Assessing Proprioception: A Systematic Review of Possibilities

Assessment of Balance During a Single-Limb Stance Task in Healthy Adults: A Cross-Sectional Study

Single-limb stance (SLS) is a demanding postural task, widely used for balance assessment in both research and clinical practice. Despite extensive data on elderly and clinical populations, less is known about younger and healthier adults. Our aim in this study was to assess balance during a SLS task among a cohort of healthy adults to determine whether there are age or sex group or testing condition differences in performances. In this cross-sectional study, we involved 120 participants aged 30-65 years and divided them into four age sub-groups with equal numbers of males and females in each. We assessed balance during a 45-s SLS task on a] the Delos Postural Proprioceptive System for both lower limbs in two conditions - open eyes (OE) and closed eyes (CE). We calculated stability (SI) and autonomy (AU) indices and used analysis of variance to determine that there was no significant effect of limb dominance or sex on balance parameters. However, there was a significant interaction effect between age group and testing condition for both SI and AU (p < .001 for both), with balance worsening as age increased only in the CE condition. These results highlight a pattern of balance decline with age when vision is eliminated from balance performance, underscoring the critical relationship between sensory input and postural control as people age.

Validation of proprioception measures of the lumbar spine

BACKGROUND

To better personalize treatment and monitor recovery of individuals with low back pain, objective tests of sensorimotor functions, such as lumbar proprioception, must be selected based on their reliability and validity. The primary objective of this study was to test the concurrent validity of three measures of lumbar proprioception.

METHODS

Thirty-one participants performed three lumbar proprioception tests (motion perception threshold, active and passive joint positioning sense), a whole-body mobility and balance (time up-and-go) and two trunk-specific postural control (threshold of stability and sensor-based sway measures) tests.

RESULTS

Only the motion perception threshold proprioception test showed some validity, correlating with the trunk-specific postural control tests [r range (positive values): 0.37 to 0.60]. The three lumbar proprioception measures were not correlated to each other. The threshold of stability measure was correlated with the time up-and-go (r = 0.37) and trunk-specific (sensor-based sway measures) postural control [r range (positive values): 0.48 to 0.77] tests.

CONCLUSION

The present study generated three original findings. Only the motion perception threshold proprioception test demonstrated its concurrent validity. In fact, the three lumbar proprioception tests performed in the present study were not correlated to each other, thus assessing different constructs. Finally, the threshold of stability protocol was validated against other tests. These findings will help in selecting the most appropriate lumbar proprioception measures to study the effects of exercise treatments in patients with back pain.

In Myotonic Dystrophy Type 1 Head Repositioning Errors Suggest Impaired Cervical Proprioception

Background: Myotonic dystrophy type 1 (DM1) is a rare multisystemic genetic disorder with motor hallmarks of myotonia, muscle weakness and wasting. DM1 patients have an increased risk of falling of multifactorial origin, and proprioceptive and vestibular deficits can contribute to this risk. Abnormalities of muscle spindles in DM1 have been known for years. This observational cross-sectional study was based on the hypothesis of impaired cervical proprioception caused by alterations in the neck spindles. Methods: Head position sense was measured in 16 DM1 patients and 16 age- and gender-matched controls. A head-to-target repositioning test was requested from blindfolded participants. Their head was passively rotated approximately 30° leftward or rightward and flexed or extended approximately 25°. Participants had to replicate the imposed positions. An optoelectronic system was adopted to measure the angular differences between the reproduced and the imposed positions (joint position error, JPE, °) concerning the intended (sagittal, horizontal) and unintended (including the frontal) planar projections. In DM1 patients, JPEs were correlated with clinical and balance measures. Static balance in DM1 patients was assessed through dynamic posturography. Results: The accuracy and precision of head repositioning in the intended sagittal and horizontal error components did not differ between DM1 and controls. On the contrary, DM1 patients showed unintended side-bending to the left and the right: the mean [95%CI] of frontal JPE was -1.29° [-1.99°, -0.60°] for left rotation and 0.98° [0.28°, 1.67°] for right rotation. The frontal JPE of controls did not differ significantly from 0° (left rotation: 0.17° [-0.53°, 0.87°]; right rotation: -0.22° [-0.91°, 0.48°]). Frontal JPE differed between left and right rotation trials (p < 0.001) only in DM1 patients. No correlation was found between JPEs and measures from dynamic posturography and clinical scales. Conclusions: Lateral head bending associated with head rotation may reflect a latent impairment of neck proprioception in DM1 patients.

Smartphone Usage and Postural Stability in Individuals With Forward Head Posture: A Nintendo Wii Balance Board Analysis

OBJECTIVE

To assess postural stability, specifically center of body sway during single-leg standing balance, among individuals with and without forward head posture (FHP) during smartphone use.

METHODS

The research recruited 53 healthy smartphone users, aged 18-25, and categorized them into FHP group comprising 26 subjects and the normal (control) group with 27 subjects. Participants were assigned the task of maintaining balance while engaged in smartphone typing during single-leg standing. The experiment involved four specific conditions according to neck posture and stable of surface. The study meticulously quantified body center of pressure (COP) sway amplitudes using the Nintendo Wii Balance Board.

RESULTS

The research revealed that individuals with FHP exhibited significantly greater body sway compared to the control group when using smartphones. Notably, distinct variations were observed in path length sway, anteroposterior (AP), and mediolateral (ML) sway amplitude, particularly evident when maintaining flexed neck positions on a soft surface while engaged with smartphones.

CONCLUSION

These findings strongly suggest that individuals with FHP encounter deteriorated postural stability during smartphone use, particularly in challenging head positions.

Non-drainage Offers Faster Proprioceptive and Functional Recovery, and More Clinical Benefits for Patients following Primary Total Knee Arthroplasty Compared to Drainage

BACKGROUND

Although a non-drainage procedure following total knee arthroplasty (TKA) is becoming more acceptable in enhanced recovery after surgery, postoperative drainage is still commonly used in TKA surgeries. This study aimed to compare the non-drainage to the drainage during the early postoperative stage regarding proprioceptive and functional recovery, and postoperative outcomes of TKA patients.

MATERIAL AND METHODS

A prospective, single-blind, randomized, controlled trial was carried out on 91 TKA patients, who were randomly allocated into the non-drainage group (NDG) or the drainage group (DG). Patients were evaluated regarding knee proprioception, functional outcomes, pain intensity, range of motion, knee circumference, and anesthetic consumption. Outcomes were assessed at the time of charge, at postoperative 7th day, and at postoperative 3rd month.

RESULTS

There were no differences between groups at baseline (p > 0.05). During the inpatient period, the NDG experienced superior pain relief (p < 0.05), had a higher Hospital for Special Surgery knee score (p = 0.001), demanded lower assistance from a sitting position to a standing position (p = 0.001) and walking for 4.5 m (p = 0.034), and performed the Timed Up and Go test in a shorter duration (p = 0.016) compared to the DG. The NDG gained the actively straight leg raise earlier (p = 0.009), needed lower anesthetic consumption (p < 0.05), and showed improved proprioception (p < 0.05) compared to the DG during the inpatient period.

CONCLUSIONS

Our findings support that a non-drainage procedure would be a better option to provide a faster proprioceptive and functional recovery, and beneficial results for patients following TKA. Therefore, the non-drainage procedure should be the first choice in TKA surgery rather than drainage.

Comparison of head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls: A cross-sectional study

BACKGROUND

Chronic pain can affect body perception at the central level by causing the somatosensory cortex to rearrange. Additionally, cervical afferent abnormalities in individuals with neck pain can impair proprioceptive sensitivity, potentially leading to alterations in body alignment and biomechanics. Nevertheless, there are insufficient studies exploring these notions.

OBJECTIVE

The main objective of this study was to compare the head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls.

METHODS

Utilizing a cross-sectional study, a total of 76 volunteers comprising 38 individuals with neck pain and 38 matched healthy controls participated in the study. Head posture and cervical joint position sense were measured using a Cervical Range of Motion Deluxe (CROM) device. Firstly, the deviation angles of the head in three planes were evaluated, then the Head Repositioning Accuracy (HRA) test was performed to determine the joint position error. Visual Analogue Scale (VAS) was used to determine the severity of pain in individuals with neck pain.

RESULTS

The deviation angles of the head in all three planes were significantly lower in the healthy control group (p< 0.05). Joint position error values were significantly higher in all directions (flexion-extension, right-left lateral flexion, and rotation) in the neck pain group (p< 0.001).

CONCLUSION

The findings show that the proprioceptive sensation of the cervical region in individuals with neck pain was adversely affected, with changes were observed in the head posture.

NOTE

The abstract of this study was presented as a verbal declaration at the International Congress of Health Sciences-ICHES-IDU 2020 that was held in İzmir on 20-21 June 2020.

Relationship between somatosensory and visuo-perceptual impairments and motor functions in adults with hemiparetic cerebral palsy

Introduction

Children with cerebral palsy (CP) exhibit a variety of sensory impairments that can interfere with motor performance, but how these impairments persist into adulthood needs further investigation. The objective of this study was to describe the sensory impairments in adults having CP and how they relate to motor impairments.

Methods

Nineteen adults having CP performed a set of robotic and clinical assessments. These assessments were targeting different sensory functions and motor functions (bilateral and unilateral tasks). Frequency of each type of impairments was determined by comparing individual results to normative data. Association between the sensory and motor impairments was assessed with Spearman correlation coefficient.

Results

Impairment in stereognosis was the most frequent, affecting 57.9% of participants. Although less frequently impaired (26.3%), tactile discrimination was associated with all the motor tasks (unilateral and bilateral, either robotic or clinical). Performance in robotic motor assessments was more frequently associated with sensory impairments than with clinical assessments. Finally, sensory impairments were not more closely associated with bilateral tasks than with unilateral tasks.

Discussion

Somatosensory and visuo-perceptual impairments are frequent among adults with CP, with 84.2% showing impairments in at least one sensory function. These sensory impairments show a moderate association with motor impairments.

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.

The model of the brain as a complex system: Interactions of physical, neural and mental states with neurocognitive functions

The isolated approaching of physical, neural and mental states and the binary classification into stable traits and fluctuating states previously lead to a limited understanding concerning underlying processes and possibilities to explain, measure and regulate neural and mental performance along with the interaction of mental states and neurocognitive traits. In this article these states are integrated by i) differentiating the model of the brain as a complex, self-organizing system, ii) showing possibilities to measure this model, iii) offering a classification of mental states and iv) presenting a holistic operationalization of state regulations and trait trainings to enhance neural and mental high-performance on a macro- and micro scale. This model integrates current findings from the theory of constructed emotions, the theory of thousand brains and complex systems theory and yields several testable hypotheses to provide an integrated reference frame for future research and applied target points to regulate and enhance performance.

Shoulder muscle weakness and proprioceptive impairments in type 2 diabetes mellitus: exploring correlations for improved clinical management

Background

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with systemic implications, potentially affecting musculoskeletal health. This study aimed to assess shoulder muscle strength and joint repositioning accuracy in individuals with T2DM, exploring potential correlations and shedding light on the musculoskeletal consequences of the condition. The objectives were two-fold: (1) to assess and compare shoulder strength and joint repositioning accuracy between individuals with T2DM and asymptomatic counterparts, and (2) to examine the correlation between shoulder strength and joint repositioning accuracy in individuals with T2DM.

Methods

A cross-sectional study enrolled 172 participants using the convenience sampling method, including 86 individuals with T2DM and an age-matched asymptomatic group (n = 86). Shoulder strength was assessed using a handheld dynamometer, while joint repositioning accuracy was evaluated with an electronic digital inclinometer.

Results

Individuals with T2DM exhibited reduced shoulder muscle strength compared to asymptomatic individuals (p < 0.001). Additionally, joint repositioning accuracy was significantly lower in the T2DM group (p < 0.001). Negative correlations were observed between shoulder strength and joint repositioning accuracy in various directions (ranging from -0.29 to -0.46, p < 0.001), indicating that higher muscle strength was associated with improved joint repositioning accuracy in individuals with T2DM.

Conclusion

This study highlights the significant impact of T2DM on shoulder muscle strength and joint repositioning accuracy. Reduced strength and impaired accuracy are evident in individuals with T2DM, emphasizing the importance of addressing musculoskeletal aspects in diabetes management. The negative correlations suggest that enhancing shoulder muscle strength may lead to improved joint repositioning accuracy, potentially contributing to enhanced physical functioning in this population.

Effect of strength training on knee proprioception in patients with knee osteoarthritis: A systematic review and meta-analysis

Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g ​= ​-1.33 [-2.33, -0.32], g = ​-2.29 [-2.82, -1.75] and g ​= ​-2.40 [-4.23, -0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g ​= ​-0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.

Comparison of the in vivo kinematics between robotic-assisted Bi-cruciate retaining and Bi-cruciate stabilised total knee arthroplasty

BACKGROUND

Up to 20% of patients remain unsatisfied after total knee arthroplasty (TKA), prompting the development of new implants. Bi-Cruciate Retaining (BCR) TKA preserves both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), with the ACL beneficial for its proprioceptive qualities. The Bi-Cruciate Stabilised (BCS) TKA substitutes the ACL and PCL with a unique dual cam-post mechanism. Robotics improve accuracy and facilitate technically demanding TKA.

METHODS

This was a retrospective case-control study recruited from two centres. Measured outcomes included kinematic analysis, proprioception, and functional outcomes.

RESULTS

There was a significantly larger maximum flexion angle and range of flexion to extension in sit-to-stand and stairs in BCR when compared to BCS. Further analysis revealed more similarities between BCR and normal native knees. Proprioception and functional scores did not have any statistical difference.

CONCLUSION

BCR TKA demonstrated better knee flexion in weight-bearing active range of motion and showed similarities with normal knee kinematics.

Biofeedback-Based Proprioceptive Training to Improve Functional Prerequisites of Dragon Boating in Breast Cancer Survivors

Breast cancer (BC)-related sequelae drastically impact the psychophysical functioning and quality of life of affected women. Adapted physical activity (APA) has proved to effectively counteract these impairments in a non-medicalized framework. In particular, dragon boats are able to promote body functionality, social interaction, and quality of life in BC survivors, but the literature on specific motor gestures is scarce and practice is still based more on a re-educative perspective than a performative one. In this context, the present longitudinal study investigated the benefits of an adapted biofeedback-based sensorimotor training intervention on upper body functionality in a team of dragon ladies. The 8-week intervention was conceived as integrated dry workout sessions led by an APA kinesiologist and applied a novel sensorized proprioceptive device, such as a Libra board. Post-protocol evaluation revealed a significant improvement in bilateral upper limb mobility, core endurance, and trunk stability along with a distress decrease and quality of life enhancement through validated assessment tools. Our findings suggest that integrating biofeedback-based workout sessions can effectively promote upper body functionality in BC survivors practicing dragon boating. Furthermore, our innovative approach could help spread methodological hints able to boost exercise adherence in this target population, thus counteracting cancer recurrence while promoting overall well-being.

Impairment of lung volume perception and breathing control in hypermobile Ehlers-Danlos syndrome

Breathing difficulties and exertional dyspnea are frequently reported in hypermobile Ehlers-Danlos syndrome (hEDS); however, they are not clearly explained. An impaired proprioception or the addition of a cognitive task could influence ventilatory control. How can the perception of lung volume be measured? Is lung volume perception impaired in hEDS patients? Is the breathing control impaired during a cognitive task in hEDS patients? A device was developed to assess the accuracy of lung volume perception in patients with hEDS and matched control subjects. In the second step, ventilation was recorded in both groups with and without a cognitive task. Two groups of 19 subjects were included. The accuracy of lung volume perception was significantly (P < 0.01) lower at 30% of inspired vital capacity in patients with hEDS in comparison to the control group, and they showed erratic ventilation (based on spatial and temporal criteria) when performing a cognitive task. These data support the influence of the proprioceptive deficit on ventilatory control in hEDS patients. These elements may help to understand the respiratory manifestations found in hEDS. Future research should focus on this relationship between lung volume perception and ventilation, and could contribute to our understanding of other pathologies or exercise physiology.Trial registration number: ClinicalTrials.gov, NCT05000151.

The efficacy of taping on elbow proprioception in healthy individuals: A single-blinded randomized placebo-controlled study

BACKGROUND

Taping stimulates the mechanoreceptors, increases sensory information to the central nervous system, and improves sensorimotor synchronization, resulting in improved motor control. However, the efficacy of taping on elbow proprioception is not clear.

PURPOSE

This study aimed to evaluate the immediate effects of taping on elbow proprioception in healthy individuals.

STUDY DESIGN

This study was a two-arm, parallel-group, randomized, controlled, single-blinded study with a sham application.

METHODS

Fifty six healthy adults were randomized 1:1 to kinesio taping (n = 27) or sham taping (n = 29). Active joint position sense error (JPSE) was used to quantify proprioception using a universal goniometer at three-time points: baseline (BS), immediately after taping (IA), and 30 minutes after taping (30MA), with the tape still in place at 70° and 110° of elbow flexion. Participants were blinded to group assignments. The Friedman analysis assessed differences between evaluations within groups, and the Mann-Whitney U test determined differences between groups.

RESULTS

The study was completed with 56 participants and there were no dropouts. No skin reaction or adverse effect was observed in the participants and no test trial was excluded. The baseline scores of the groups were similar (p > 0.05). A significant difference was detected in the study group after kinesio taping at 70° (MD = -1.22; CI = (-2.33: -0.10; p < 0.005; d = 0.653) and 110° of elbow flexion (MD = -1.34; CI = 2,47: -0,21; p < 0.005; d = 0.73). This statistically significant difference was observed even at the 30MA evaluations at 70° (p < 0.05). Also, there was a statistically insignificant tendency to decrease in JPSE of both groups at both degrees following taping.

CONCLUSIONS

Elbow proprioception may be enhanced by kinesio taping, and this effect could last up to 30 minutes at 70° of elbow flexion. In contrast, sham taping did not produce such an improvement. Based on the differences in JPSE, kinesio taping proved more effective and had a longer-lasting impact than the sham application. The statistically insignificant tendency to decrease in JPSE may indicate that the 30-minute application period is inadequate to create a statistically significant effect on elbow proprioception. Longer usage periods can better reveal the effects of orthoses on proprioception.

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.

Proprioception evaluation and treatment: Hand therapist practice patterns

BACKGROUND

Little is known about how hand therapists assess proprioception and treat deficits in clinical practice and what types of diagnoses they see most often. To our knowledge, no survey has been completed regarding proprioception practice patterns among hand therapists.

PURPOSE

The purpose of this study was to examine current practice patterns related to the treatment and assessment of proprioception deficits by hand therapists in the United States.

STUDY DESIGN

This was a cross-sectional study using a survey instrument.

METHODS

The survey was sent to occupational and physical therapists identified as certified hand therapists or members of the American Society of Hand Therapists. The Checklist for Reporting Results of Internet E-Surveys was used in reporting results.

RESULTS

Members of American Society of Hand Therapists (n=152) responded to the survey. The participants were asked if they provided rehabilitation services to people who have proprioceptive deficits, and 122 (82%) responded yes, and 27 (18%) responded no. Most therapists use a standardized technique for assessing proprioceptive deficits. Hand therapists' mean confidence level in treating proprioception deficits was 7.2 out of 10 compared to the mean confidence level reported evaluating them, which was 6.1 out of 10.

CONCLUSIONS

Most hand therapists evaluate and treat proprioception deficits across a variety of diagnoses. While the frequency and duration of proprioception treatment varies, most hand therapists reported high use of open- and closed-chain exercises and activities along with elastic taping as part of their intervention approach.

Test-retest reliability of joint position sense in the elbow among healthy adults

BACKGROUND

Proprioception of the elbow is necessary for daily activities. Proprioception can be impaired with injury or pathology, and rehabilitation efforts seek to improve proprioception for improved upper extremity functioning. In clinical practice, joint position sense (JPS) testing is often utilized to assess conscious proprioception; however, varying methods exist with little evidence of psychometric properties, especially for the elbow.

PURPOSE

The primary aim of this study was to create a standardized elbow JPS test protocol using goniometry measurement to determine the most reliable testing position. The secondary aim was to determine if the elbow JPS test had acceptable test-retest reliability in healthy adults.

STUDY DESIGN

This was a cross-sectional study using a convenience sample of healthy adults.

METHODS

Three elbow positions (45°, 60°, and 75° of elbow flexion) were measured twice on the same day by a single rater using a universal goniometer. We calculated the absolute error in degrees between each position and reposition and the intraclass correlation coefficient (3,1) for relative reliability. We also calculated the standard error of the measurement and visually inspected Bland-Altman plots for absolute reliability.

RESULTS

Sixty-eight healthy adults (mean age 27.9 years, standard deviation 8.59) were assessed. The mean absolute error for all positions for test and retest was 5.7°. The intraclass correlation coefficients were moderate to good (0.57-0.75), and the standard error of the measurement was 2° (rounded) for all positions. The limits of agreement were moderately narrow, and the Bland-Altman plots showed a random distribution of errors for each position, indicating clinically acceptable measurement error.

CONCLUSIONS

The joint position reproduction test for JPS using goniometry demonstrated moderate to good test-retest reliability and acceptable measurement error in healthy adults. The elbow joint angle of 60° flexion was the most reliable for JPS testing, providing insight for JPS assessment in clinical practice.

Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report

BACKGROUND

Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements.

PURPOSE

This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS).

CASE DESCRIPTION

A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed.

OUTCOMES

The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability.

CONCLUSION

Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.

How does a motor or cognitive dual-task affect our sense of upper limb proprioception?

BACKGROUND

Daily upper limb activities require multitasking and our division of attention. How we allocate our attention can be studied using dual-task interference (DTi). Given the vital role proprioception plays in movement planning and motor control, it is important to investigate how conscious upper limb proprioception is impacted by DTi through cognitive and motor interference.

PURPOSE

To examine how dual-task interference impacts conscious upper limb proprioception during active joint repositioning tasks (AJRT).

METHODS

Forty-two healthy participants, aged between 18 and 35, took part in this cross-sectional study. Participants completed two AJRT during three conditions: baseline (single task), dual-cognitive task (serial subtractions), and dual-motor task (non-dominant hand movements). The proprioceptive error (PE; difference between their estimation and targeted position) was measured using an AJRT of 75% and 90% of maximum internal rotation using the Biodex System IIITM and the Upper Limb Proprioception Reaching Test (PRO-Reach). To determine if PEs differed during dual-task interference, interference change scores from baseline were used with one sample t-tests and analyses of variance.

RESULTS

The overall mean PE with the Biodex was 4.1° ± 1.9 at baseline. Mean change scores from baseline reflect a mean improvement of 1.5° ± 1.0 (p < .001) during dual-cognitive task and of 1.5° ± 1.2 (p < .001) during dual-motor task. The overall mean PE with the PRO-Reach was 4.4cm ± 1.1 at baseline. Mean change scores from baseline reflect a mean worsening of 1.0cm ± 1.1 (p < .001) during dual-cognitive task and improvement of 0.8cm ± 0.6 (p < .001) during dual-motor task. Analysis of variance with the Biodex PEs revealed an interference effect (p < .001), with the cognitive condition causing greater PEs compared to the motor condition and a criterion position effect (p = .006), where 75% of maximum IR produced larger PEs during both interference conditions. An interference effect (p = .022) with the PRO-Reach PEs was found highlighting a difference between the cognitive and motor conditions, with decreased PEs during the contralateral motor task.

CONCLUSION

Interference tasks did impact proprioception. Cognitive interference produced mixed results, whereas improved proprioception was seen during motor interference. Individual task prioritization strategies are possible, where each person may choose their own attention strategy when faced with dual-task interference.

Neural correlates of bilateral proprioception and adaptation with training

Bilateral proprioception includes the ability to sense the position and motion of one hand relative to the other, without looking. This sensory ability allows us to perform daily activities seamlessly, and its impairment is observed in various neurological disorders such as cerebral palsy and stroke. It can undergo experience-dependent plasticity, as seen in trained piano players. If its neural correlates were better understood, it would provide a useful assay and target for neurorehabilitation for people with impaired proprioception. We designed a non-invasive electroencephalography-based paradigm to assess the neural features relevant to proprioception, especially focusing on bilateral proprioception, i.e., assessing the limb distance from the body with the other limb. We compared it with a movement-only task, with and without the visibility of the target hand. Additionally, we explored proprioceptive accuracy during the tasks. We tested eleven Controls and nine Skilled musicians to assess whether sensorimotor event-related spectral perturbations in μ (8-12Hz) and low-β (12-18Hz) rhythms differ in people with musical instrument training, which intrinsically involves a bilateral proprioceptive component, or when new sensor modalities are added to the task. The Skilled group showed significantly reduced μ and low-β suppression in bilateral tasks compared to movement-only, a significative difference relative to Controls. This may be explained by reduced top-down control due to intensive training, despite this, proprioceptive errors were not smaller for this group. Target visibility significantly reduced proprioceptive error in Controls, while no change was observed in the Skilled group. During visual tasks, Controls exhibited significant μ and low-β power reversals, with significant differences relative to proprioceptive-only tasks compared to the Skilled group-possibly due to reduced uncertainty and top-down control. These results provide support for sensorimotor μ and low-β suppression as potential neuromarkers for assessing proprioceptive ability. The identification of these features is significant as they could be used to quantify altered proprioceptive neural processing in skill and movement disorders. This in turn can be useful as an assay for pre and post sensory-motor intervention research.

Reduced shoulder proprioception due to fatigue after repeated handball throws and evaluation of test-retest reliability of a clinical shoulder joint position test

Background

Proprioception is vital for motor control and can be disturbed, for example, due to fatigue or injury. Clinical feasible, reliable and valid tests of shoulder proprioception are warranted. The aim was to investigate the effects of local fatigue on shoulder proprioception and the reliability of a feasible joint position sense test using an experimental repeated measures design.

Method

Forty participants repeated a shoulder joint position sense test to assess test-retest reliability. The test was then utilized on a subgroup of handball players who were subjected to five bouts of a repeated throwing task with the dominant hand. The effect of local fatigue was investigated by comparing the fatigued with the non-fatigued shoulder.

Results

There was a significant interaction for the arm × bout (p = 0.028, ηp2 = 0.20) and a significant effect for the arm (p = 0.034, ηp2 = 0.35) with a significant decrease in joint position sense for the throwing arm compared to the non-throwing arm. The intraclass correlation coefficient was 0.78 (95% CI = [0.57; 0.89]). The standard error of measurement between trials was 0.70° (range: 0.57°-0.90°).

Discussion

The results indicate that repeated throwing to fatigue disturbs shoulder joint position sense. Assessment with the modified test showed acceptable reliability and can be a valuable assessment tool in the clinic.

Joint position sense error in the hip and knee without reference to the joint angle

BACKGROUND

Joint position reproduction measures the angle acuity of reference angle reproduction using an indicator angle. However, reference angles are often not available.

OBJECTIVE

This study aimed to examine joint position sense at three different targeted joint angles, which were estimated from the maximum range of motion (maxROM) without a reference angle at each targeted joint angle.

METHODS

The maxROM was measured in straight leg raise (SLR) and active knee extension (AKE) positions. In both positions, a targeted joint angle at 75% of the maxROM was assessed first, followed by that at 50% and 25% of the maxROM. A one-sample t-test was used to analyze differences between the targeted and reproduced angles in both positions.

RESULTS

All reproduced angles significantly differed from the targeted angle in both SLR and AKE positions except for the reproduced angle measured at 75% maxROM. Overall, position errors in the AKE position were higher than those in the SLR position.

CONCLUSIONS

Estimating the angle based on the maxROM without a matched reference angle may lead to significant discrepancies in comparison with the targeted joint angle. In clinical settings, if accurate reproduction of motions is required to improve proprioception, providing a reference angle might be helpful.

Proprioception-related gene mutations in relation to the aetiopathogenesis of idiopathic scoliosis: A scoping review

Since idiopathic scoliosis is a multifactorial disorder, the proprioceptive defect is considered one of its etiological factors. Genetic studies have separately revealed this relationship, yet it remains indeterminate which specific genes that related to proprioception contributed to the initiation, progression, pathology, and treatment outcomes of the curvature. A systematic search was conducted on four online databases, including PubMed, Web of Science, Embase, and Academic search complete. Studies were included if they involved human or animal subjects with idiopathic scoliosis and evaluated with proprioceptive genes. The search period was the inception of the database to February 21, 2023. Four genes (i.e., Ladybird homeobox 1 [LBX1], Piezo type mechanosensitive ion channel component 2 [PIEZO2], Runx family transcription factor 3 [RUNX3], and neurotrophin 3 [NTF3]) investigated in 19 studies were included. LBX1 has confirmed the correlation with the development of idiopathic scoliosis in 10 ethnicities, whereas PIEZO2 has shown a connection with clinical proprioceptive tests in subjects with idiopathic scoliosis. However, curve severity was less likely to be related to the proprioceptive genes. The potential pathology took place at the proprioceptive neurons. Evidence of proprioception-related gene mutations in association with idiopathic scoliosis was established. Nevertheless, the causation between the initiation, progression, and treatment outcomes with proprioceptive defect requires further investigation.

A Comparative Study of Knee Joint Proprioception Assessment in 12-Week Postpartum Women and Nulliparous Women

Introduction Proprioception is one's capacity to perceive bodily position, alignment, and movement. Several connective tissues, such as skin, ligaments, joint capsules, and muscles in the body, contain proprioceptive sensory receptors. Joint elasticity results from hormonal variations, notably the peak relaxin hormone during pregnancy, which also affects proprioceptive receptors. The musculoskeletal system may be affected by hormones and anatomical changes brought on by pregnancy, including joint laxity and modifications to posture and gait. The capacity to perceive the joint position and movement, or proprioception, may be impacted. To comprehend the impacts of pregnancy on joint function and postpartum women's rehabilitation options, this study compares knee joint proprioception in women who gave birth 12 weeks ago to nulliparous women. The study aims to assess and compare the degree of alteration in knee joint proprioception in 12-week postpartum females. Methodology A total of 160 participants were assessed during the entire study. Women from 18 to 35 years of age were included in the study. Women with any present knee joint injury, multiparty, or relevant surgical history were excluded. The procedure was performed under the author's surveillance at the Department of Community Health Physiotherapy. The knee joint reposition test was used to assess the knee joint proprioceptive error among two groups (80 each), including nulliparous women and the other 12-week postpartum women. An image tool provided by the University of Texas Health Science Centre at San Antonio (UTHSCSA) was created and offers the tool as computer software or a digital application for handling medical pictures and associated data, software 3.0 was used to determine the angular variation between angles in the targeted and achieved positions during the test. Result A significant proprioceptive error was observed among 12-week postpartum women compared to the nulliparous group of women. The mean error of knee joint repositions among 12-week postpartum women was 0.80±6.08 (P=0.0001), and among nulliparous women was 0.09±0.72 (P=0.0001). Conclusion Concluding insight that pregnancy affects postpartum women's risk of fall injuries and joint function due to altered proprioception. Compared to nulliparous women, proprioceptive error for the dominant knee joint was significant among 12-week postpartum females. The hormonal changes during pregnancy affect the proprioceptive receptors, especially the relaxin hormone surge, which results in joint laxity and may impair joint position sensing, increasing the risk of falls. To better acknowledge the effects of pregnancy on joint function and postpartum women's rehabilitation options, this study compares knee joint proprioception in postpartum and nulliparous women. It proves right about altered proprioception post-childbirth. The results of this study might aid medical practitioners in creating successful rehabilitation plans and treatments to stop postpartum women from falling.

A Systematic Review of the Learning Dynamics of Proprioception Training: Specificity, Acquisition, Retention, and Transfer

OBJECTIVE

We aimed to identify key aspects of the learning dynamics of proprioception training including: 1) specificity to the training type, 2) acquisition of proprioceptive skills, 3) retention of learning effects, and 4) transfer to different proprioceptive skills.

METHODS

We performed a systematic literature search using the database (MEDLINE, EMBASE, Cochrane Library, and PEDro). The inclusion criteria required adult participants who underwent any training program that could enhance proprioceptive function, and at least 1 quantitative assessment of proprioception before and after the intervention. We analyzed within-group changes to quantify the effectiveness of an intervention.

RESULTS

In total, 106 studies with 343 participant-outcome groups were included. Proprioception-specific training resulted in large effect sizes with a mean improvement of 23.4 to 42.6%, nonspecific training resulted in medium effect sizes with 12.3 to 22% improvement, and no training resulted in small effect sizes with 5.0 to 8.9% improvement. Single-session training exhibited significant proprioceptive improvement immediately (10 studies). For training interventions with a midway evaluation (4 studies), trained groups improved by approximately 70% of their final value at the midway point. Proprioceptive improvements were largely maintained at a delayed follow-up of at least 1 week (12 studies). Finally, improvements in 1 assessment were significantly correlated with improvements in another assessment (10 studies).

CONCLUSIONS

Proprioceptive learning appears to exhibit several features similar to motor learning, including specificity to the training type, 2 time constant learning curves, good retention, and improvements that are correlated between different assessments, suggesting a possible, common mechanism for the transfer of training.

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.

Acute effects of muscle vibration on elbow joint position sense in healthy young men: A randomized trial

BACKGROUND

The study aimed to investigate and compare the acute effects of 2 local vibration frequencies (63 Hz vs 42 Hz frequencies) applied to the biceps brachii muscles on the elbow joint position sense (JPS) in healthy young men.

METHODS

A 3-arm parallel-group design with randomization of participants was used. Forty-five healthy young men aged 19 to 30 years were randomly assigned to 3 groups: to receive 63 Hz (n = 15) in experimental group 1 (EG1) or 42 Hz (n = 15) in experimental group 2 (EG2) or sham vibration in the control group (n = 15). Participants in the EG1 and EG2 received 5 bouts of 1-minute vibration exposure to the biceps brachii muscle, with a 1-minute rest between the bouts. In control group, sham vibration was applied with the same duration and interval as in EG1 and EG2. The active elbow joint position error was selected as an outcome measure to assess elbow JPS. The target angle and the angle reproduced were measured using a Universal Goniometer. The difference between the target and the reproduced angles was calculated to determine active elbow joint position error. Measurements were made before the vibration application and right after it.

RESULTS

No statistically significant difference was observed in the JPS of the elbow joint over time in any group (P = .625). No statistically significant differences were observed between the 33 groups in the JPS of the elbow (P = .075).

CONCLUSION

There was no acute effect of vibration of the biceps brachii muscle at 63 and 42 Hz on active elbow JPS in healthy adults.

Is There a Difference in the Distribution of Mechanoreceptors among the Three Sections of the Anterior Talofibular Ligament?

BACKGROUND

We investigated whether the distribution of mechanoreceptors in three sections of the anterior talofibular ligament (ATFL) differed.

METHODS

The ATFL was obtained from 29 ankles of 21 fresh-frozen cadavers and divided into fibular attachment, mid-ligament, and talar attachment parts. Histologically, mechanoreceptors were classified as Ruffini (type I), Vater-Pacini (type II), Golgi-Mazzoni (type III), and free nerve ending corpuscles (type IV); the presence of these mechanoreceptors was compared among the three ATFL sections.

RESULTS

Type I mechanoreceptors were significantly more numerous than the other receptor types. Comparing the three sections of the ATFL, the number of type I mechanoreceptors differed significantly between the mid-ligament and fibular attachment (p = 0.006), while the number of type III mechanoreceptors differed significantly between the talar and fibular attachments (p = 0.005) and between the mid-ligament and talar attachment (p = 0.011).

CONCLUSIONS

The four types of mechanoreceptors were distributed differently among the three sections of the ATFL. Type I mechanoreceptors were more numerous in all sections compared to the other receptors.

Ankle proprioception in table tennis players: Expertise and sport-specific dual task effects

OBJECTIVES

To compare ankle proprioception between professional adolescent table tennis players at national and regional levels and age-matched non-athletes, and, in a nominally upper-limb sport, to explore the relationships between single- and dual-task ankle proprioception, years of training and sport-specific performance.

DESIGN

Cross-sectional observational study.

METHODS

Fifty-five participants (29 professional adolescent table tennis players and 26 non-athletic peers) volunteered. Ankle proprioception was first assessed using the active movement extent discrimination apparatus (AMEDA-single) for all; yet only the players were then re-assessed while executing a secondary ball-hitting task (AMEDA-dual). The mean Area Under the Receiver Operating Characteristic Curve was calculated as the proprioceptive score, and years of training and hitting rate were recorded.

RESULTS

National-level players had significantly better ankle proprioception as shown by higher AMEDA-single scores than the other groups (all p < 0.05). Ankle proprioceptive performance was significantly impaired while ball-hitting (F1,28 = 58.89, p ≤ 0.001, ηp2 = 0.69). National-level players outperformed the regional-level significantly on the AMEDA-dual task (F1,27 = 21.4, p ≤ 0.001, ηp2 = 0.44). Further, ankle proprioceptive performance was related to expertise, in that both AMEDA-single and AMEDA-dual proprioceptive scores were correlated with years of training and ball-hitting rate (r from 0.40 to 0.54, all p < 0.05).

CONCLUSIONS

Ankle proprioception is a promising measure that may be used to identify different ability levels among adolescent table tennis players. Superior ankle proprioception may arise from rigorous training and contribute to stroke accuracy. Dual-task proprioceptive assessment suggests how elite table tennis players perform differently from lower-ranked players in complex and changeable sports circumstances.

Measuring upper limb active joint position sense: Introducing a new clinical tool - The Upper Limb Proprioception Reaching Test

BACKGROUND

Proprioception is our sense of body awareness, including the sub-category of active joint position sense (AJPS). AJPS is fundamental to joint stability and movement coordination. Despite its importance, there remain few confident ways to measure upper limb AJPS in a clinic.

OBJECTIVE

To assess a new AJPS clinical tool, the Upper Limb Proprioception Reaching Test (PRO-Reach; seven targets), for discriminant validity, intra-rater and absolute reliability.

DESIGN

Cross-sectional measurement study.

METHODS

Seventy-five healthy participants took part in a single session with 2 consecutive evaluations (E1 and E2) (within-day reliability). Twenty participants were randomly selected to perform a dominant shoulder fatigue protocol (discriminant validity), whereafter a third evaluation was repeated (E3). The PRO-Reach was analyzed with paired t tests (discriminant validity), intra-class correlation coefficients (ICCs) and minimal detectable change [MDC]) (intra-rater: within-day and between-trial relative and absolute reliability).

RESULTS

The PRO-Reach supports moderate (mostly superior targets) to excellent (mostly inferior targets) reliability. Between-trial ICCs (T1/T2/T3) varied between 0.72 and 0.90, and within-day (E1/E2) ICCs between 0.45 and 0.72, with associated MDC95 values (3.9-5.0 cm). The overall scores (seven targets) supported the strongest within-day reliability (ICC = 0.77). The inferior targets demonstrated the highest between-trial and within-day reliability (ICCs = 0.90 and 0.72). A fatigue effect was found with the superior and superior-lateral targets (P < .05).

CONCLUSIONS

The inferior targets and overall scores demonstrate the strongest reliability. The use of the PRO-Reach tool may be suitable for clinical use upon further psychometric testing amongst pathological populations.

LEVEL OF EVIDENCE

Level III cross-sectional study.

Changes in proprioception at different time points following anterior cruciate ligament injury or reconstruction

PURPOSE

To investigate the changes in 30° and 60° position sense in patients with anterior cruciate ligament (ACL) injury at different time points after injury and reconstruction.

METHODS

Patients were divided into six groups according to time after ACL injury and reconstruction: group A (ACL injury 1.5-6 months), group B (ACL injury 6-12 months), group C (ACL injury > 12 months), group D (postoperative ACL reconstruction 1-6 months), group E (postoperative ACL reconstruction > 6 months), and group F consisting of 14 healthy adults (control group). The ability of the affected leg to reproduce the same joint position during knee flexion was tested using active joint position sense assays to assess proprioception in both the lower extremities of the patient or between groups.

RESULTS

Proprioception decreased rapidly during the early stages of ACL injury. Significant difference in the affected side at 30° compared to the healthy side (Group A: 4.70 (4.78, 9.00) vs 4.15 (3.35, 6.13), P = 0.03; Group B: 2.90 (0.48, 4.56) vs 8.30 (4.18, 10.43), P = 0.001; Group E: 6.25 (2.55, 11.60) vs 9.60 (3.90, 12.73), P = 0.009). However, no significant differences were detected for a double lower limb contrast of 60° (Group A: 5.1 (1.00, 8.00) vs 3.00 (0.75, 3.55), P = 0.044). Finally, the affected side of patients in groups C, D and E had significant differences in position perception at 30° compared with healthy subjects (P < 0.01), and the affected side of patients in groups C and E had significant differences in position sense at 60° compared with healthy subjects (P < 0.01).

CONCLUSION

ACL injury had a greater impact on the patient's 30° position sense, with only a small impact for 60°. Further, the early and middle proprioception recovery stages after ACL injury were the best before surgery. Finally, proprioception recovery training should be performed soon after injury.

Known-group validity of passive knee joint position sense: a comparison between individuals with unilateral anterior cruciate ligament reconstruction and healthy controls

BACKGROUND

Knee joint position sense (JPS) might be negatively affected after injuries to the anterior cruciate ligament (ACL). Recent systematic reviews suggest further investigation of psychometric properties, including validity, of knee JPS tests following ACL reconstruction (ACLR). This study investigated the known-group validity by comparing knee JPS errors between individuals who underwent unilateral ACLR and healthy controls.

METHODS

This cross-sectional study involved 36 men, including 19 after ACLR (ACLR group) and 17 healthy controls (control group). In both groups, the absolute error (AE), constant error (CE) and variable error (VE) of passive knee JPS were calculated in the flexion and extension directions, for two target angles (30° and 60° flexion) per direction. Discriminative validity was evaluated by comparing JPS errors between the operated and non-operated knees in the ACLR group. Known-group validity was evaluated by comparing JPS errors between the operated knees in the ACLR group and the asymptomatic non-dominant knees of healthy controls.

RESULTS

Mean AE, CE and VE for all tests were 4.1°, - 2.3° and 3.6° for the operated knees in the ACLR group, 5.5°, - 2.6° and 3.3° for the non-operated knees in the ACLR group and 4.6°, - 2.6° and 3.3° for the non-dominant knees in the control group, respectively, regardless of the test direction and target angle. The operated knees in the ACLR group did not show significantly greater JPS errors compared to the contralateral knees in the ACLR group and to the non-dominant knees in the control group (p ≥ 0.05). On the other hand, the non-operated knees showed significantly greater AE for the 0°-60° flexion test (p = 0.025) and CE for the 0°-30° flexion test (p = 0.024) than the operated knees in the ACLR group. JPS errors did not significantly differ in the operated knees in the ACLR group based on the direction of movement and the target angle. However, the errors were significantly higher when the knee was moved through a greater range compared to that of a lesser range between the starting and target angles.

CONCLUSION

The ACLR knees did not show greater passive JPS errors than the contralateral or control knees. The direction of movement and target angle did not influence the JPS acuity after ACLR. However, higher JPS errors were evident when the knee was moved through a greater range compared to a lesser range of motion. Further studies investigating the psychometric properties of standardized JPS tests following ACLR are warranted.

Robotically quantifying finger and ankle proprioception: Role of range, speed, anticipatory errors, and learning

Proprioception plays a key role in motor control and stroke recovery. Robotic devices are increasingly being used to improve proprioceptive assessments, but there is a lack of knowledge about how programmable factors such as testing range, speed, and prior exposure affect tests. From a physiological standpoint, such factors may regulate the sensitivity of limb proprioceptors, thereby influencing assessment results when not controlled for. To determine the relative influence of such factors, we studied the Crisscross proprioceptive assessment, a recently developed robotic assessment that requires participants to indicate when two joints pass by each other as they are moved passively by the robot. We implemented Crisscross with novel robots for the fingers and ankles and tested young unimpaired participants in single sessions (N = 16) and longitudinally (N = 5, across 15-30 sessions over 3-10 weeks). In single-session testing, we found that proprioceptive acuity was better for the fingers than the ankle (p < 0.01). For both limbs, acuity improved near the ends of the range of motion, which may be due to greater involvement of load and joint receptors. Acuity was poorer for slower movements due to greater anticipatory errors. These results show how the range and speed selected for a proprioceptive test affect proprioceptive acuity and highlight the heightened role of anticipatory errors at slow speeds. Improvements in proprioceptive acuity were not detectable in a single session, but acuity improved across multiple testing sessions (p < 0.01). This result shows that multiple prior exposure over at least several days can affect acuity.Clinical Relevance- Proprioceptive assessments should account for range and speed, which could be enabled by leveraging robotics technology. Proprioceptive acuity can be improved through repeated testing, an observation that is relevant to proprioceptive rehabilitation as well.

Use of a physiological profile to document upper limb motor impairment in ageing and in neurological conditions

Profiling performance in the physiological domains underpinning upper limb function (such as strength, sensation, coordination) provides insight into an individual's specific impairments. This compliments the traditional medical 'diagnosis' model that is currently used in contemporary medicine. From an initial battery of 13 tests in which data were collected across the adult lifespan (n = 367, 20-95 years) and in those with neurological conditions (specifically, multiple sclerosis (n = 40), Parkinson's disease (n = 34), and stroke (n = 50)), six tests were selected to comprise a core upper limb physiological profile assessment (PPA). This comprised measures of handgrip strength, simple reaction time, finger dexterity, tactile sensation, bimanual coordination, and a functional task. Individual performance in each of these tests can be compared to a reference population score (devised from our database of healthy individuals aged under 60 years), informing the researcher or clinician how to best direct an intervention or treatment for the individual based on their specific impairment(s). Lastly, a composite score calculated from the average performance across the six tests provides a broad overview of an individual's overall upper limb function. Collectively, the upper limb PPA highlights specific impairments that are prevalent within distinct pathologies and reveals the magnitude of upper limb motor impairment specific to each condition.

A reliable and efficient adaptive Bayesian method to assess static lower limb position sense

BACKGROUND

Lower limb proprioception is critical for maintaining stability during gait and may impact how individuals modify their movements in response to changes in the environment and body state, a process termed "sensorimotor adaptation". However, the connection between lower limb proprioception and sensorimotor adaptation during human gait has not been established. We suspect this gap is due in part to the lack of reliable, efficient methods to assess global lower limb proprioception in an ecologically valid context.

NEW METHOD

We assessed static lower limb proprioception using an alternative forced choice task, administered twice to determine test-retest reliability. Participants stood on a dual-belt treadmill which passively moved one limb to stimulus locations selected by a Bayesian adaptive algorithm. At the stimulus locations, participants judged relative foot positions and the algorithm estimated the point of subjective equality (PSE) and the uncertainty of lower limb proprioception.

RESULTS

Using the Bland-Altman method, combined with Bayesian statistics, we found that both the PSE and uncertainty estimates had good reliability.

COMPARISON WITH EXISTING METHOD(S)

Current methods assessing static lower limb proprioception do so within a single joint, in non-weight bearing positions, and rely heavily on memory. One exception assessed static lower limb proprioception in standing but did not measure reliability and contained confounds impacting participants' judgments, which we experimentally controlled here.

CONCLUSIONS

This efficient and reliable method assessing lower limb proprioception will aid future mechanistic understanding of locomotor adaptation and serve as a useful tool for basic and clinical researchers studying balance and falls.

Cervical mobility and cervical proprioception in relation to fall risk among older adults: a prospective cohort study

PURPOSE

Age-related decreases in cervical mobility and proprioception have previously been demonstrated. Potential associations of these deteriorations with fall risk have not been investigated so far. This study aims to compare cervical mobility and proprioception between fallers and non-fallers and prospectively assess the contribution of these parameters in fall risk identification among healthy older adults.

METHODS

95 community-dwelling older adults underwent a cervical screening. Active cervical range of motion (aCROM) was measured using a digital inclinometer and cervical proprioception was assessed by determining joint position error (JPE). Fear of falling was identified through the Iconographical Falls Efficacy Scale (iconFES). Falls were prospectively recorded during a 1-year follow-up period using monthly calendars. Univariate and multivariate logistic regression analyses were conducted to examine the association between these parameters and falls occurrence.

RESULTS

Baseline measurements revealed reduced cervical performance (i.e., smaller aCROM and larger JPE) among individuals who reported at least one fall during the following year ("fallers"). The multivariate logistic regression model contained eight independent variables (age, sex, walking aid, fall history, iconFES, aCROM F, aCROM E and JPE) and correctly classified 77.8% of cases.

CONCLUSION

Although the contribution of cervical parameters to fall risk identification seems to be rather small compared to well-known (though often unmodifiable) major risk factors, further research is needed to elucidate underlying mechanisms of cervical functions in relation to falls. Second, it would be interesting to develop a targeted fall preventive cervical exercise program and assess its effectiveness in terms of falls occurrence.

A reliable and efficient adaptive Bayesian method to assess static lower limb position sense

Background

Lower limb proprioception is critical for maintaining stability during gait and may impact how individuals modify their movements in response to changes in the environment and body state, a process termed "sensorimotor adaptation". However, the connection between lower limb proprioception and sensorimotor adaptation during human gait has not been established. We suspect this gap is due in part to the lack of reliable, efficient methods to assess global lower limb proprioception in an ecologically valid context.

New Method

We assessed static lower limb proprioception using an alternative forced choice task, administered twice to determine test-retest reliability. Participants stood on a dual-belt treadmill which passively moved one limb to stimulus locations selected by a Bayesian adaptive algorithm. At the stimulus locations, participants judged relative foot positions and the algorithm estimated the point of subjective equality (PSE) and the uncertainty of lower limb proprioception.

Results

Using the Bland-Altman method, combined with Bayesian statistics, we found that both the PSE and uncertainty estimates had good reliability.

Comparison with Existing Methods

Current methods assessing static lower limb proprioception do so within a single joint, in non-weight bearing positions, and rely heavily on memory. One exception assessed static lower limb proprioception in standing but did not measure reliability and contained confounds impacting participants' judgments, which we experimentally controlled here.

Conclusions

This efficient and reliable method assessing lower limb proprioception will aid future mechanistic understanding of locomotor adaptation and serve as a useful tool for basic and clinical researchers studying balance and falls.

Cervical Proprioception Assessed through Targeted Head Repositioning: Validation of a Clinical Test Based on Optoelectronic Measures

Neck proprioception is commonly assessed with head repositioning tests. In such a test, an operator rotates the head of a blindfolded individual to a target position. After returning to the rest position, the participant actively repositions the head to the target. Joint Position Error (JPE) is the angular difference between the target angle (however oriented in a 3D space) and the actively reached positions (the smaller the difference, the better the proprioception). This study aimed to validate a head-to-target (HTT) repositioning test using an optoelectronic system for also measuring the components of the JPE in the horizontal, frontal, and sagittal planes. The head movements requested by the operator consisted of 30° left-right rotations and 25° flexion-extension. The operators or subjects could not obtain these movements without modest rotations in other planes. Two operators were involved. Twenty-six healthy participants (13 women) were recruited (mean (SD): 33.4 (6.3) years). The subjects’ JPE in the requested (intended) plane of motion (JPEint-component) was a few degrees only and smaller for flexion-extensions than for left-right rotations (right rotation: 5.39° (5.29°); left rotation: 5.03° (4.51°), extension: 1.79° (3.94°); flexion: 0.54° (4.35°)). Participants’ average error in unintended planes was around 1° or less. Inter-operator consistency and agreement were high. The smallest detectable change, at p < 0.05, for JPEint-component ranged between 4.5° and 6.98°. This method of optoelectronic measurement in HTT repositioning tests provides results with good metric properties, fostering application to clinical studies.

Limb Preference Changes after Focused-Ultrasound Thalamotomy for Tremor

BACKGROUND

Magnetic resonance-guided focused-ultrasound (MRgFUS) thalamotomy is an effective treatment for essential and other tremors. It targets the ventrointermedius (Vim) nucleus, which is the thalamic relay in a proprioceptive pathway, and contains kinesthetic cells. Although MRgFUS thalamotomy reduces some risks associated with more invasive surgeries, it still has side effects, such as balance and gait disturbances; these may be caused by the lesion impacting proprioception.

OBJECTIVES

Our aim was to quantitatively measure the effects of MRgFUS on proprioception and limb use in essential tremor patients. We hypothesized that this thalamotomy alters proprioception, because the sensorimotor Vim thalamus is lesioned.

METHODS

Proprioception was measured using the Kinarm exoskeleton robot in 18 patients. Data were collected pre-operatively, and then 1 day, 3 months, and 1 year after surgery. Patients completed four tasks, assessing motor coordination and postural control, goal-directed movement and bimanual planning, position sense, and kinesthesia.

RESULTS

Immediately after surgery there were changes in posture speed (indicating tremor improvement), and in bimanual hand use, with the untreated limb being preferred. However, these measures returned to pre-operative baseline over time. There were no changes in parameters related to proprioception. None of these measures correlated with lesion size or lesion-overlap with the dentato-rubro-thalamic tract.

CONCLUSIONS

This is the first quantitative assessment of proprioception and limb preference following MRgFUS thalamotomy. Our results suggest that focused-ultrasound lesioning of the Vim thalamus does not degrade proprioception but alters limb preference. This change may indicate a required "relearning" in the treated limb, because the effect is transient. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Test-Retest Reliability of a Passive Joint Position Sense Test After ACL Reconstruction: Influence of Direction, Target Angle, Limb, and Outcome Measures

Background:

The joint position sense (JPS) is an element of proprioception and defined as an individual’s ability to recognize joint position in space. The JPS is assessed by measuring the acuity of reproducing a predetermined target angle. The quality of psychometric properties of knee JPS tests after anterior cruciate ligament reconstruction (ACLR) is uncertain.

Purpose/Hypothesis:

The purpose of this study was to evaluate the test-retest reliability of a passive knee JPS test in patients who underwent ACLR. We hypothesized that the passive JPS test would produce reliable absolute error, constant error, and variable error estimates after ACLR.

Study Design:

Descriptive laboratory study.

Methods:

Nineteen male participants (mean age, 26.3 ± 4.4 years) who had undergone unilateral ACLR within the previous 12 months completed 2 sessions of bilateral passive knee JPS evaluation. JPS testing was conducted in both the flexion (starting angle, 0°) and the extension (starting angle, 90°) directions in the sitting position. The absolute error, constant error, and variable error of the JPS test in both directions were calculated at 2 target angles (30° and 60° of flexion) by using the angle reproduction method for the ipsilateral knee. The standard error of measurement (SEM), smallest real difference (SRD), and intraclass correlation coefficients (ICCs) with 95% Cis were calculated.

Results:

ICCs were higher for the JPS constant error (operated and nonoperated knee, 0.43-0.86 and 0.32-0.91, respectively) compared with the absolute error (0.18-0.59 and 0.09-0.86, respectively) and the variable error (0.07-0.63 and 0.09-0.73, respectively). The constant error of the 90°-60° extension test showed moderate to excellent reliability for the operated knee (ICC, 0.86 [95% CI, 0.64-0.94]; SEM, 1.63°; SRD, 4.53°), and good to excellent reliability for the nonoperated knee (ICC, 0.91 [95% CI, 0.76-0.96]; SEM, 1.53°; SRD, 4.24°).

Conclusion:

The test-retest reliability of the passive knee JPS tests after ACLR varied depending on the test angle, direction, and outcome measure (absolute error, constant error, or variable error). The constant error appeared to be a more reliable outcome measure than the absolute error and the variable error, mainly during the 90°-60° extension test.

Clinical Relevance:

As constant errors have been found reliable during the 90°-60° extension test, investigating these errors—in addition to absolute and variable errors—to reflect bias in passive JPS scores after ACLR is warranted.

The effects of chronic concentric and eccentric training on position sense and joint reaction angle of the knee extensors

The aim of the present study was to compare the effect of chronic concentric or eccentric training on position sense and joint reaction angle, in healthy, untrained young men. Twenty-four men were randomly assigned into a pure concentric (CT) or a pure eccentric (ET) group and performed for 8 weeks, one training session/week, 75 maximal knee extensors contractions. Before and 48 h after the first (W1) and the last (W8) training sessions, knee joint position sense and joint reaction angle were assessed at three different knee angles (i.e. 30°, 45° and 60°). At the same time points, indirect indices of exercise-induced muscle damage (EIMD) were evaluated (i.e. range of motion [ROM], optimal angle, maximum isometric, concentric and eccentric torques, delayed onset muscle soreness [DOMS] and blood creatine kinase concentrations [CK]). Forty-eight hours post W1, position sense, reaction angle and all EIMD indices were significantly changed for both groups (p < 0.05; η²: 0.125-0.618), however, greater alterations were observed after ET. Significant correlations were found, in both groups, between the training-induced changes of position sense, reaction angles and the changes of EIMD biomarkers (r: -0.855-0.825; p < 0.005). No significant changes were found 48 h post W8 for position sense, reaction angle and EIMD indices (p > 0.285) for both CT or ET groups. In conclusion, exercise-induced changes in position sense and reaction angle, were related to the magnitude of EIMD, and not by the type of muscle contraction per se. HighlightsExercise induced changes in position sense and reaction angle, were related to the magnitude of EIMD, and not by the type of muscle contraction per se.After the 1st training session eccentric exercise caused greater disturbances, compared to concentric exercise, in EIMD indices which caused concomitant disturbances to position sense and knee reaction angle.8 weeks of either eccentric or concentric training leads to preservation of position sense and knee reaction angle 48 h after maximal intensity exercise of either types of muscle contraction.

Muscle strength, balance and upper extremity function are not predictors of cervical proprioception in healthy young subjects

Purpose/Aim: The aim of this study is to examine the relationship between cervical proprioception sense and balance, hand grip strength, cervical region muscle strength and upper extremity functionality in healthy young subjects.Methods: A total of 200 people with a mean age of 20.8 ± 1.8 participated in the study. Cervical proprioception sense of the participants was evaluated with Cervical Joint Position Error Test (CJPET), balance with Biodex Stability System, hand grip strength with hand dynamometer, and upper extremity functionality with Perdue Pegboard test. The relationship of variables with cervical proprioception was evaluated with Pearson Correlation analysis.Results: According to this study results, there was no significant relationship between CJPET (extension, left rotation, right rotation) and sub-parameters of dynamic balance (anteroposterior, mediolateral, overall), cervical muscle strength and hand grip strength (p > 0.05). There was a significant correlation between CJPET flexion and static balance variables (p < 0.05).Conclusion: According to this study, there is no relationship between cervical proprioception and balance, hand grip muscle strength, cervical region muscle strength and upper extremity functionality in healthy young subjects.

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.

Knee position sense and knee flexor neuromuscular function are similarly altered after two submaximal eccentric bouts

PURPOSE

This study examined eccentric-induced fatigue effects on knee flexor (KF) neuromuscular function and on knee position sense. This design was repeated across two experimental sessions performed 1 week apart to investigate potential repeated bout effects.

METHODS

Sixteen participants performed two submaximal bouts of KF unilateral eccentric contractions until reaching a 20% decrease in maximal voluntary isometric contraction force. Knee position sense was evaluated with position-matching tasks in seated and prone positions at 40° and 70° of knee flexion so that KF were either antagonistic or agonistic during the positioning movement. The twitch interpolation technique was used to assess KF neuromuscular fatigue. Perceived muscle soreness was also assessed. Measurements were performed before, immediately (POST) and 24 h after (POST24) each eccentric bout.

RESULTS

No repeated bout effect on neuromuscular function and proprioceptive parameters was observed. At POST, central and peripheral factors contributed to the force decrement as shown by significant decreases in voluntary activation level (- 3.8 ± 4.8%, p < 0.01) and potentiated doublet torque at 100 Hz (- 10 ± 15.8%, p < 0.01). At this time point, position-matching errors significantly increased by 1.7 ± 1.9° in seated position at 40° (p < 0.01). At POST24, in presence of muscle soreness (p < 0.05), although KF neuromuscular function had recovered, position-matching errors increased by 0.6 ± 2.6° in prone position at 40° (p < 0.01).

CONCLUSION

These results provide evidence that eccentric-induced position sense alterations may arise from central and/or peripheral mechanisms depending on the testing position.

Assessing proprioception through time-variability properties of acceleration

Proprioception is a crucial property for movement stability and balance, but its current assessment, based on clinical testing, lacks precision and adequacy in real contexts. This study proposes assessing proprioception and its sensitivity to training effects through acceleration time series recorded during two slackline experiments. In the first experiment, slackliners of different expertise (highly and poorly trained) had to walk on a slackline for 30 s. In the second, twelve beginners had to balance up on the slackline for at least 11 s before and after a training process. Acceleration time series were recorded in body components (legs and centre of mass) and the slackline. The acceleration fluctuations were analysed through Detrended Fluctuation Analysis. The obtained Hurst (H)-exponents were compared between both groups (first experiment) and before and after training (second experiment) using Whitney and Wilcoxon tests, respectively. The values of H-exponents were lower in the highly trained group (Z = -2.15, p = 0.03) (first experiment), and in the post-training conditions (Z = -2.35, p = 0.02) (second experiment). These results suggest better motor and proprioceptive control with training status. Hence, the time-variability structure of acceleration in real contexts, like slackline tasks, is proposed as an objective measure of proprioception and its training effects.

Reliability of the active knee joint position sense test and influence of limb dominance and sex

The output of a sensorimotor performance can be measured with the joint position sense (JPS) test. However, investigations of leg dominance, sex and quality measures on this test are limited. Therefore, these potential influencing factors as well as reliability and consistency measures were evaluated for angular reproduction performance and neuromuscular activity during the active knee JPS test in healthy participants. Twenty healthy participants (10 males; 10 females; age 29 ± 8 years; height 165 ± 39 cm; body mass 69 ± 13 kg) performed a seated knee JPS test with a target angle of 50°. Measurements were conducted in two sessions separated by two weeks and consisted of two blocks of continuous angular reproduction (three minutes each block). The difference between reproduced and target angle was identified as angular error measured by an electrogoniometer. During reproduction, the neuromuscular activity of the quadriceps muscle was assessed by surface electromyography. Neuromuscular activity was normalized to submaximal voluntary contraction (subMVC) and displayed per muscle and movement phase. Differences between leg dominance and sex were calculated using Friedman-test (α = 0.05). Reliability measures including intraclass correlation coefficient (ICC), Bland-Altman analysis (bias ± limits of agreement (LoA)) and minimal detectable change (MDC) were analysed. No significant differences between leg dominance and sex were found in angular error and neuromuscular activity. Angular error demonstrated inter-session ICC scores of 0.424 with a bias of 2.4° (± 2.4° LoA) as well as MDC of 6.8° and moderate intra-session ICC (0.723) with a bias of 1.4° (± 1.65° LoA) as well as MDC of 4.7°. Neuromuscular activity for all muscles and movement phases illustrated inter-session ICC ranging from 0.432 to 0.809 with biases between - 2.5 and 13.6% subMVC and MDC from 13.4 to 63.9% subMVC. Intra-session ICC ranged from 0.705 to 0.987 with biases of - 7.7 to 2.4% subMVC and MDC of 2.7 to 46.5% subMVC. Leg dominance and sex seem not to influence angular reproduction performance and neuromuscular activity. Poor to excellent relative reliability paired with an acceptable consistency confirm findings of previous studies. Comparisons to pathological populations should be conducted with caution.

Wrist Proprioception in Adults with and without Subacute Stroke

Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) completed the Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception, as well as motor and cognitive testing. Patients were serially tested when available (n = 12, mean 11 days between assessments). In controls, mean(±SD) WPST error was 9.7 ± 3.5° in the dominant wrist and 8.8 ± 3.8° in the nondominant wrist (p = 0.31). In patients with stroke, WPST error was 18.6 ± 9° in the more-affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6° in the less-affected wrist, with abnormal values present in 72.2%. Error in the more-affected wrist was higher than in the less-affected wrist (p = 0.003) or in the dominant (p = 0.001) and nondominant (p < 0.001) wrist of controls. Age and BBT performance correlated with dominant hand WPST error in controls. WPST error in either wrist after stroke was not related to age, BBT, MoCA, or Fugl-Meyer scores. WPST error did not significantly change in retested patients. Wrist proprioception deficits are common, bilateral, and persistent in subacute stroke and not explained by cognitive or motor deficits.

Concurrent validity and reliability of a smartphone-based application for the head repositioning and cervical range of motion

Objectives

To evaluate the validity and reliability of a smartphone-based application against inertial sensors to measure head repositioning (by using joint position sense –JPS) and cervical range of motion (ROM).

Methods

JPS and cervical ROM were evaluated for neck flexion, extension and both-sides lateral flexion in thirty-one volunteers. Participants were simultaneously evaluated with inertial sensors and the smartphone application. A total of 248 angles were compared for concurrent validity. Inter-tester and intra-tester reliability were evaluated through scoring of images with the smartphone application by two testers, and re-scoring images by the same tester.

Results

Very high correlation was observed between both methods for ROM in all neck movements and JPS in left-side lateral flexion (r>0.9), and high for JPS in the rest of movements (r>0.8). Bland-Altman plots always demonstrated absolute agreement. Inter-and intra-tester reliability was perfect for JPS and ROM in all the neck movements (ICC>0.81).

Conclusions

This smartphone-based application is valid and reliable for evaluating head repositioning and cervical ROM compared with inertial sensors in healthy and young adults. Health professionals could use it in an easier and portable way in field conditions.