Can We Target Close Therapeutic Goals in the Gait Re-Education Algorithm for Stroke Patients at the Beginning of the Rehabilitation Process?

(1) Background: The study aimed to determine the most important activities of the knee joints related to gait re-education in patients in the subacute period after a stroke. We focused on the tests that a physiotherapist could perform in daily clinical practice. (2) Methods: Twenty-nine stroke patients (SG) and 29 healthy volunteers (CG) were included in the study. The patients underwent the 5-meter walk test (5mWT) and the Timed Up and Go test (TUG). Tests such as step up, step down, squat, step forward, and joint position sense test (JPS) were also performed, and the subjects were assessed using wireless motion sensors. (3) Results: We observed significant differences in the time needed to complete the 5mWT and TUG tests between groups. The results obtained in the JPS show a significant difference between the paretic and the non-paretic limbs compared to the CG group. A significantly smaller range of knee joint flexion (ROM) was observed in the paretic limb compared to the non-paretic and control limbs in the step down test and between the paretic and non-paretic limbs in the step forward test. (4) Conclusions: The described functional tests are useful in assessing a stroke patient's motor skills and can be performed in daily clinical practice.

Sensorimotor function and standing balance in older adults with transtibial limb loss

BACKGROUND

Limited research has focused on older prosthesis users despite the expected compounded effects of age and amputation on sensorimotor function, balance, and falls. This study compared sensorimotor factors and standing balance between older individuals with and without transtibial amputation, hypothesizing that prosthesis users would demonstrate worse sensorimotor function. Secondarily we assessed the relationship between standing balance and somatosensation in prosthesis users.

METHODS

Thirteen persons with unilateral transtibial amputation (71.7 years) and 10 able-bodied controls (71.7 years) participated in this cross-sectional observational study. Passive joint range-of-motion, muscle strength, proprioception (joint position sense), tactile sensitivity, and standing balance (center-of-pressure sway) were compared between groups. A multiple linear regression analysis assessed the relationship between proprioception and balance (without vision) in prosthesis users.

FINDINGS

Our hypotheses were generally not supported, with the only differences being reduced joint range-of-motion and strength in prosthesis users (with large effect sizes), but comparable sensation and balance. Notably, prosthesis users demonstrated better proprioception than controls as reflected through better joint position sense when the limb was non-weight bearing. Worse amputated limb proprioception was associated with better standing balance in prosthesis users.

INTERPRETATION

Older prosthesis users have impaired passive joint motion and muscle strength compared to controls that could challenge their ability to position and control the amputated limb to avoid falls during daily activities. However, their better amputated limb proprioception might help counteract those limitations by leveraging sensory feedback from the suspended limb. The relationship between amputated limb proprioception and standing balance suggests a nuanced relationship that warrants further study.

Effects of 2 Different External Loads on Joint Position Sense and the Relationship Between Muscle Strength and Force Sense

CONTEXT

Joint position sense (JPS) tests of proprioception lack ecological validity because the testing conditions are so different from the normal function that they can contribute little to understanding the role proprioception plays in daily and sporting activities.

OBJECTIVE

To evaluate the effect of low and high external load on the knee JPS and to investigate the relationship between maximum voluntary isometric contraction and force sense (FS).

DESIGN

Experimental study.

SETTING

Research laboratory.

PARTICIPANTS

A total of 47 volunteers with no history of knee pathology.

INTERVENTIONS

Three active JPS tests performed with no load, low load, and high load were compared at the 45° target angle. For isometric FS test, 50% load was used. For isotonic low load and high load JPS tests, 30% and 70% loads were applied, respectively.

MAIN OUTCOME MEASURES

To analyze obtained data set 2-way multiple analysis of variance, repeated measures of analysis of variance, paired sample t test, and the Pearson correlation coefficient were used.

RESULTS

JPS was not affected by gender (male and female) and activity levels (sedentary, recreational, and trained). Results of the repeated measure of analysis of variance demonstrated the significant main effect of loads (P = .001). Significant differences were found between no load, low load, and high load JPS (P = .001). A positive and significant correlation was found between maximum voluntary isometric contraction and FS error values (r = .41, P = .001).

CONCLUSIONS

The results suggest that as the load level increases, the knee JPS improves. Knee JPS assessed under external load may be a more appropriate alternative to the nature of the sport. Those with higher muscle strength have a worse FS.

Effect of Force Sense to Active Joint Position Sense and Relationships between Active Joint Position Sense, Force Sense, Jumping and Muscle Strength

We aimed to investigate the effect of external load on the joint position sense (JPS) accuracy and its relation to the target jump height. The present study also aimed to explore the relationship between force sense (FS) and maximum voluntary isometric contraction (MVIC). Participants' MVIC levels were determined during the 45-degree knee extension task. Then, participants were asked to execute a knee JPS task with external load (EL-JPS) and with no-load (EL-JPS). To assess jumping accuracy participants were instructed to jump with their 50% of maximum jump height. Results indicated that EL-JPS error values were lower than NL-JPS. EL-JPS was correlated to jumping errors. However, the relationship between NL-JPS and jumping errors was not significant. A significant correlation was found between MVIC and FS errors.

Stochastic resonance electrical stimulation to improve proprioception in knee osteoarthritis

Proprioceptive deficits occur with knee osteoarthritis (OA) and improving proprioception may slow joint degeneration by allowing more appropriate joint loading. Stochastic resonance (SR) stimulation improves balance and the sensitivity of specific mechanoreceptors. Our purpose was to evaluate the effects of SR electrical stimulation combined with a knee sleeve on proprioception in subjects with knee OA. Joint position sense (JPS) was measured in 38 subjects with knee OA during four conditions in both a partial weight-bearing (PWB) and non weight-bearing (NWB) task: no electrical stimulation/no sleeve, no electrical stimulation/sleeve, 50 μA-RMS stimulation/sleeve, and 75 μA-RMS stimulation/sleeve. Subjects also reported their knee pain, stiffness, functionality (WOMAC), and instability. Repeated measures ANOVA and Spearman correlations were performed to investigate differences between the conditions and relationships among the outcome measures. JPS during the 75 μA-RMS stimulation/sleeve and sleeve alone conditions was significantly improved compared to the control condition in the PWB task. However, the 75 μA-RMS stimulation/sleeve and the sleeve alone conditions did not differ from each other. A moderate correlation was found between the improvements with the 75 μA-RMS stimulation/sleeve condition compared to the JPS of the control condition in the PWB task. No differences in JPS were found between the four conditions in the NWB task. Significant correlations were found between the control JPS and WOMAC indices (p<0.005). Improved proprioception during the PWB task was achieved with a sleeve alone and in combination with SR stimulation. The observed correlations suggest that subjects with larger proprioceptive deficits may benefit most from these therapies.

The effects of stochastic resonance electrical stimulation and neoprene sleeve on knee proprioception

Background

A variety of knee injuries and pathologies may cause a deficit in knee proprioception which may increase the risk of reinjury or the progression of disease. Stochastic resonance stimulation is a new therapy which has potential benefits for improving proprioceptive function. The objective of this study was to determine if stochastic resonance (SR) stimulation applied with a neoprene sleeve could improve knee proprioception relative to a no-stimulation/no-sleeve condition (control) or a sleeve alone condition in the normal, healthy knee. We hypothesized that SR stimulation when applied with a sleeve would enhance proprioception relative to the control and sleeve alone conditions.

Methods

Using a cross-over within subject design, twenty-four healthy subjects were tested under four combinations of conditions: electrical stimulation/sleeve, no stimulation/sleeve, no stimulation/no sleeve, and stimulation/no sleeve. Joint position sense (proprioception) was measured as the absolute mean difference between a target knee joint angle and the knee angle reproduced by the subject. Testing was conducted during both partial-weight bearing (PWB) and non-weight bearing (NWB) tasks. Differences in joint position sense between the conditions were evaluated by repeated-measures analysis of variance testing.

Results

Joint position sense error during the stimulation/sleeve condition (2.48° ± 1.32°) was found to be more accurate (P < 0.05) relative to the control condition (3.35° ± 1.63°) in the PWB task. No difference in joint position sense error was found between stimulation/sleeve and sleeve alone conditions for the PWB task. Joint position sense error was not found to differ between any of the conditions for the NWB task.

Conclusion

These results suggest that SR electrical stimulation when combined with a neoprene sleeve is an effective modality for enhancement of joint proprioception in the PWB knee. We believe these results suggest the need for further study of the potential of SR stimulation to correct proprioceptive deficits in a clinical population with knee injury/pathology or in subjects at risk of injury because of a proprioceptive deficit.

Proprioceptive acuity in active rotation movements in healthy knees

OBJECTIVES

To investigate the ability of asymptomatic participants to discriminate between active knee rotation movements of different magnitude and to determine whether proprioceptive acuity of active knee rotation differs between limbs (dominant and nondominant and right and left).

DESIGN

Cross-sectional study.

SETTING

Laboratory in an Australian university.

PARTICIPANTS

Healthy volunteers (N=30) without previous cruciate ligament injury or surgery, previous fracture of the lower limbs, or other lower-limb disorders in the last 3 months.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Knee rotation proprioceptive acuity was determined by using our custom-designed device. The measure of proprioceptive acuity used in this study was the just-noticeable difference (JND). Participants actively rotated the knee (internal or external rotation) to 1 of 4 movement blocks and judged the magnitude of the permitted motion. Proprioceptive acuity scores, representing a participant's ability to detect small differences in magnitude of active knee rotation movements, were then calculated.

RESULTS

The means of the JND for proprioceptive acuity of internal rotation (1.37 degrees +/-.11 degrees ) were significantly (P=.04) lower than for external rotation (1.6 degrees +/-.14 degrees ) regardless of side (right, left) or dominance. No significant difference was found between the mean JND for left and right knee rotations (P=.84) or between the mean JND for dominant and nondominant knee rotation (P=.69).

CONCLUSIONS

Participants perceived smaller differences between active internal rotation movements than external rotation. No significant difference was found between the dominant and nondominant leg or between the left and right leg; therefore, clinicians can establish whether a proprioceptive deficit exists after unilateral injury and can use acuity of the uninjured knee as a normal status for rehabilitation.

Knee-Joint Position Sense: The Relationship between Open and Closed Kinetic Chain Tests

Context:

Authors have investigated knee joint-position sense (JPS) in non-weight-bearing open kinetic chain (OKC) manner, but few have investigated JPS during closed kinetic chain (CKC) weight-bearing activities or the relationship between these two.

Objective:

To investigate the relationship between knee JPS during OKC and CKC maneuvers.

Design:

2-group (men and women) repeated-measures.

Setting:

Biomechanics laboratory.

Participants:

80 asymptomatic subjects.

Interventions:

None.

Main Outcome Measure:

Absolute error score of knee JPS during 2 conditions, a CKC squat or OKC knee-flexion maneuver.

Results:

Statistical analysis by 2-way ANOVA showed sex not to have a significant effect on error score (P= .475), but statistically significant differences between error scores occurred during the 2 tests (P= .0001), the CKC test producing lower error scores (group mean absolute error score OKC [5.6° ± 4.3°] and CKC [2.8° ± 2.4°]), with the absence of a correlation between scores of each test (r= .1).

Conclusion:

Testing JPS in a CKC scenario would seem appropriate—the ability is greatest (least errors), and conversely any deficits might be most obvious.

Weight-Bearing and Non-Weight-Bearing Knee-Joint Reposition Sense and Functional Performance

Objective:

To determine the relationship between weight-bearing (WB) and non-weight-bearing (NWB) joint reposition sense (JRS) and a functional hop test (FH) and to compare performance on these parameters between athletes and nonathletes.

Design:

Repeated-measures ANOVA and Pearson correlations.

Setting:

Research laboratory.

Participants:

40 men (age = 20.8 ± 1.7 y; ht = 176.9 ± 5.8 cm; wt = 82.6 ± 9.5 kg): 20 lacrosse players and 20 nonathletes.

Main Outcome Measures:

Ability to actively reproduce 30° of knee flexion in the WB and NWB conditions and functional performance on a single-leg crossover-hop test.

Results:

No significant correlations were observed between JRS and FH in athletes and nonathletes. No significant differences were observed between athletes and nonathletes in JRS. All participants were significantly more accurate at WB than at NWB JRS.

Conclusions:

There appears to be no relationship between WB or NWB JRS and functional performance, regardless of one’s physical activity level