Knee Joint Mobility and Position Sense in Healthy Young Adults

Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study

BACKGROUND

In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking.

Assessing the concurrent validity and reliability of an iPhone application for the measurement of range of motion and joint position sense in knee and ankle joints of young adults

OBJECTIVE

To analyze the concurrent validity and reliability of an iPhone application for assessing range of motion (ROM) and joint position sense (JPS) in ankle and knee joints.

DESIGN

Cross-sectional study.

SETTING

Sport laboratory.

PARTICIPANTS

Twenty healthy and physically active volunteers.

INTERVENTIONS

All participants performed a ROM and a JPS test in ankle and knee joints, which were simultaneously evaluated with photo-analysis and the iPhone application.

MAIN OUTCOMES MEASURES

A total of 80 angles were obtained with the iPhone app and the photo-analysis and compared for concurrent validity. Reliability was evaluated through re-scoring of images with the iPhone app by two different testers.

RESULTS

Very high correlation was observed between both methods for ankle and knee ROM and knee JPS (r > 0.90), and high correlation for ankle JPS (r = 0.71-0.90), while Bland-Altman plots showed absolute agreement for all the variables. Inter- and intra-tester reliability was perfect for all the variables (ICC > 0.81), except for the inter-tester reliability of ankle JPS, which was substantial (ICC = 0.61-0.81).

CONCLUSIONS

This new iPhone application is valid and reliable for measuring ankle and knee ROM and JPS, although special attention is needed during ankle evaluation to avoid errors.

Human motion component and envelope characterization via wireless wearable sensors

BACKGROUND

The characterization of limb biomechanics has broad implications for analyzing and managing motion in aging, sports, and disease. Motion capture videography and on-body wearable sensors are powerful tools for characterizing linear and angular motions of the body, though are often cumbersome, limited in detection, and largely non-portable. Here we examine the feasibility of utilizing an advanced wearable sensor, fabricated with stretchable electronics, to characterize linear and angular movements of the human arm for clinical feedback. A wearable skin-adhesive patch with embedded accelerometer and gyroscope (BioStampRC, MC10 Inc.) was applied to the volar surface of the forearm of healthy volunteers. Arms were extended/flexed for the range of motion of three different regimes: 1) horizontal adduction/abduction 2) flexion/extension 3) vertical abduction. Data were streamed and recorded revealing the signal "pattern" of movement in three separate axes. Additional signal processing and filtering afforded the ability to visualize these motions in each plane of the body; and the 3-dimensional motion envelope of the arm.

RESULTS

Each of the three motion regimes studied had a distinct pattern - with identifiable qualitative and quantitative differences. Integration of all three movement regimes allowed construction of a "motion envelope," defining and quantifying motion (range and shape - including the outer perimeter of the extreme of motion - i.e. the envelope) of the upper extremity. The linear and rotational motion results from multiple arm motions match measurements taken with videography and benchtop goniometer.

CONCLUSIONS

A conformal, stretchable electronic motion sensor effectively captures limb motion in multiple degrees of freedom, allowing generation of characteristic signatures which may be readily recorded, stored, and analyzed. Wearable conformal skin adherent sensor patchs allow on-body, mobile, personalized determination of motion and flexibility parameters. These sensors allow motion assessment while mobile, free of a fixed laboratory environment, with utility in the field, home, or hospital. These sensors and mode of analysis hold promise for providing digital "motion biomarkers" of health and disease.

Effect of stochastic resonance on proprioception and kinesthesia in anterior cruciate ligament reconstructed patients

Low amplitude mechanical noise vibration has been shown to improve somatosensory acuity in various clinical groups with comparable deficiencies through a phenomenon known as Stochastic Resonance (SR). This technology showed promising outcomes in improving somatosensory acuity in other clinical patients (e.g., Parkinson's disease and osteoarthritis). Some degree of chronic somatosensory deficiency in the knee has been reported following anterior cruciate ligament (ACL) reconstruction surgery. In this study, the effect of the SR phenomenon on improving knee somatosensory acuity (proprioception and kinesthesia) in female ACL reconstructed (ACLR) participants (n = 19) was tested at three months post-surgery, and the results were compared to healthy controls (n = 28). Proprioception was quantified by the measure of joint position sense (JPS) and kinesthesia with the threshold to detection of passive movement (TDPM). The results based on the statistical analysis demonstrated an overall difference between the somatosensory acuity in the ACLR limb compared to healthy controls (p = 0.007). A larger TDPM was observed in the ACLR limb compared to the healthy controls (p = 0.002). However, the JPS between the ACLR and healthy limbs were not statistically significantly different (p = 0.365). SR significantly improved JPS (p = 0.006) while the effect was more pronounced in the ACLR cohort. The effect on the TDPM did not reach statistical significance (p = 0.681) in either group. In conclusion, deficient kinesthesia in the ACLR limb was observed at three months post-surgery. Also, the positive effects of SR on somatosensory acuity in the ACL reconstructed group warrant further investigation into the use of this phenomenon to improve proprioception in ACLR and healthy groups.

Six weeks of multistation program on the knee proprioception and performance of futsal players

BACKGROUND

Proprioception and vertical jump are important parameters in the performance and prevention of injuries in futsal. However, very few studies have analyzed the role of multistation exercises to improve these variables. The purpose of this study was to assess the effects of a six-week multistation exercise program on knee joint position sense (JPS) and countermovement jump (CMJ) of futsal players.

METHODS

Thirty-four male futsal players randomly classified into experimental (N.=17) or control group (N.=17). The experimental group included a multistation exercise protocol to their training routines (2 times/week - 6 weeks); the control group continued their training routines. All the players completed similar training routines outside of the multistation exercises. Before (baseline), just after the intervention (Post6Wk) and four weeks later (Post10Wk), CMJ and knee JPS (absolute, relative and variable angular error: AAE, RAE and VAE, respectively) were evaluated.

RESULTS

ANOVA showed that the experimental group significantly decreased VAE at Post10Wk compared to baseline, suggestive of greater proprioceptive precision, while the control group significantly increased AAE, RAE and VAE at Post10Wk compared to baseline. The experimental group exhibited lower and thus, better AAE and VAE than the control group at Post10Wk, although no significant differences were found at Post6Wk. No significant differences was found in the CMJ.

CONCLUSIONS

A six weeks of multistation program may help improve proprioceptive precision of futsal players, even one month after finishing the 6-wk multistation training program. However, this is not long enough to improve proprioceptive acuity and maximum vertical jump. Therefore, the meaningful of these results in term of performance are unclear.

Effect of blocked vision treadmill training on knee joint proprioception of patients with chronic stroke

[Purpose] The purpose of this study was to compare the effect of treadmill training with the eyes closed and eyes open on the joint position sense of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. Patients performed the timed up and go test and were assigned to one of two treadmill training groups with and without visual deprivation. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. The knee joint proprioception was measured using the Biodex System Pro 3 before and after the intervention. [Results] The knee joint proprioception of the treadmill training with blocked vision group showed more significant improvement after the treadmill training sessions than that of the eyes open group. [Conclusion] This study demonstrated that treadmill training with blocked vision may be useful for the proprioceptive sensory rehabilitation of patients with chronic stroke.

Does knee joint proprioception alter following medial patellofemoral ligament reconstruction?

BACKGROUND

This study firstly aimed to determine whether proprioception deficits, as measured by joint position sense (JPS), occur in people following recurrent patellar dislocations. Secondly, to determine whether JPS changes following medial patellofemoral ligament reconstruction (MPFL) reconstruction for patellar instability.

METHODS

Thirty people following recurrent patellar dislocation were recruited. Pre-operative JPS was assessed using the passive angle reproduction test. Through this, an assessor moved a participant's limb to a target position. This was returned to neutral, before finally moving the limb again, whilst requiring the participant to indicate when they thought the target angle was reached. The actual angular error (AAE) was calculated as the difference between the perceived angle and target angle. Clinical outcomes included the Kujala Patellofemoral Disorder Score, the International Knee Documentation Committee (IKDC) form, pain, knee motion, extensor muscle strength and frequency of patellar dislocation. Outcomes were assessed pre-operative, 6 weeks, 3 and 12 months.

RESULTS

Mean AAE was 2.2° (inner range) to 3.9° (mid-range); this was not clinically significant. There was no statistically significant difference between the baseline-and-6 week, 6 week-and-3 month or baseline-and-12 month AAE measures (p=0.38 to 1.00). There was a statistically significant improvement in functional outcomes as measured by the Kujala score, IKDC form, reduced pain and increased extension strength from baseline to 12 months (p<0.01).

CONCLUSIONS

Following recurrent patellar dislocation, patients exhibit minimal deficits in JPS. Whilst MPFL reconstruction significantly improved clinical and functional outcomes for this population, this operation did not significantly alter JPS during the first post-operative year.

A systematic review to determine the reliability of knee joint position sense assessment measures

BACKGROUND

The assessment of joint position sense (JPS) is the most widely used measurement of knee proprioceptive capability within the literature. However, it remains unclear what the most reliable method is to assess this. The purpose of this study was to determine the intra- and inter-rater reliability of the various methods used to assess knee JPS.

METHODS

A systematic review of published and unpublished literature sources was conducted up to June 2012. All studies principally assessing the reliability (intra- or inter-rater) or reproducibility of a JPS of the knee were included. The methodological quality of each study was reviewed using the Critical Appraisal Skills Programme tool.

RESULTS

A total of 18 studies were eligible, assessing the reliability of JPS with 456 knees. The reliability of four methods of JPS has been recorded: position replication using a model, image recorded angulation, electrogoniometry and dynamometry/angular motion chair. Intra-rater reliability was good for the assessment of JPS using photographs and digital images, and replicating knee position using a paper model, this was good but variable when electrogoniometry was used, and moderate but variable when assessed using dynamometry/angle motion chairs. The assessment of JPS by image recorded angulation, electrogoniometry and dynamometry/angular motion chair has demonstrated good inter-rater reliability.

CONCLUSIONS

Whilst JPS methods appear to have variable reliability, the four assessment methods should be further assessed with pathological populations such as those following patellar dislocation or anterior cruciate ligament rupture. This will better facilitate the generalisability of JPS assessment methods to inform clinical practice.

Concordância inter-observador em testes de avaliação proprioceptiva do joelho por goniometria

O propósito deste foi determinar o grau de concordância inter-avaliador de dois testes que mensuram a propriocepção do joelho por meio da goniometria, em uma amostra de universitárias (n=13; 23,8±6,4 anos). Mensurou-se a acurácia proprioceptiva pelos testes de percepção do limiar de movimento passivo lento (T1), movendo-se passivamente a perna até o ângulo alvo; e pelo teste de senso de posição articular (T2), solicitando-se movimento ativo até o ângulo alvo, previamente atingido passivamente. Os ângulos alvos foram sorteados e as medições feitas simultaneamente, de forma cega, por dois avaliadores, por meio de dois goniômetros idênticos posicionados nas faces medial e lateral do joelho. As participantes sinalizavam ao atingir o ângulo alvo, registrando-se, por ambos os avaliadores, os valores angulares efetivamente alcançados. A diferença (em números absolutos) entre o ângulo alvo e aquele alcançado foi considerada o "valor de erro", que reflete a acuidade proprioceptiva. Determinou-se a concordância inter-avaliador pelo teste de concordância de Kappa; os valores encontrados (T1, Kappa=0,55; T2, Kappa=0,58) mostram concordância moderada. Como a concordância inter-avaliador nos dois testes foi moderada, conclui-se que a goniometria é limitada, na avaliação proprioceptiva de movimento do joelho.

Linking stability to demographics, strength and sensory system function in women over 40 to support pre-emptive preventive intervention

OBJECTIVE

To investigate differences in demographics, strength and sensory system function of 254 women aged 40-80 years categorized as stable, unsteady or unstable using simple balance tests.

METHOD

Demographics (age, height, weight, medications, co-morbidities, falls history, activity level), measures of quadriceps, hip abductor and adductor strength, somatosensory, visual and vestibular function were recorded. Subjects were categorized as stable (completed all trials), unsteady (failed one/two trials) or unstable (failed all trials) after three 10-s trials of bilateral stance (foam surface, eyes closed (EC)) and one-leg stance (firm surface, eyes open (EO)), and the results were compared.

RESULTS

Both balance tasks identified women in their fifties as unstable ( approximately 9%), with 60% of these women failing both tasks. More women were unsteady or unstable on foam EC (27%) than in one-leg stance EO (20%). Unsteady and unstable categories of women were older, reported more co-morbidities and medications and less activity than stable women. The women categorized as unstable in either test recorded weaker hip muscles, higher vibration thresholds, greater joint positioning error, reduced edge contrast sensitivity, low-contrast visual acuity and reduced dynamic visual acuity than the stable categories (p < 0.01). The two tests detected differences in characteristics of unstable women, with those failing one-leg stance EO being heavier, and those failing foam EC having weaker quadriceps.

CONCLUSION

These data link instability in women from the fifties to multiple demographic and sensorimotor factors associated with increased risk of falls, thus supporting use of balance tests in primary-care settings to assist referral for diagnostic assessment and pre-emptive interventions.

Hypermobility and the hypermobility syndrome

Hypermobile joints by definition display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility, when associated with symptoms is termed the joint hypermobility syndrome or hypermobility syndrome (JHS). JHS is an under recognised and poorly managed multi-systemic, hereditary connective tissue disorder, often resulting in a great deal of pain and suffering. The condition is more prevalent in females, with symptoms frequently commencing in childhood and continuing on into adult life. This paper provides an overview of JHS and suggested clinical guidelines for both the identification and management of the condition, based on research evidence and clinical experience. The Brighton Criteria and a simple 5-point questionnaire developed by Hakim and Grahame, are both valid tools that can be used clinically and for research to identify the condition. Management of JHS frequently includes; education and lifestyle advice, behaviour modification, manual therapy, taping and bracing, electrotherapy, exercise prescription, functional rehabilitation and collaborative working with a range of medical, health and fitness professionals. Progress is often slow and hampered by physical and emotional setbacks. However with a carefully considered management strategy, amelioration of symptoms and independent functional fitness can be achieved.

Effects of experimentally-induced anterior knee pain on knee joint position sense in healthy individuals

PURPOSE

The ability to sense the position of limb segments is a highly specialised proprioceptive function important for control of movement. Abnormal knee proprioception has been found in association with several musculoskeletal pathologies but whether nociceptive stimulation can produce these proprioceptive changes is unclear. This study evaluated the effect of experimentally induced knee pain on knee joint position sense (JPS) in healthy individuals.

STUDY DESIGN

Repeated measures, within-subject design.

METHODS

Knee JPS was tested in 16 individuals with no history of knee pathology under three experimental conditions: baseline control, a distraction task and knee pain induced by injection of hypertonic saline into the infrapatellar fat pad. Knee JPS was measured using active ipsilateral limb matching responses at 20 degrees and 60 degrees flexion whilst non-weightbearing (NWB) and 20 degrees flexion single leg stance. During the tasks, the subjective perception of distraction and severity of pain were measured using 11-point numerical rating scales.

RESULTS

Knee JPS was not altered by acute knee pain in any of the positions tested. The distraction task resulted in poorer concentration, greater JPS absolute errors at 20 degrees NWB, and greater variability in errors during the WB tests. There were no significant correlations between levels of pain and changes in JPS errors. Changes in JPS with pain and distraction were inversely related to baseline knee JPS variable error in all test positions (r=-0.56 to -0.91) but less related to baseline absolute error.

CONCLUSION

Knee JPS is reduced by an attention-demanding task but not by experimentally induced pain.

Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis

Proprioception plays an integral role in neuromotor control of the knee joint and deficits in knee joint proprioception are well documented in individuals with knee osteoarthritis (OA). However, the functional relevance of these deficits is not clear. This cross-sectional study evaluated the relationship between knee joint proprioception and pain and disability in a large cohort of individuals with knee OA. Two hundred and twenty participants (145 F, 75 M) with symptomatic knee OA were recruited from the community. Five non-weight bearing active tests with ipsilateral limb matching responses were performed at 20 degrees and 40 degrees flexion to measure knee joint position sense. Pain and disability were assessed by self-reported questionnaires and objective measures of balance and gait. Results showed little association between knee joint position sense variables and measures of pain and disability (r values <0.24, most p>0.05). When comparing participants with the worst and best joint position sense, no significant differences in pain and disability could be found (p>0.05). While our study design does not allow causality to be established, these results suggest that deficits in joint position sense may be due to factors other than pain and that deficits are not large enough to impact upon disability.