Clinical evaluation of motion and position sense in the upper extremities of the elderly using motion analysis system

Concentric exercise-induced fatigue of the shoulder impairs proprioception but not motor control or performance in healthy young adults

OBJECTIVES

To investigate the effect of concentric fatigue on proprioception, motor control and performance of the shoulder in healthy young adults.

DESIGN

Test-retest experimental design.

SETTING

Human performance laboratory.

PARTICIPANTS

20 healthy adults.

MAIN OUTCOME MEAUSURE(S)

Proprioception was assessed using the joint repositioning sense (JRS) and the threshold to detection of passive movement (TTDPM). Motor control was assessed using the Y-balance Upper Quarter test (YBT-UQ) and performance using the Athletic Shoulder test (ASH test). All tests were conducted before and immediately after fatigue intervention (CON/CON protocol).

RESULTS

Following fatigue, absolute angular error (AAE) was significantly increase by 160.27 %. Moreover, there was a significant increase (48.41 %) in TTDPM after fatigue. Furthermore there was no significant differences in motor control and performance before and after fatigue intervention.

CONCLUSIONS

Since muscular fatigue negatively affects shoulder proprioception, it is essential to assess proprioception before and after fatigue to detect any dysfunctions that may arise as a result of fatigue. To address these dysfunctions, it is recommended to engage in proprioceptive exercises under situations of fatigue in order to enhance the sensitivity of the mechanoreceptors.

The effect of juggling on the proprioceptive and attentional abilities among older women

Background

Age-related changes in attentional abilities can lead to a decline in body segment awareness in space. However, studies have reported that physical activity can improve proprioception among older adults, although proven activities with this potential are limited. Juggling is a promising activity for enhancing proprioception, as it requires high levels of attention and sensory precision. The first hypothesis posited that a juggling intervention would positively impact ipsilateral and contralateral elbow joint position matching without visual input. The second hypothesis suggested a correlation between cognitive abilities and joint position sense efficiency.

Methods

A total of 20 older women (mean age: 69.95 ± 4.58) participated in a repeated-measures study using a Latin square design. Measurements were taken at three time points (baseline, post-juggling, and control). Ipsilateral and contralateral elbow joint position matchings without visual or verbal feedback of accuracy were used to assess proprioception. Attention and reaction time variables were measured using the Vienna Test System protocols.

Results

Although significant changes were observed between baseline and subsequent time points in joint position sense accuracy, no specific effect of juggling was detected. Low and medium correlations were found between decision time and the variability of choice reaction time with contralateral accuracy. For ipsilateral accuracy, a relationship was observed only with handedness. No correlations were found between attention test scores and joint position sense accuracy.

Conclusion

The study did not demonstrate a significant effect of juggling on position-matching ability. However, cognitive abilities such as decision speed and the stability of choice reaction time may play a role in enhancing position-matching in older women.

Clinical trial registration

ClinicalTrials.gov, identifier NCT06108713.

Assessment of joint position sense in active and passive modes with various elbow flexion angles and movement speeds using an isokinetic dynamometer

BACKGROUND

Joint position sense is the ability to detect body segment position in space and is commonly used to represent proprioceptive performance. The isokinetic dynamometer is frequently used to evaluate elbow joint position sense during active and passive reproduction tasks with various testing protocols. However, few studies have reported the performance of joint position sense under different testing conditions.

OBJECTIVE

To compare elbow joint position sense between active and passive reproduction tasks under different matching speeds and reference targets.

DESIGN

A cross-sectional study.

METHODS

Twenty participants without a history of upper-extremity surgery or neuromuscular diseases that affect the joint position sense of the elbow. Active and passive ipsilateral matching tasks were performed at four movement speeds (0.5°/s, 1°/s, 2°/s, and 4°/s) and three reference targets (elbow flexion at 0°-15°, 45°-60°, and 75°-90°), using an isokinetic dynamometer. The absolute and variable errors of each condition were calculated for comparison.

RESULTS

In active matching task with elbow flexion of 0°-15°, the absolute error at 0.5°/s was significantly larger than that at 2°/s and 4°/s, while the variable error at 1°/s was significantly larger than that at 2°/s. However, no differences were found at elbow flexion angles of 45°-60° and 75°-90°. Larger absolute errors were found at 4°/s with three testing angles in passive matching task.

CONCLUSIONS

This study compared the joint position sense errors under various testing conditions in the active and passive reproduction tasks. The movement speeds and target position effects should be considered during evaluation.

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.

Aging increases proprioceptive error for a broad range of movement speed and distance estimates in the upper limb

Previous work has identified age-related declines in proprioception within a narrow range of limb movements. It is unclear whether these declines are consistent across a broad range of movement characteristics that more closely represent daily living. Here we aim to characterize upper limb error in younger and older adults across a range of movement speeds and distances. The objective of this study was to determine how proprioceptive matching accuracy changes as a function of movement speed and distance, as well as understand the effects of aging on these accuracies. We used an upper limb robotic test of proprioception to vary the speed and distance of movement in two groups: younger (n = 20, 24.25 ± 3.34 years) and older adults (n = 21, 63 ± 10.74 years). The robot moved one arm and the participant was instructed to mirror-match the movement with their opposite arm. Participants matched seven different movement speeds (0.1-0.4 m/s) and five distances (7.5-17.5 cm) over 350 trials. Spatial (e.g., End Point Error) and temporal (e.g., Peak Speed Ratio) outcomes were used to quantify proprioceptive accuracy. Regardless of the speed or distance of movement, we found that older controls had significantly reduced proprioceptive matching accuracy compared to younger control participants (p ≤ 0.05). When movement speed was varied, we observed that errors in proprioceptive matching estimates of spatial and temporal measures were significantly higher for older adults for all but the slowest tested speed (0.1 m/s) for the majority of parameters. When movement distance was varied, we observed that errors in proprioceptive matching estimates were significantly higher for all distances, except for the longest distance (17.5 cm) for older adults compared to younger adults. We found that the magnitude of proprioceptive matching errors was dependent on the characteristics of the reference movement, and that these errors scaled increasingly with age. Our results suggest that aging significantly negatively impacts proprioceptive matching accuracy and that proprioceptive matching errors made by both groups lies along a continuum that depends on movement characteristics and that these errors are amplified due to the typical aging process.

Joint Specificity and Lateralization of Upper Limb Proprioceptive Perception

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

An investigation of upper extremity function in patients with multiple sclerosis, and its relation with shoulder position sense and disability level

Purpose: The purposes of this study were to investigate upper extremity function and shoulder position sense in patients with multiple sclerosis and its relation with disability level. Materials and methods: In this study, 20 multiple sclerosis and 20 healthy subjects participated. The disability level was determined by the Expanded Disability Status Scale. Mental state was assessed using the Mini-Mental State Examination. Upper extremity function was measured with the 9-Hole Peg Test and shoulder position sense was evaluated with a Dualer IQTM digital inclinometer. The study protocol was also registered at http://clinicaltrials.gov (NCT03846336). Results: Upper extremity function scores were lower and shoulder position sense error scores were greater in patients with multiple sclerosis in comparison to healthy controls (p < .05). While disability level was associated with dominant and non-dominant upper extremity function, no relationship was found between the disability level and shoulder position sense (p < .05). Only the dominant side shoulder position senses at 30° and 60° abduction were found to be associated with upper extremity function (p < .05). Conclusions: These results indicate that shoulder position sense and upper extremity function were affected in patients with multiple sclerosis with mild to moderate disability. Upper extremity functions were associated with shoulder abduction joint sense in patients with multiple sclerosis. In the assessment of upper extremity functions, joint position sense should be taken into account even at early stages of multiple sclerosis, so it may provide guidance in planning rehabilitation programs.

Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report

Functional electrical stimulation (FES) has shown to improve motor function of the affected side in stroke patients; however, the effects of FES on proprioception, the functional recovery of the paretic upper limb, and the patient quality of life (QoL) are not clear. The aim of the current case report was to determine whether FES can improve joint position sense and the scores on measurements of upper limb function and a QoL survey. The participant was assessed before and after 10 consecutive intervention sessions; in addition, the patient performed the training tasks in the workstation assisted by the FES device. Improvements in angles and time only in the affected wrist and enhancement in the Action Research Arm Test scores for both upper limbs were found after FES intervention. In addition, the patient's health-related QoL measurements improved. FES could ameliorate the proprioceptive deficit and the activity limitations of a stroke survivor.

OXFORD LEVEL OF EVIDENCE

3b; individual case control study.

A new clinical test for sensorimotor function of the hand - development and preliminary validation

BACKGROUND

Sensorimotor disturbances of the hand such as altered neuromuscular control and reduced proprioception have been reported for various musculoskeletal disorders. This can have major impact on daily activities such as dressing, cooking and manual work, especially when involving high demands on precision and therefore needs to be considered in the assessment and rehabilitation of hand disorders. There is however a lack of feasible and accurate objective methods for the assessment of movement behavior, including proprioception tests, of the hand in the clinic today. The objective of this observational cross- sectional study was to develop and conduct preliminary validation testing of a new method for clinical assessment of movement sense of the wrist using a laser pointer and an automatic scoring system of test results.

METHODS

Fifty physiotherapists performed a tracking task with a hand-held laser pointer by following a zig-zag pattern as accurately as possible. The task was performed with left and right hand in both left and right directions, with three trials for each hand movement. Each trial was video recorded and analysed with a specifically tailored image processing pipeline for automatic quantification of the test. The main outcome variable was Acuity, calculated as the percent of the time the laser dot was on the target line during the trial.

RESULTS

The results showed a significantly better Acuity for the dominant compared to non-dominant hand. Participants with right hand pain within the last 12 months had a significantly reduced acuity (p < 0.05), and although not significant there was also a similar trend for reduced Acuity also for participants with left hand pain. Furthermore, there was a clear negative correlation between Acuity and Speed indicating a speed-accuracy trade off commonly found in manual tasks. The repeatability of the test showed acceptable intra class correlation (ICC_2.1) values (0.68-0.81) and standard error of measurement values ranging between 5.0-6.3 for Acuity.

CONCLUSIONS

The initial results suggest that the test may be a valid and feasible test for assessment of the movement sense of the hand. Future research should include assessments on different patient groups and reliability evaluations over time and between testers.

A Protocol for Evaluation and Rehabilitation of Distal Radius Fractures Using Sensorimotor Input: A Case Series

BACKGROUND

Proprioception and sensorimotor input are used to treat neurological and joint injuries. Following distal radius fractures (DRF) there is a temporary loss of proprioception that should be addressed. We created a protocol for evaluation, and a treatment plan following wrist surgery that is based on proprioceptive and sensorimotor input. We describe a series of patients undergoing surgery for DRF that were evaluated and treated with these protocols.

METHODS

Both evaluation and treatment protocols included comprehensive sensorimotor procedures performed with eyes open and closed. These included Semmes- Weinstein, static and moving 2-point discrimination, vibration, temperature testing, Moberg pick-up- test, stereognosis and proprioception.

RESULTS

A series of twelve patients was evaluated and treated with the protocol following surgical treatment for DRF. Patients demonstrated significant sensorimotor deficits, which improved utilizing the comprehensive sensorimotor treatment protocol.

CONCLUSIONS

Further study is necessary to validate the results of this pilot series. Use of proprioception and sensorimotor input may improve outcomes of rehabilitation following DRF.

Upper Extremity Proprioception After Stroke: Bridging the Gap Between Neuroscience and Rehabilitation

Proprioception is an important aspect of function that is often impaired in the upper extremity following stroke. Unfortunately, neurorehabilitation has few evidence based treatment options for those with proprioceptive deficits. The authors consider potential reasons for this disparity. In doing so, typical assessments and proprioceptive intervention studies are discussed. Relevant evidence from the field of neuroscience is examined. Such evidence may be used to guide the development of targeted interventions for upper extremity proprioceptive deficits after stroke. As researchers become more aware of the impact of proprioceptive deficits on upper extremity motor performance after stroke, it is imperative to find successful rehabilitation interventions to target these deficits and ultimately improve daily function.

Adaptive Staircase Measurement of Hand Proprioception

Clinicians and researchers often need to measure proprioception (position sense), for example to monitor the progress of disease, to identify the cause of movement or balance problems, or to ascertain the effects of an intervention. While researchers can use sophisticated equipment to estimate proprioceptive acuity with good precision, clinicians lack this option and must rely on the subjective and imprecise methods currently available in the clinic. Here we describe a novel technique that applies psychometric adaptive staircase procedures to hand proprioception with a simple tablet-style apparatus that could easily be adapted for the clinic. We report test-retest reliability, inter-rater reliability, and construct validity of the adaptive staircase method vs. two other methods that are commonly used in clinical settings: passive motion direction discrimination (PMDD) and matching. As a first step, we focus on healthy adults. Subjects ages 18–82 had their proprioception measured with each of the three techniques, at the metacarpophalangeal joint in the second finger of the right hand. A subset completed a second session in which the measures were repeated, to assess test-retest reliability. Another subset had the measurements done by two different testers to assess inter-rater reliability. Construct validity was assessed using stepwise regression on age and activity level, and correlations calculated across the three methods. Results suggest that of the three methods, the adaptive staircase method yields the best test-retest reliability, inter-rater reliability, and construct validity. The adaptive staircase method may prove to be a valuable clinical tool where more accurate assessment of proprioception is needed.