Comparing single and multi-joint methods to detect knee joint proprioception deficits post primary unilateral total knee arthroplasty

Surface electromyography-based biofeedback can facilitate recovery from total knee arthroplasty

Knee osteoarthritis is among the most prevalent chronic diseases. Total knee arthroplasty is a common solution that effectively addresses the continued structural degeneration of the articular cartilage. However, effective physical therapy is critical for recovery. Despite participating in physical therapy, many patients fail to recover. This study investigated the potential efficacy of a behaviorally informed approach to surface electromyographic biofeedback following total knee arthroplasty relative to the clinical standard, neuromuscular electrical stimulation. The surface electromyographic biofeedback procedure incorporated improved techniques for establishing a baseline and individualized and adjusting criteria for feedback. The findings suggest some advantages for surface electromyographic biofeedback over neuromuscular electrical stimulation in quadriceps strength, range of motion, functional recovery, and quality of life. Behaviorally informed surface electromyographic biofeedback holds promise for total knee arthroplasty recovery and these data suggest considerable room for collaboration between behavior analysts and physical therapists.

Dual-Task Interference Slows Down Proprioception

It is well-known that multitasking impairs the performance of one or both of the concomitant ongoing tasks. Previous studies have mainly focused on how a secondary task can compromise visual or auditory information processing. However, despite dual tasking being critical to motor performance, the effects of dual-task performance on proprioceptive information processing have not been studied yet. The purpose of the present study was, therefore, to investigate whether sensorimotor task performance would be affected by the dual task and if so, in which phase of the sensorimotor task performance would this negative effect occur. The kinematic variables of passive and active knee movements elicited by the leg drop test were analyzed. Thirteen young adults participated in the study. The dual task consisted of performing serial subtractions. The results showed that the dual task increased both the reaction time to counteract passive knee-joint movements in the leg drop test and the threshold to detect those movements. The dual task did not affect the speed and time during the active knee movement and the absolute angle error between the final and the target knee angles. Furthermore, the results showed that the time to complete the sensorimotor task was prolonged in dual tasking. Our findings suggest that dual tasking reduces motor performance due to slowing down proprioceptive information processing without affecting movement execution.

The effects of total knee arthroplasty on knee proprioception of patients with knee osteoarthritis: a meta-analysis

BACKGROUND

Studies have given some pieces of evidence for the effect of total knee arthroplasty (TKA) on knee proprioception of patients with knee osteoarthritis (KOA), but their results were conflicting. This review was performed to provide an updated evidence-based meta-analysis investigating the influence of TKA on knee proprioception.

METHODS

The electronic databases including PubMed, Google Scholar, and the Cochrane Library were accessed from their inception to March 2020. Two reviewers identified the studies that met the selection criteria for this review. Information on study type, participants, follow-up time, and outcome measures was extracted. Methodological quality was independently assessed by two reviewers using the Cochrane Handbook 5.1.0. Eleven studies with 475 participants were included in the meta-analysis.

RESULTS

The I² index assessed the heterogeneity between studies. The results showed that the pooled standard mean difference of mean angle of error was - 0.58° (95% CI - 1 to - 0.16; P = 0.007; I² = 69%), and the joint position sense of KOA patients was better after TKA surgery than that before surgery. Pooled standard mean difference of displacement of center of pressure (COP) was - 0.39 (95% CI - 0.72 to - 0.06; P = 0.02; I² = 51%), and KOA patients had better static balance after TKA surgery than before surgery.

CONCLUSIONS

To conclude, no standardized comprehensive evaluation protocol presently exists though different assessment tools are available to measure proprioception. Contrasting results were found in the literature since some studies found that TKA improves proprioception in KOA patients, while others found no difference in proprioception. These differences are seen whether the proprioception was assessed by joint position sense (JPS), or it was indirectly assessed by static balance. However, the lack of sufficient data on the threshold to detect passive movement (TTDPM) and dynamic balance made it difficult to draw a conclusion about whether or not the sense of motion improved after surgery. The method for measuring and evaluating knee joint force sense is worth paying attention, which will make progress with knee proprioception on TKA patients.

Proprioception: a new look at an old concept

Proprioception, which can be defined as the awareness of the mechanical and spatial state of the body and its musculoskeletal parts, is critical to motor actions and contributes to our sense of body ownership. To date, clinical proprioceptive tests have focused on a person's ability to detect, discriminate or match limb positions or movements, and reveal that the strength of the relationship between deficits in proprioception and physical function varies widely. Unfortunately, these tests fail to assess higher-level proprioceptive abilities. In this Perspective, we propose that to understand fully the link between proprioception and function, we need to look beyond traditional clinical tests of proprioception. Specifically, we present a novel framework for human proprioception assessment that is divided into two categories: low-level and high-level proprioceptive judgments. Low-level judgments are those made in a single frame of reference and are the types of judgments made in traditional proprioceptive tests (i.e. detect, discriminate or match). High-level proprioceptive abilities involve proprioceptive judgments made in a different frame of reference. For example, when a person indicates where their hand is located in space. This framework acknowledges that proprioception is complex and multifaceted, and that tests of proprioception should not be viewed as interchangeable, but rather as complimentary. Crucially, it provides structure to the way researchers and clinicians can approach proprioception and its assessment. We hope this Perspective serves as the catalyst for discussion and new lines of investigation.

Surface electromyography and gamification: Translational research to advance physical rehabilitation

Many problems that fall in medical domains of inquiry have behavioral components that can be optimized to increase benefits for patients. For example, although surgical intervention is effective in reducing the pain resulting from osteoarthritis of the knee, patients often struggle to regain complete functional use of the joint. In this translational study, we point to some ways in which behavioral contingencies of reinforcement are compromised, making the recovery process more difficult. We also report on the use of surface electromyography (sEMG) with healthy participants to create supplementary contingencies of reinforcement to support the development and maintenance of clinically relevant exercises. The procedures reported provide a proof-of-concept and can contribute to an increase in the systematic use of games and feedback in physical rehabilitation in recovery from knee surgery. The results of this translational study suggest an expanded role for applied behavior analysis in the domains of health and medicine.

Instrumented platforms for balance and proprioceptive assessment in patients with total knee replacement: A systematic review and meta-analysis

BACKGROUND

The functional outcome of total knee replacement (TKR) is usually satisfying. However, patients may show functional limitations for years after surgery, which have been ascribed to impairments in balance and proprioception, mainly during standing tasks. A number of instrumentations and parameters have been used, rising confusion for clinical decisions on the assessment of patients.

RESEARCH QUESTION

Which are the most widespread and consistent procedures to assess balance and proprioception following TKR?

METHODS

A literature review was conducted in Pubmed, PEDro, and Cochrane database. From a total sample of 112 articles, 23 original studies published between 2008 and 2019 met inclusion criteria. The primary outcomes selected were variables related to balance and proprioception assessment in static and dynamic tasks performed with instrumented platforms. Data from papers using the same instrumentation, on patients with unilateral TKA and at least 12 months postoperatively were synthesized quantitatively in a random effect meta-analysis.

RESULTS

Fourteen articles were appropriate for the review. A large variability was found both in the instrumentation and the parameters used. The Neurocom Balance Master System™ was the most used instrument (four articles). On a total population of 186 patients with unilateral TKR 12 months postoperatively, a low degree of heterogeneity was found adopting the random effect in the four tasks explored (Firm and Foam Surface both with Eyes Open and Eyes Closed).

SIGNIFICANCE

This review found a large variability in the instrumentation used to assess balance and proprioception in patients operated on TKR. The meta-analysis demonstrated that the Neurocom Balance Master System™ for static assessment of balance showed an acceptable consistency and can be considered as a reference for further studies. However, balance and proprioception impairments following TKR have not been widely quantified by means of instrumented platforms. Further research is needed to address this issue, and improve clinical practice.