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The effects of shoulder plyometric training on proprioception and selected muscle performance characteristics.

The purpose of this study was to determine the effect of plyometric training of the shoulder internal rotators on proprioception, kinesthesia, and selected muscle performance characteristics in female swimmers. Twenty-four female division I swimmers were evaluated before and after a 6-week plyometric training program. Proprioception and kinesthesia were assessed for internal and external rotation at 0 degrees, 75 degrees, and 90% of the subject's maximum external rotation. The Biodex II was used to assess strength characteristics at 60 degrees /s, 240 degrees /s, and 450 degrees /s. Plyometric training sessions (2 times/week) involved 3 sets of 15 repetitions with a trampoline, weighted balls, and elastic tubing. A 2-way analysis of variance revealed significant improvement (P <.05) in proprioception at 0 degrees moving into external rotation, as well as 75 degrees and 90% moving into both internal and external rotation. Kinesthesia demonstrated significant improvement for all test conditions after plyometric training. Significant gains in selected muscle performance characteristics included time to peak torque (60 degrees /s and 240 degrees /s), amortization time (450 degrees /s), and torque decrement (240 degrees /s). This study suggests that plyometric activities may facilitate neural adaptations that enhance proprioception, kinesthesia, and muscle performance characteristics. Significant neuromuscular benefits may be attained if they are implemented earlier into shoulder rehabilitation programs.

Adult↗

Proprioceptive influence on the optokinetic nystagmus.

The influence of neck and leg proprioceptive inputs on optokinetic-induced quick phases was studied in humans. Ten subjects received unidirectional horizontal optokinetic stimulation (10-20%/s) during sinusoidal neck, leg and combined neck + leg proprioceptive stimulation. The optokinetic reflex was measured by electro-oculography. Neck stimulation induced a shift in the nystagmus beating field in the opposite direction to body movement (gain 0.3 0.4, phase 140-180 degrees). The beating field shift resulted totally from the amplitude and frequency modulation of optokinetic quick phases, as slow phases were not affected. Leg proprioceptive stimulation induced a similar effect, but the phase of the response lagged by approximately 90 degrees compared with that of neck response. With combined neck + leg stimulation, the amplitude of the effect was a sum of the separate effects, but the phase coincided with that of the leg response. This suggests that neck and leg proprioceptive signals do not add linearly and that the leg signal determines the time of the response.

Adult↗

Modifications with aging in the role played by vision and proprioception for movement control.

Young and older adults performed manual aiming movements to a visible target for either 40 or 200 trials. Under each level of practice, half of the subjects practiced the task under normal visual conditions (proprioception + vision [PV] condition), whereas the other half were not permitted to see their ongoing movement toward the target (proprioception-only [P] condition). Each acquisition trial was followed with knowledge of results (KR). After the last acquisition trial, all subjects were transferred to a common task in which only the target to be reached was visually available, with no KR. During acquisition, the younger subjects were found to be spatially more accurate than their older counterparts, and this was so regardless of the number of acquisition trials. Withdrawing KR during the transfer test did not modify the spatial accuracy of the subjects who had trained under the P condition. This indicates that the subjects had a reliable reference of the movement to be realized. Withdrawing vision of the moving hand and KR in the transfer test caused a significant increase in spatial error for both the older and the younger subjects. However, the increase in error was less pronounced for the older than for the younger subjects. In fact, the older subjects performed as well in the transfer test as the subjects who had trained in the P condition. This pattern of results suggests that in the transfer test, the older subjects could still guide their movements with the proprioceptive information that was available during both acquisition and transfer. However, such was not the case for the younger subjects. This suggests that, unlike the younger subjects, the older subjects could still rely on the proprioceptive cues available during acquisition in the PV condition. These results are taken to indicate that practicing with numerous sources of afferent information, as was the case in the PV condition, resulted in an integrated reference store for the younger subjects. In contrast, while practicing the task in the PV condition, the older subjects appeared to process independently from each other the different sources of sensory information available.

Adult↗

A randomised controlled trial of proprioceptive and balance training after surgical reconstruction of the anterior cruciate ligament.

A randomised controlled trial (29 participants) was used to compare a 6-week proprioceptive and balance exercise program with a 6-week strengthening program in the early phases of rehabilitation after anterior cruciate ligament (ACL) reconstruction. Measurements of functional activity were taken by a blinded assessor before the intervention and at the end of the 6 weeks. Results demonstrated that there were no significant differences between groups on hop testing at 6 weeks. For several items in the Cincinnati knee rating system and the patient specific functional scale however, the strengthening group improved more than the proprioceptive and balance group (p < .05). The hypothesis that proprioceptive and balance training would improve functional activity more than strengthening exercises was not supported. There was either no difference between the two forms of exercise or strength training may be more beneficial than proprioceptive and balance training in the early phase of rehabilitation after ACL reconstructive surgery.

Adult↗

Proprioception and spatial neglect after stroke.

Proprioception and neglect were studied in 287 patients surviving up to one week after the onset of their stroke. The presence of proprioceptive loss indicated a more extensive lesion and a larger proportion of these patients had impairment of intellectual function, motor power in the upper and lower limb, and postural function. Proprioceptive loss also had an adverse effect on the level of independence achieved by discharge, final placement, mortality and length of stay in hospital. In 87% of the survivors recovery of proprioception had occurred by eight weeks. Significant neglect was associated with high mortality and poor outcome for functional recovery.

Aged↗

Proprioception with the proximal interphalangeal joint of the index finger. Evidence for a movement sense without a static-position sense.

Proprioceptive ability with the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the index finger in human subjects was examined using a method that could assess static-position sense independently of movement sense (Clark et al., 1985). The similarity in location and function of these joints would suggest similar proprioceptive mechanisms, but proprioceptive ability was found to be quite different for the two joints. The method of distinguishing a static-position sense from a movement sense was based on whether a subject's ability to detect a small change in joint position was impaired when the rate of rotation was progressively reduced. An awareness of static-position should not depend on the rate at which a joint is placed into position. However, if subjects use movement signals to detect changes in joint position, slowing the rate of displacement should reduce the intensity of these signals and make the displacements more difficult to detect. This method indicated a static-position sense with the MCP joint but only a movement sense with the PIP joint. It was confirmed that sensory input from regions of skin not stretched or deformed by rotation of the joint can influence proprioceptive sensibility with the fingers. Anaesthesia of the tip of the index finger or of the thumb blunted subject's perceptions of movement of the PIP joint of the index finger. However, anaesthesia of the PIP joint itself had no observable effect on the ability to sense movement of the joint.

Adult↗

Knee bracing for medial compartment osteoarthritis: effects on proprioception and postural control.

OBJECTIVE: To evaluate the effects of a functional knee brace specifically designed for patients with varus gonarthrosis on measures of proprioception and postural control. SUBJECTS: Fourteen men and six women (aged 59+/-9 yr) with measurable varus alignment and osteoarthritis of the knee medial compartment. METHODS: Proprioception was assessed in the sitting position using an isokinetic dynamometer and was quantified as the ability to replicate target knee-joint angles. Postural control was assessed with a force platform using tests of single-limb standing balance performed, while the patient was standing on a stable surface and standing on foam, and was quantified as the total length of the path of the centre of pressure. All tests were performed with and without the patient's own custom-fit valgus brace. RESULTS: Proprioception was significantly improved following application of the brace [mean difference=0.7 degrees, 95% confidence interval (CI)=0.2 to 1.1 degrees ). Postural control was not significantly affected by the use of the brace during the stable surface test (mean difference=2.6 cm, 95% CI=-4.3 to 9.5 cm) or the foam surface test (mean difference=0.9 cm, 95% CI=-7.5 to 9.4 cm). CONCLUSION: Although enhanced proprioception may be partially responsible for reported improvements with the use of a brace, the present findings call into question the functional importance of the small changes observed.

Braces↗

Disrupted cortical proprioceptive representation evokes symptoms of peculiarity, foreignness and swelling, but not pain.

OBJECTIVES: It has been proposed that disruption of the internal proprioceptive representation, via incongruent sensory input, may underpin pathological pain states, but experimental evidence relies on conflicting visual input, which is not clinically relevant. We aimed to determine the symptomatic effect of incongruent proprioceptive input, imparted by vibration of the wrist tendons, which evokes the illusion of perpetual wrist flexion and disrupts cortical proprioceptive representation. METHODS: Twenty-nine healthy and naive volunteers reported symptoms during five conditions: control, active and passive wrist flexion, extensor carpi radialis tendon vibration to evoke illusion of perpetual wrist flexion, and ulnar styloid (sham) vibration. No advice was given about possible illusions. RESULTS: Twenty-one subjects reported the illusion of perpetual wrist flexion during tendon vibration. There was no effect of condition or of whether or not subjects reported an illusion on discomfort/pain (P>0.28). Peculiarity, swelling and foreignness were greater during tendon vibration than during the other conditions, and greater during tendon vibration in those who reported an illusion of wrist flexion than in those who did not (P<0.05 for all). Symptoms were reported by at least two subjects in each condition and four subjects reported systemic symptoms (e.g. nausea). CONCLUSIONS: In healthy volunteers, incongruent proprioceptive input does not cause discomfort or pain but does evoke feelings of peculiarity, swelling and foreignness in the limb.

Female↗

Role of proprioception in pathoetiology of shoulder instability.

Proprioception is a specialized sensory modality that gives information about extremity position and direction of movement. This kind of afferent sensory feedback is probably important in mediating muscular control of the shoulder joint. As this articulation is minimally constrained, such a coordinated dynamic control of muscles about the joint is necessary for stability during arm motion. The authors evaluated proprioception in individuals with normal shoulders, unstable shoulders, and after surgical stabilization, by assessing threshold to detection of passive motion and the ability to passively reposition the arm in space. In normal shoulders there is no difference between the dominant and nondominant shoulder, though in unstable shoulders there is a significantly decreased proprioceptive ability. Surgical stabilization normalizes proprioception of the shoulder.

Adult↗

Proprioception after unicondylar knee arthroplasty versus total knee arthroplasty.

Proprioception was measured in 2 groups of patients after successful knee arthroplasty. Twenty-eight patients had total knee arthroplasty and their results were compared with an age matched group of 10 subjects who had undergone unicondylar knee arthroplasty. The threshold to detection of passive motion was quantified as a measure of proprioception. The degree of preoperative arthritis was objectively classified according to Resnick. The anterior cruciate ligament and posterior cruciate ligament were present and preserved in all the patients who had undergone unicondylar knee arthroplasty. The anterior cruciate ligament was sacrificed and posterior cruciate ligament retained in 15 of the patients who had total knee arthroplasty and the anterior cruciate ligament and posterior cruciate ligament were sacrificed in 13 of the patients who had total knee arthroplasties. There was no difference in threshold to detection of passive motion among any of the 3 groups. Maintaining the anterior cruciate ligament and posterior cruciate ligament did not impart improved proprioception in unicondylar knee arthroplasty nor did maintaining the posterior cruciate ligament impart improved proprioception in total knee arthroplasty.

Aged↗

Proprioceptive improvement in knees with anterior cruciate ligament reconstruction.

The correlation between the prospective course of proprioceptive improvement and knee stability after anterior cruciate ligament reconstruction was investigated in 38 patients. Proprioception, on the basis of the patient's capacity to reposition the limb accurately, was evaluated at 3-month intervals for 24 months after hamstring graft anterior cruciate ligament surgery. Knee stability was evaluated concurrently with a KT-2000 knee arthrometer. Thirty patients experienced improvement in postoperative position sense in at least one of the examinations, although eight patients had no improvement at any time. Of the 30 patients who had improvement, 28 maintained improved position sense from 18 months to the final followup. Thirty patients maintained significantly better knee stability for a postoperative period of at least 24 months. These results indicated that a minimum of 18 months after anterior cruciate ligament reconstruction may be needed for complete restoration of the proprioceptive function in knees, although the mean position sense in all patients gradually improved from 9 months. Improvement in postoperative knee stability may have facilitated recovery of proprioception.

Adolescent↗

Dynamic upper limb proprioception in multidirectional shoulder instability.

The ability of subjects with multidirectional shoulder instability to use proprioception to complete a series of upper limb repositioning tasks was investigated. Twelve subjects with multidirectional instability and 12 control subjects were blindfolded and instructed to use proprioception to reproduce a self-selected target position as accurately as possible. Subjects completed 10 repetitions for each limb using three distinct upper limb movements: overhead reaching, scapular plane pointing, and humeral external rotation with abduction. A three-dimensional video motion analysis system tracked limb position and determined spatial hand position error. Subjects with multidirectional shoulder instability showed significantly greater hand position error than control subjects. No hand position error differences were found between the symptomatic and the asymptomatic limbs of subjects in the instability group. Inter-repetition error for subjects in both groups improved significantly during the first three movement cycles. These results suggest that after movement initiation, dynamic proprioception was a factor in improving hand position accuracy in both groups, but to a lesser degree in subjects with multidirectional instability. Consequently, subjects with multidirectional instability may have a reduced capacity to use proprioception to refine and control the motor output of the upper limb.

Adult↗

Proprioception with bicondylar sledge prostheses retaining cruciate ligaments.

The current study was designed to evaluate the proprioceptive performance of the knee after implantation of bicondylar sledge prostheses in comparison with contralateral knees and knees of healthy control subjects. After implantation of a sledge prosthesis in the medial and lateral condyles of a knee retaining all ligaments, 15 patients were evaluated clinically and by proprioceptive testing. Clinical examination was done using common scoring systems. Proprioceptive performance was examined using sway measurements during single-leg stance on a force platform. Eleven healthy subjects of the same age served as a control group. Clinical results of both groups differed significantly in all applied scores, except for the subcategories gait, muscle force, and pain. Sway measurements did not differ between right and left legs of subjects in the control group. The patients' surgically treated legs had slightly higher values than the control group, but a statistical significance was not found. Statistical analysis revealed no significant correlation between clinical scores and sway measurement results. Total knee arthroplasty that retains all intraarticular ligaments achieves proprioceptive results comparable with healthy subjects of the same age.

Aged↗

Effect of rehabilitation on hip and knee proprioception in older adults after hip fracture: a pilot study.

OBJECTIVE: Impaired proprioception may predispose patients with hip fracture to increased risk of future disability. The purpose of the study was to determine the effect of rehabilitation on proprioceptive changes in both the hip and knee joints of patients after hip fracture. DESIGN: Data were collected on 30 patients with hip fracture (mean age, 79.6 +/- 6.7 yrs) who attended physical and occupational therapy sessions five times per week during a rehabilitation hospital stay of 24.8 +/- 8.1 days. Proprioception was assessed with an electrogoniometer within 48 hrs of admission to and discharge from the rehabilitation unit. The passive-to-active reproduction of joint angle technique determined absolute angular error in non-weight-bearing positions at 15, 30, and 60 degrees of hip flexion and knee extension in both injured and noninjured sides. RESULTS: Absolute angular error decreased significantly (P < 0.05) from admission (5.3 +/- 2.6 degrees, 4.1+/- 3.1 degrees) to discharge (3.0 +/- 2.3 degrees, 2.8 +/- 3.1 degrees) in hip flexion and knee extension, respectively, on the injured side. Absolute angular error was significantly less (P < 0.05) at 15 degrees compared with 30 and 60 degrees of hip flexion at admission and discharge on the injured side. CONCLUSIONS: Hip and knee joint proprioception significantly improved in the injured side after the rehabilitation program. This may be an important outcome regarding future disability in this population.

Aged↗

Phobic postural vertigo: body sway during vibratory proprioceptive stimulation.

Phobic postural vertigo patients might rely more on proprioceptive than visual cues to regulate stance. We tested 14 phobic postural vertigo patients and 24 healthy subjects with posturography during quiet stance and periods of vibratory proprioceptive calf muscle stimulation, both with eyes open and closed. During quiet stance phobic postural vertigo patients showed higher torque variance than healthy subjects, especially above 0.1 Hz. Vibratory proprioceptive stimulation increased the differences between healthy subjects and phobic postural vertigo patients. The patients were less able to use vision to counteract vibration-induced movements. Phobic postural vertigo patients are more sensitive to proprioceptive disturbances than healthy subjects are, and less apt to use visual information to control upright stance. This might be part of an anxious mode of balance control.

Adult↗

Use of proprioception in normal and clumsy children.

This study investigates the relation between performance on simple tasks dependent on proprioception, and performance of complex perceptual-motor skills in clumsy children and age-matched control children. One hundred and forty-six right-handed children aged between 5 and 8 years were tested on non-visual aiming, non-visual posture matching, the Kinaesthetic Sensitivity Test (KST), and the Movement Assessment Battery for Children (ABC). Half of the children had scores below the 15th centile on the Movement ABC and were classed into the developmental coordination disorder (clumsiness) group. Scores on the proprioceptive tasks were used to predict performance on complex tasks of the subscales of the Movement ABC (manual dexterity, ball skills, and balance). Specific relations were found between the proprioceptive tasks and the subscales of the Movement ABC, but the KST did not predict differences in motor skills, and no relation was found between tasks carried out without vision. Simple non-visual movement tasks do predict performance in more complex skilled tasks but this is affected by many task features rather than simply the reliance on proprioception for information about movement.

Child↗

Parallel organization of proprioceptive inputs from joint receptors to cortical somatosensory areas I and II in the cat.

1. Studies in monkeys indicate that proprioceptive and tactile inputs are conveyed from the thalamus to the primary somatosensory cortex (SI) and thence to the secondary somatosensory area (SII) in a serial scheme. In contrast, in the cat, tactile information is conveyed in parallel from the thalamus to SI and SII. The present study, in the cat, employed reversible inactivation of SI to determine whether proprioceptive inputs to SII from joint receptors depend on an indirect serial path via SI or are conveyed over a direct path from the thalamus. 2. SI and SII foci for knee joint inputs were determined with evoked potential mapping. Reversible inactivation of the SI focus by cooling had no effect on the amplitude, latency or time course of SII potentials evoked by joint inputs. There was also no consistent effect on the response levels of individual SII neurones examined during SI inactivation. Furthermore, there was no attenuation of the later components of the responses, and therefore no evidence that these depended on an indirect path to SII via SI. 3. Results demonstrate that proprioceptive inputs project directly from thalamus to SII over a pathway organized in parallel with that to SI, in contrast to the serial scheme reported for proprioceptive processing in primates.

Animals↗

Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis.

OBJECTIVES: To investigate whether a "standard" sized (that is, a size that would be prescribed by a physiotherapist) elastic bandage (S-bandage) around the knee of subjects with knee osteoarthritis (OA) would, in the short term (a) reduce pain, (b) improve knee joint proprioception, and (c) decrease sway in comparison with a looser (L-bandage). METHODS: In a cross over, within-subject study, 68 subjects (49 women, 19 men; mean age 67.1, range 36-87) with symptomatic and radiographic knee OA were randomly assigned to either an S-bandage or an L-bandage. Two weeks later they were assigned to the opposite bandage size. Knee pain (10 cm visual analogue scale (VAS)), knee proprioception, and static postural sway were assessed for each bandage two weeks apart. During each visit assessments were performed at baseline, after 20 minutes of bandage application, and immediately after bandage removal. RESULTS: The S-bandage did not have any effect on knee pain, proprioception, or postural sway. The L-bandage reduced knee pain significantly (pre-bandage application: median VAS 4.36, IQR 3.84 -4.90; after 20 minutes of bandage application: median VAS 3.80, IQR 3.3-4.3, p<0.001), improved static postural sway (pre-bandage: median sway 4.50, IQ range 3.5-6.4; bandage applied: median sway 4.45, IQ range 3.4-6.3, p=0.027), but had no significant influence on knee proprioception. CONCLUSIONS: In subjects with knee OA application of an elastic bandage around the knee can reduce knee pain and improve static postural sway. This outcome depends on the size of applied bandage.

Adult↗