespread distribution of proprioceptors in human anatomy raises questions about proprioceptive uniformity across different body parts. For the upper limbs, previous research, using mostly active and/or contralateral matching tasks, has suggested better proprioception of the non-preferred arm, and at the elbow rather than the wrist. Here we assessed proprioceptive perception through an ipsilateral passive matching task by comparing the elbow and wrist joints of the preferred and non-preferred arms. We hypothesized that upper limb proprioception would be better at the elbow of the non-preferred arm. We found signed errors to be less variable at the non-preferred elbow than at the preferred elbow and both wrists. Signed errors at the elbow were also more stable than at the wrist. Across individuals, signed errors at the preferred and non-preferred elbows were correlated. Also, variable signed errors at the preferred wrist, non-preferred wrist, and preferred elbow were correlated. These correlations suggest that an individual with relatively consistent matching errors at one joint may have relatively consistent matching errors at another joint. Our findings also support the view that proprioceptive perception varies across upper limb joints, meaning that a single joint assessment is insufficient to provide a general assessment of an individual's proprioception.

Can therapeutic exercises improve proprioception in chronic ankle instability? a systematic review and network meta-analysis

OBJECTIVE

To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI).

DATA SOURCES

Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021.

STUDY SELECTION

Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included.

DATA EXTRACTION

Data were extracted by two independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the PEDro scale.

DATA SYNTHESIS

The end-trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense (JPS) in multiple directions was evaluated.

RESULTS

Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the Network Meta-Analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking (SUCRA)=74.6%). The next two were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels, and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively.

CONCLUSIONS

Foot and ankle muscle strengthening exercise may have a good effect when used to improve JPS in individuals with CAI. Probably, the more complex balance exercise intervention becomes, the less effective the proprioceptive outcome.

PROSPERO REGISTRATION NUMBER

CRD42021240331.

Sex differences in the association of postural control with indirect measures of body representations

Besides anthropometric variables, high-order body representations have been hypothesised to influence postural control. However, this has not been directly tested before. Moreover, some studies indicate that sex moderates the relationship of anthropometry and postural control. Therefore, as a proof of concept we investigated the association of body representations with postural control as well as the influence of participants’ sex/gender. Body image measures were assessed with a figural drawing task. Body schema was tested by a covert and an overt task. Body sway was measured during normal bipedal quiet standing with eyes closed (with/without neck extended). Statistical analysis consisted of hierarchical multiple linear regressions with the following regression steps: (1) sensory condition, (2) sex/gender, (3) age, (4) anthropometry, (5) body schema, (6) body image, (7) sex/gender-interactions. Across 36 subjects (19 females), body schema was significantly associated with body sway variability and open-loop control, in addition to commonly known influencing factors, such as sensory condition, gender, age and anthropometry. While in females, also body image dissatisfaction substantially was associated with postural control, this was not the case in males. Sex differences and possible causes why high-order body representations may influence concurrent sensorimotor control of body sway are discussed.

Assessing Proprioception in an Older Population: Reliability of a Protocol Based on Active Movement Extent Discrimination

Proprioceptive ability - the sense of where body parts are located in space - is one of many factors thought to affect falls risk among the elderly. Active movement extent discrimination is an approach to measuring proprioception that is administered in an ecologically valid testing environment to better reflect the exercise of proprioceptive skills in daily life. The Active Movement Extent Discrimination Apparatus (AMEDA) was developed to objectively measure this proprioceptive discrimination. However, the current absolute identification testing protocol is cognitively demanding, and it yields results that are insufficiently reliable to assess performance at the individual level. The objectives of this pilot study were to test the reliability and feasibility of a proposed new AMEDA testing protocol and to explore how performance related to cognitive ability and any perceived dysfunction in the foot or ankle. We tested 42 participants (aged 19 - 94 years) three times on the ankle AMEDA using a newly developed protocol that asked participants to report whether a given angle of ankle inversion was shallower or deeper than the immediately preceding inversion. Participants also completed the Stroop test, as a measure of cognitive ability, and two validated questionnaires for identifying foot or ankle dysfunction (the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure). The proportion of correct responses for the AMEDA test showed the expected sigmoid shape of the psychometric function as signal strength increased. The intraclass correlation coefficient measured over the three tests was 0.65 (95% confidence interval: 0.49 - 0.78), suggesting moderate reliability. We found a positive and statistically significant correlation between AMEDA performance and Stroop results but no relationship between the AMEDA score and questionnaire-measured foot or ankle dysfunction. This study confirmed that the alternative testing protocol was simple to administer and easily understood by participants.

Self-reported chronic ankle instability effects on the development of fitness during an Infantry Commanders Course

OBJECTIVES

To determine whether self-reported chronic ankle instability (CAI) affects the physical performance of soldiers during army training, in routine army fitness tests and other sensorimotor tests.

DESIGN

Prospective cohort comparison.

METHODS

Soldiers enrolled on the Infantry Commanders Course (ICCourse) of the Israeli Defense Force were tested in weeks one and fourteen of the course, including a 3000 m timed run, an agility test over an X-shaped course, the Y Balance Test (YBT) and the Active Movement Extent Discrimination Assessment (AMEDA) somatosensory test. Soldiers were trained using routine ICCourse physical training throughout the course. Changes in physical performance were analysed using a two-way ANOVA, for soldier groups categorised as having healthy ankles or CAI.

RESULTS

Soldiers improved their scores on all 4 tests (3000 m run, X-agility test, YBT and AMEDA) during the course. However, soldiers with CAI did not improve on the X-agility test, whilst those with healthy ankles did. Soldiers with CAI performed worse on the YBT-PM (postero-medial direction) at the start of the course, but this difference was no longer present at 14 weeks. Soldiers with CAI performed better on the AMEDA at the start and 14-week testing points.

CONCLUSIONS

Self-reported CAI restricts agility performance gains in soldiers during 14-weeks of physical training but has no effect on 3000 m running performance. Soldiers with CAI perform worse in YBT balance tests. Soldiers with CAI have better proprioceptive acuity than those with stable ankles. These findings indicate possible sensorimotor factors for training of soldiers with known CAI.

The effect of neck muscle fatigue on shoulder humeral rotation joint position sense

INTRODUCTION

Cervical extensor muscle (CEM) fatigue causes decrements in upper limb proprioceptive accuracy during constrained single-joint tasks. This study used a novel humeral rotation joint position sense (JPS) measurement device to compare JPS accuracy in participants who received acute CEM fatigue vs. non-fatigued controls.

METHODS

Participants had vision occluded and were passively guided into postures of internal humeral rotation from a baseline posture before and after a CEM fatigue or control protocol. Mixed model repeated measures ANOVAs were used to verify fatigue and compared absolute, constant, and variable JPS error between groups.

RESULTS

CEM fatigue was verified via pre-post reduction in CEM strength, and myoelectric indicators of fatigue. However, between-group comparisons of absolute, constant, and variable JPS error were not statistically significant, despite having large effect sizes.

DISCUSSION

Contrary to prevailing literature, unconstrained humeral rotation JPS did not appear to be affected by CEM fatigue in this study. However, between-group differences in JPS error were dwarfed by inter-trial variability, which likely arose due to the unconstrained nature of this task, conflating chances for a Type II error. Future research should perform a kinematic analysis of task constraints to highlight potential compensatory mechanisms obscuring significant findings in this otherwise robust effect.

Wrist Position Sense in Two Dimensions: Between-Hand Symmetry and Anisotropic Accuracy Across the Space

A deep investigation of proprioceptive processes is necessary to understand the relationship between sensory afferent inputs and motor outcomes. In this work, we investigate whether and how perception of wrist position is influenced by the direction along which the movement occurs. Most previous studies have tested Joint Position Sense (JPS) through 1 degree of freedom (DoF) wrist movements, such as flexion/extension (FE) or radial/ulnar deviation (RUD). However, the wrist joint has 3-DoF and many activities of daily living produce combined movements, requiring at least 2-DoF wrist coordination. For this reason, in this study, target positions involved movement directions that combined wrist flexion or extension with radial or ulnar deviation. The chosen task was a robot-aided Joint Position Matching (JPM), in which blindfolded participants actively reproduced a previously passively assumed target joint configuration. The JPM performance of 20 healthy participants was quantified through measures of accuracy and precision, in terms of both perceived target direction and distance along each direction of movement. Twelve different directions of movement were selected and both hands tested. The left and right hand led to comparable results, both target extents and directions were differently perceived according to the target direction on the FE/RUD space. Moreover, during 2-DoF combined movements, subjects' perception of directions was impaired when compared to 1-DoF target movements. In summary, our results showed that human perception of wrist position on the FE/RUD space is symmetric between hands but not isotropic among movement directions.

Ankle inversion proprioception measured during landing in individuals with and without chronic ankle instability

BACKGROUND

Research evidence has suggested that a more sensitive ankle proprioceptive testing method with higher ecological validity is needed for assessing proprioceptive deficits in individuals with chronic ankle instability (CAI).

OBJECTIVES

(1) To determine the test-retest reliability of a novel ankle proprioception assessment tool, the Ankle Inversion Discrimination Apparatus for Landing (AIDAL); (2) To assess whether AIDAL scores were sufficiently sensitive to detect proprioceptive deficits in chronic ankle instability (CAI); and (3) To examine whether AIDAL scores correlated with Cumberland Ankle Instability Tool (CAIT) scores.

DESIGN

Cross-sectional study.

METHODS

The AIDAL was purpose-built to assess ankle discrimination in four positions of ankle inversion (10°, 12°, 14° and 16°) upon landing from a 10cm drop. Area Under the Receiver Operating Curve (AUC) was employed as the ankle proprioceptive discrimination score. Seven-day test-retest reliability was evaluated with 23 university students (12 CAI and 11 non-CAI), and another 36 university students (18 CAI and 18 non-CAI) were in the comparison study.

RESULTS

The test-retest reliability ICC score for the whole group was 0.763 (95% CI=0.519-0.892), which showed an excellent reliability level. ICC _(3,1) was 0.701 for the non-CAI group (95%CI=0.210-0.910) and 0.804 for the CAI group (95%CI=0.451-0.939). The CAI group performed at a significantly lower level on the AIDAL assessment than the non-CAI group (0.777±0.05 vs. 0.815±0.05, F=5.107, p=0.03). The discriminative AUC value for the AIDAL test was 0.756 with a cut point of 0.819 (sensitivity=0.733, specificity=0.800). The MDC₉₀ scores for CAI and non-CAI groups were both 0.04. Spearman's correlation showed that the CAIT scores were significantly correlated with the ankle proprioceptive discrimination scores (rho=0.401, p=0.015).

CONCLUSION

The AIDAL showed good test-retest reliability for both non-CAI and CAI groups. Measuring ankle inversion proprioception during landing may be important for assessing the outcomes of CAI rehabilitation, as proprioceptive performance obtained from the AIDAL was significantly correlated with severity of functional ankle instability CAIT scores.

Proprioceptive accuracy after uni-joint and multi-joint patterns of arm-raising movements directed to overhead targets

AIM

To determine the effect of arm-raising pattern on upper limb proprioceptive accuracy for movements made to overhead targets.

MATERIALS AND METHODS

Sixteen healthy young adults were tested in standing with arms at the sides, made dominant arm-raising movements to an unseen overhead stop, randomly placed at one of five different overhead targets. Movements were made either as a uni-joint shoulder flexion movement in an arc, or as an unconstrained arm raising that was a series of multi-joint movements involving the shoulder, elbow, and wrist.

RESULTS

Overall proprioceptive accuracy for discrimination between the five unseen overhead targets was not different after arm-raising with either a uni-joint or mult-joint pattern (F_{1, 15} = 0.50, p = 0.49, partial η² = 0.03). Better performers with one pattern also tended to perform well with the other (r = 0.70, p = 0.003). Trend analysis across the 4 pairwise scores for discriminations between the target positions (171.8°-173.6°, 173.6°-175.4°, 175.4°-177.2°, and 177.2°-179.0°) showed worsening discrimination towards the more distant targets (F_{1, 15} = 8.44, p = 0.01, partial η² = 0.36). However, this linear trend of falling discrimination accuracy was not different between the two movement patterns (p = 0.27).

CONCLUSION

Proprioceptive accuracy did not differ between simple uni-joint and more complex multi-joint arm-raising movement patterns, and the further the extent of the overhead target movement, the worse proprioceptive discrimination sensitivity for both movement patterns. Upper limb proprioceptive accuracy was therefore movement extent dependent, but movement pattern independent.

The Relationship Between Ankle Proprioception and Functional Mobility in People With Parkinson's Disease: A Cross-Sectional Study

Previous research has found ankle proprioception to be impaired in people with Parkinson's disease (PD). However, the relationship between ankle proprioception and functional mobility in people with PD has not been fully investigated. The purpose of this study was to examine whether ankle proprioception is related to the functional mobility of people with PD. Forty-two participants with mild to moderate PD volunteered. Ankle proprioceptive acuity was measured in standing, by using active movement extent discrimination assessment (AMEDA). Functional mobility measures included the timed-up-and-go test (TUG), 30 s sit-to-stand test (30s-STS) and 10-meter walking test (10MWT). Step length and step cadence were recorded during the 10MWT. No significant correlation was found between ankle proprioceptive discrimination scores and any mobility performance measure in people with PD (−0.20<r<0.04, all p > 0.05). However, ankle proprioception scores were significantly correlated with step length (r = 0.38, p < 0.05) and step cadence (r = −0.30, p < 0.05), and were significantly and negatively correlated with the stage of modified Hoehn and Yahr (rho = −0.53, p < 0.01). The lack of relationship between ankle proprioceptive acuity and functional mobility in PD suggests that people with PD may be more limited by reduced sensorimotor integration or may rely more on other sensory input, rather than ankle proprioception, to achieve functional mobility, a finding consistent with sensory reweighting theory. In addition, poorer ankle proprioceptive acuity was associated with decreased step length and increased step cadence, suggesting that the shuffling gait observed in PD may be related to impaired ankle proprioception, which has important clinical implications for gait retraining in people with PD. Given that ankle proprioception was significantly and negatively correlated with the stage of modified Hoehn and Yahr, it may warrant being used as an objective biomarker to monitor the progression of PD.

Cardiac and Proprioceptive Accuracy Are Not Related to Body Awareness, Perceived Body Competence, and Affect

Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs (visceroception) and the motor system (proprioception). Dimensions of interoception include (1) interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, (2) confidence rating with respect to perceived performance in an actual behavioral test, and (3) interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with affect are scarcely studied. In the present study, undergraduate students (N = 105, 53 males, age: 21.0 ± 1.87 years) filled out questionnaires assessing positive and negative affect (Positive and Negative Affect Schedule), interoceptive sensibility (Body Awareness Questionnaire), and body competence (Body Competence Scale of the Body Consciousness Questionnaire). Following this, they completed a behavioral task assessing cardioceptive accuracy (the mental heartbeat tracking task by Schandry) and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles (weight discrimination task) and the angular position of the elbow joint (joint position reproduction task). Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states (PANAS) are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities.

Ankle proprioception, range of motion and drop landing ability differentiates competitive and non-competitive surfers

OBJECTIVES

To determine whether ankle proprioception differs by competitive level and is related to years of surf-specific experience. A secondary objective of this study is to further compare the physical capacities and abilities that may differentiate between the competitive levels of surfing.

DESIGN

Cross-sectional.

METHODS

Twelve junior-elite (currently competing at a state level or higher and 12-18 years of age), twelve senior-elite (currently competing at a national level and/or the World Qualifying Series and over 16 years of age), and twelve recreational surfers (minimum of two years surfing experience; actively surfing at least once a week and over 18 years of age) were recruited for this study. All participants completed a pre-exercise medical questionnaire, anthropometric assessment, ankle dorsiflexion range of motion assessment, medial-lateral ankle proprioception assessment, countermovement jump, squat jump, isometric mid-thigh pull and drop-and-stick.

RESULTS

Senior-elite surfers had large and significantly better ankle proprioception and range of motion than junior-elite and recreational surfers. However, the relationship between years of surf-specific experience and ankle proprioception was small and non-significant. Better drop-and-stick performance, indicated by lower relative peak force, was present in the senior-elite compared to the junior-elite and recreational groups.

CONCLUSIONS

The results indicate that medial-lateral ankle proprioception is a distinguishing characteristic of senior-elite surfers and therefore, may be a critical ability for competitive success. Greater ankle range of motion and the ability to attenuate energy to reduce landing force may be developed through long-term training commensurate with competitive surfing.

Vibration of calf muscles has reverse effects on right and left ankle proprioception in high and low proprioceptive performer groups

PURPOSE

Previous research has found hemispheric asymmetries in the utilization of proprioceptive information. It is undetermined, however, if there is any change in asymmetry in proprioceptive function when external stimulation, such as vibration, is presented. The present study was to investigate the immediate effects of vibration stimulation (VS) on bilateral ankle proprioception.

MATERIALS AND METHODS

Forty-six recreational male basketball players were included. Proprioception was assessed by using the active movement extent discrimination apparatus (AMEDA) in standing, and vibration was provided by using a vibrating form roller on the peroneal or gastrocnemius muscles.

RESULTS

When participants were divided into high score and low score groups, according to the median of the baseline proprioceptive performance, VS (irrespective of whether vibrating the peroneal or gastrocnemius muscles) significantly improved left non-dominant ankle proprioception in the low proprioceptive performer group (p = 0.019), while significantly deteriorated right dominant ankle proprioception in the high proprioceptive performer group (p = 0.011).

CONCLUSIONS

The results found that external stimuli reversely affect proprioception in better and worse performing groups. This suggests that there are differences in the processing of external stimulus signals on different bilateral hemispheres and in different groups (high score vs low score groups), which may be related to hemispheric asymmetry and stochastic resonance. Therefore, it is necessary to explore more specific interventions in the future.

Proprioception but not cardiac interoception is related to the rubber hand illusion

The rubber hand illusion (RHI) is a widely used tool in the study of multisensory integration. It develops as the interaction of temporally consistent visual and tactile input, which can overwrite proprioceptive information. Theoretically, the accuracy of proprioception may influence the proneness to the RHI but this has received little research attention to date. Concerning the role of cardioceptive information, the available empirical evidence is equivocal. The current study aimed to test the impact of proprioceptive and cardioceptive input on the RHI. 60 undergraduate students (32 females) completed sensory tasks assessing proprioceptive accuracy with respect to the angle of the elbow joint, a heartbeat tracking task assessing cardioceptive accuracy (the Schandry-task) and the RHI. We found that those with more consistent joint position judgements (i.e., less variable error) in the proprioceptive task were less prone to the illusion, particularly with respect to disembodiment ratings in the asynchronous condition. Systematic error, indicating a systematic distortion in position judgements influenced the illusion in the synchronous condition. Participants with more proprioceptive bias toward the direction of the rubber hand in the proprioceptive test reported a stronger felt embodiment. The results are in accordance with Bayesian causal inference models of multisensory integration. Cardioceptive accuracy, however, was not associated with the strength of the illusion. We concluded that individual differences in proprioceptive processing impact the RHI, while cardioceptive accuracy is unrelated to it. Theoretical and practical relevance of the findings are discussed.

A novel approach to measuring wobble board performance in individuals with chronic ankle instability

Computerized wobble boards (WB) are used to objectively assess balance in healthy and chronic ankle instability individuals. As in field setting health professionals might not own WB, objective evaluations are not always feasible. Therefore, the aim of this tudy was to investigate the contribution of sagittal plane joints angular-displacement and anthropometrics to predict equations to estimate WB performance by portable two-dimensional motion analysis (2D-MA) and cross-validate the developed equations in chronic ankle instability individuals. Thirty-nine healthy and twenty chronic ankle instability individuals stood on a WB in single stance position. The balance test consisted of three 30s trials per limb keeping the platform flat at 0°. Trials were video recorded, and three time-segments joints angular-displacement analyzed with 2D-MA: segment 1 (T1) including 30s data, segment 2 (T2) from second 0 to 10, segment 3 (T3) only the first 5s. Mixed regression for multilevel models was used to estimate WB performance for each time-segment and to examine limb differences for the predicted WB performance in chronic ankle instability sample. The accuracy of the equations to detect injured limbs was calculated via area under the curve for receiver operating characteristic. Ankle and knee angular-displacement parameters, body height and lower limb length were the major predictors of WB performance for the extrapolated models (p < 0.05; R² = 0.83-0.56). The measured WB performance and T1 model showed significant (p < 0.05) performance differences between the injured and uninjured limbs. Receiver operating characteristic analysis showed an asymptotic significance of 0.03 for T1 equation with area under the curve of 0.70. The proposed models provide different methods to quantify the performance and accurately detect the injured limb in individuals with unilateral chronic ankle instability, when measuring balance via WB might not be feasible. App-makers may use the equations to provide an automatic all-in-one system to monitor the performance status and progress.

Effects of calf muscle conditioning upon ankle proprioception

Ankle proprioception is crucial for balance and relies upon accurate input from calf muscle spindles. Spindle input, in turn, depends upon the physiological and mechanical properties of surrounding muscle tissue. Altering these properties could affect ankle proprioception, with potential consequences for balance. Here we determine the effects of prior muscle cooling, stretch and contraction upon performance of a contralateral ankle joint matching task. Participants stood passively leaning against a board oriented 22° rearward from vertical. Their right ankle was rotated to a randomised position between ± 6° plantar/dorsiflexion. The task was to align the left ankle to the same position, without vision. In the first experiment, immediately prior to each testing session, participants either produced a strong calf muscle contraction in a fully plantarflexed (tiptoe) posture or underwent 15° dorsiflexion stretch. Contraction had no effect on task performance, whereas stretch produced a significant bias in ankle placement of 0.89 ± 0.6°, indicating that participants perceived their foot to be more plantarflexed compared to a control condition. In the second experiment, the right lower leg was cooled in iced water (≤ 5°C) for 10 minutes. Cooling increased joint matching error by ~0.4°, through a combination of increased bias and variability. These results confirm that conditioning the triceps surae muscles can alter perception of ankle joint position. Since body movement during quiet stance is in the order of 1°, the magnitude of these changes are relevant for balance.

Control Methods for Transradial Prostheses Based on Remnant Muscle Activity and Its Relationship with Proprioceptive Feedback

The loss of a hand can significantly affect one's work and social life. For many patients, an artificial limb can improve their mobility and ability to manage everyday activities, as well as provide the means to remain independent. This paper provides an extensive review of available biosensing methods to implement the control system for transradial prostheses based on the measured activity in remnant muscles. Covered techniques include electromyography, magnetomyography, electrical impedance tomography, capacitance sensing, near-infrared spectroscopy, sonomyography, optical myography, force myography, phonomyography, myokinetic control, and modern approaches to cineplasty. The paper also covers combinations of these approaches, which, in many cases, achieve better accuracy while mitigating the weaknesses of individual methods. The work is focused on the practical applicability of the approaches, and analyses present challenges associated with each technique along with their relationship with proprioceptive feedback, which is an important factor for intuitive control over the prosthetic device, especially for high dexterity prosthetic hands.

No need to touch this: Bimanual haptic slant adaptation does not require touch

In our daily life, we often interact with objects using both hands raising the question the question to what extent information between the hands is shared. It has, for instance, been shown that curvature adaptation aftereffects can transfer from the adapted hand to the non-adapted hand. However, this transfer only occurred for dynamic exploration, e.g. by moving a single finger over a surface, but not for static exploration when keeping static contact with the surface and combining the information from different parts of the hand. This raises the question to what extent adaptation to object shape is shared between the hands when both hands are used in static fashion simultaneously and the object shape estimates require information from both hands. Here we addressed this question in three experiments using a slant adaptation paradigm. In Experiment 1 we investigated whether an aftereffect of static bimanual adaptation occurs at all and whether it transfers to conditions in which one hand was moving. In Experiment 2 participants adapted either to a felt slanted surface or simply be holding their hands in mid-air at similar positions, to investigate to what extent the effects of static bimanual adaptation are posture-based rather than object based. Experiment 3 further explored the idea that bimanual adaptation is largely posture based. We found that bimanual adaptation using static touch did lead to aftereffects when using the same static exploration mode for testing. However, the aftereffect did not transfer to any exploration mode that included a dynamic component. Moreover, we found similar aftereffects both with and without a haptic surface. Thus, we conclude that static bimanual adaptation is of proprioceptive nature and does not occur at the level at which the object is represented.

Ipsilateral vs Contralateral Presentation of Familiarization Trials in a Lower-Limb Proprioception Test

We examined the effect of pretest familiarization with ipsilateral or contralateral limbs on the performance in a proprioception test conducted afterwards. Sixty adults were randomly assigned to six different familiarization-session patterns. Ankle proprioception was tested using active movement extent discrimination assessment. The results reflected a beneficial effect of familiarization session on performance in the subsequent proprioception test (ES = 0.777). However, no significant difference was found between proprioceptive acuity scores when familiarization and test happened with either ipsilateral or contralateral limbs (ES= 0.361), or between the tested left and right foot no matter which side was familiarized (ES = 0.343). These results suggest that proprioceptive information from the familiarization session facilitates the subsequent proprioception test and is equally available to both hemispheres without loss of quality.

The Effect of Acute Body Unloading on Somatosensory Performance, Motor Activation, and Visuomotor Tasks

Evaluating countermeasures designed to reduce the impact of microgravity exposure on astronaut performance requires the development of effective methods of assessing changes to sensorimotor function in 1g analog systems. In this study, somatosensation at the ankle and fingers, lower leg muscle activity and visuomotor control were assessed using a full body loading and acute unloading model to simulate microgravity. It was hypothesized that the function of the hands and eyes are not constrained to 'weight bearing' postures for optimal function and would not differ between the loaded and acute unloaded conditions, whereas lower leg muscle activity and ankle somatosensation would be reduced in the acute unloaded condition. Somatosensation was recorded using the Active Movement Extent Discrimination Apparatus (AMEDA) protocol where participants were required to make an absolute judgment of joint position sense. A score closer to 1.0 demonstrates higher accuracy. Lower leg muscle activity was recorded using electromyography of major lower leg musculature to observe peak muscle activity and duration of contraction. The King Devick infrared eye tracking test was used to asses visuomotor control by monitoring saccade velocity and fixation time. In acute unloading, it was found that ankle somatosensation had decreased accuracy (loaded 0.68, unloaded 0.66, p = 0.045) while finger somatosensation improved (loaded 0.77, unloaded 0.79, p = 0.006). When acutely unloaded, peak lower leg muscle activation reduced ( > 27%) and total contraction time increased (2.02 × longer) compared to loading. Visuomotor assessment results did not vary between the loaded and acute unloaded postures, however the underlying techniques used by the participant to complete the task (saccade velocity and fixations time) did increase in acute unloaded conditions.

Significance

This research provides an insight to how to the human body responds immediately to acute changes of gravitational load direction. It provides insight to the acute affects' astronauts may encounter when in microgravity.

Unilateral and bilateral patellofemoral pain in young female dancers: Associated factors

Aiming to evaluate the prevalence of unilateral/bilateral patellofemoral pain (PFP) among young dancers, and to investigate whether different factors are associated with PFP in young dancers, 132 dancers aged 12-14 years were assessed for PFP. Anthropometric parameters, proprioception ability, dynamic postural balance (DPB), and muscle strength were measured. PFP was found in 64.1% of the dancers. No significant differences in the prevalence of dancers with no, unilateral, or bilateral PFP at different ages were found. Significant age effects were found for anthropometric and developmental measurements, and for intensity of training. PFP effect was found for DPB asymmetry, ankle proprioception, and leg-length %height. A higher hip abductor/adductor ratio was associated with PFP in 14-year-old dancers. Binomial logistic regression showed that increased number of hours per day (h/day) and decreased number of hours per week (h/week), low proprioception scores, greater leg length as %height, and more anterior DPB asymmetry were significant predictors of PFP. In conclusion: unilateral/bilateral PFP is common among young dancers. Body morphology, reduced ankle proprioception ability, DPB asymmetry, and increased h/day of practice are associated with PFP. Dance teachers should start monitoring the impact of training and implement injury modification/prevention strategies when their students are at a young age.

Effects of Textured Balance Board Training in Adolescent Ballet Dancers With Ankle Pathology

CONTEXT

Ankle sprains are common among adolescent ballet dancers and may be attributed to inadequate ankle proprioception. Thus, a short period of training utilizing proprioceptive activities requires evaluation.

OBJECTIVE

To assess training conducted for 3 or 6 weeks on a textured-surface balance board using ankle proprioception scores for ballet dancers with and without chronic ankle instability, and with and without previous ankle sprain (PAS).

DESIGN

Intervention study.

SETTING

The Australian Ballet School.

PARTICIPANTS

Forty-two ballet dancers, aged 14-18 years.

INTERVENTIONS

Dancers randomized into 2 groups: group 1 undertook 1 minute of balance board training daily for 3 weeks; group 2 undertook the same training for 6 weeks.

MAIN OUTCOME MEASURES

Preintervention, Cumberland Ankle Instability Tool questionnaire data were collected, and PAS during the last 2 years was reported. Active ankle inversion movement discrimination ability was tested immediately pre and post intervention and at 3 and 4 weeks.

RESULTS

Ankle discrimination acuity scores improved over time for both groups, with a performance decline associated with the early cessation of training for group 1 (P = .04). While dancers with PAS had significantly worse scores at the first test, before balance board training began (P < .01), no significant differences in scores at any test occasion were found between dancers with and without chronic ankle instability. A significantly faster rate of improvement in ankle discrimination ability score over the 4 test occasions was found for dancers with PAS (P = .002).

CONCLUSIONS

Three weeks of textured balance board training improved the ankle discrimination ability of ballet dancers regardless of their reported level of chronic ankle instability and at a faster rate for dancers with PAS. Previous ankle sprain was associated with a lower level of ankle discrimination ability; however, following 3 weeks of balance board training, previously injured dancers had significantly improved their ankle discrimination acuity scores.

Proprioceptive accuracy is not associated with self-reported body awareness, body competence, and affect

PURPOSE

Proprioception plays an essential role in motor control and in psychological functioning: it is the basis of body schema and the feeling of body ownership. There are individual differences in the processing accuracy of proprioceptive stimuli. Although proprioceptive acuity plays an important role in physical competence, there are contradictory findings concerning the role it plays in healthy psychological functioning. This study aims to shed more light on this association.

MATERIAL AND METHODS

Sixty-eight young adults participated in this study. We estimated proprioceptive acuity by the reposition accuracy of elbow joint positions. We tested both dominant and non-dominant hands with two different versions of Joint Position Reproduction Test. Perceived physical competence, body awareness, and affectivity were assessed using questionnaires (Physical Competence scale of Body Consciousness Questionnaire, Somatic Absorption Scale, and Positive and Negative Affectivity Schedule, respectively).

RESULTS

No significant association between proprioceptive acuity and body awareness, perceived body competence, and positive and negative affect was found.

CONCLUSION

Proprioceptive acuity, measured in the elbow joint, does not play a substantial role in body awareness, perceived body competence, and affect.

Age-specific modifications in healthy adults' knee joint position sense

Aim: Right-handed young adults perform target-matching tasks more accurately with the non-dominant (ND) compared to the dominant (D) limb, but it is unclear if age affects this disparity. We determined if age affects target-matching asymmetry in right-side dominant healthy adults. Method: Young (n = 12, age: 23.6 y, 6 females) and older (n = 12; age: 75.1 y, 7 females) adults performed a passive joint position-matching task with the D and ND leg in a randomized order. Result: Age affected absolute, constant, and variable knee JPS errors but, contrary to expectations, it did not affect target-matching asymmetries between the D and ND knees. However, older participants tended to underestimate while young subjects overestimated the target angles. Moreover, older as compared to young subjects performed the target-matching task with higher variability. Conclusion: Altogether, age seems to affect passive knee target-matching behaviour in right-side dominant healthy adults. The present data indicate that healthy aging produces age-specific modifications in passive joint position sense.

Can texture change joint position sense at the knee joint in those with poor joint position accuracy?

Purpose: Skin contributes to joint position sense (JPS) at multiple joints. Altered cutaneous input at the foot can modulate gait and balance and kinesiology tape can enhance proprioception at the knee, but its effect may be dependent on existing capacity. The effect of texture at the knee, particularly in those with poor proprioception, is unknown. The aim of this study was to determine the effect of textured panels on JPS about the knee. Materials and methods: Eighteen healthy females were seated in an adjustable chair. Their left leg (target limb) moved passively from 65° to a target of flexion (115° or 90°) or extension (40°). Their right leg (matching limb) was passively moved towards this target angle and participants indicated when their limbs felt aligned. We tested three textured panels over the knee of the matching limb and two control conditions. The target limb maintained a control panel. Directional error, absolute error and variable error in matching between limbs were calculated. Results: On average textured panels over the knee increased JPS error compared to control pants for participants with poor JPS. These participants undershot the target at 90° of flexion significantly more with textured panels (-11° ± 3°) versus control (-7° ± 3°, p = 0.04). Conclusions: For participants with poor JPS accuracy, increased JPS error at 90° with a textured panel suggests these individuals utilised altered cutaneous information to adjust joint position. We propose increased error results from enhanced skin input at the knee leading to the perception of increased flexion.