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PubMed2000

Proprioception after total knee arthroplasty: a comparison with clinical outcome.

We determined proprioception in replaced and unreplaced arthrotic knees by measuring threshold levels for the perception of passive knee motion. In addition, results of these proprioception measurements were compared with the clinical outcomes in patients with a total knee arthroplasty. Threshold detection levels were significantly higher in the replaced than in the unreplaced knees. Moreover, detection-failure rates were significantly higher in the replaced knees as well. In contrast to this diminished movement sense in the replaced knees, clinical examination of these knees showed good or excellent outcome in all cases. A correlation between the clinical outcome and the ability to perceive passive motion in either patient group could not be found. We hypothesize that our findings may be due to the operative removal of intraarticular receptor-rich tissue that is affected by arthrosis. This would not only contribute to marked clinical improvements but also to a significant decrease in proprioception.

Activities of Daily Living↗
PubMed2000

Effect of parafunctional clenching on temporomandibular disorder pain and proprioceptive awareness.

This study tested the hypothesis that parafunctional clenching increases pain, can lead to a diagnosis of temporomandibular disorder (TMD) pain, and can produce reductions in proprioceptive awareness. Twenty individuals participated in EMG biofeedback training sessions on the left and right temporalis and masseter muscles. No subjects had TMD prior to training. Subjects were randomly assigned to either a Decrease group, who were instructed to maintain EMG activity below 2 microV during training, or an increase group, who were instructed to maintain EMG activity above 10 microV. To test the impact of parafunctional clenching on proprioceptive awareness, all subjects were instructed to barely touch their teeth together while EMG activity was recorded pre- and post-training. Three subjects assigned to the Increase group and no subjects assigned to the Decrease group were diagnosed with TMD pain following training. Self-reported pain post-training was significantly higher for the Increase group. Parafunctional clenching did not affect performance in the proprioceptive test.

Adult↗
PubMed1999

Proprioceptive control of wrist extensor motor units in humans: dependence on handedness.

The effectiveness of the monosynaptic proprioceptive assistance to the wrist extensor motoneurone activity was investigated during voluntary contraction in relation to the subjects' handedness. The reflex responses of 411 single motor units to homonymous tendon taps were recorded in the wrist extensor carpi radialis muscles in both arms of five right-handed and five left-handed subjects. In the right-handed subjects, the motor unit reflex responses were clearly lateralized in favour of their right arm, whereas no side-related differences were observed in the left-handed subjects, whatever the motor units' mechanical properties and firing rates. When the muscle spindle sensitivity was by-passed by electrically stimulating the primary afferents in both arms of three right-handed and three left-handed subjects, no side-related differences were observed in the Hoffmann reflex (H-reflex) amplitude in either of the two lateralization groups. The effectiveness of the primary afferent synapses on to the motoneurones therefore does not seem to depend on the subject's handedness. Without excluding the possibility of structural changes being involved at the periphery, the comparisons carried out on the data obtained using electrical vs mechanical stimulation suggest that the asymmetrical effectiveness of the proprioceptive assistance observed in favour of the right arm in the right-handed subjects might result from either the gamma or beta drive being more efficient. This asymmetry might result from the preferential use of the right hand in skilled movements. In a predominantly right-handed world, however, left-handed people might tend to develop the ability to use their right arm almost as skillfully as their preferred left arm, which could explain the symmetrical effectiveness of the proprioceptive assistance observed here in the left-handers' wrist extensor muscles.

Action Potentials↗
PubMed2004

Re-examination of the possible role of Golgi tendon organ and muscle spindle reflexes in proprioceptive neuromuscular facilitation muscle stretching.

Literature concerning the theoretical role of spinal reflex circuits and their sensorimotor signals in proprioceptive neuromuscular facilitation (PNF) muscle stretching techniques was examined. Reviewed data do not support the assertion commonly made in PNF literature that contraction of a stretched muscle prior to further stretch, or contraction of opposing muscles during muscle stretch, produces relaxation of the stretched muscle. Further, following contraction of a stretched muscle, inhibition of the stretch reflex response lasts only 1 s. Studies examined suggested that decreases in the response amplitude of the Hoffmann and muscle stretch reflexes following a contraction of a stretched muscle are not due to the activation of Golgi tendon organs, as commonly purported, but instead may be due to presynaptic inhibition of the muscle spindle sensory signal. The current view on the complex manner by which the spinal cord processes proprioceptive signals was discussed. The ability of acute PNF stretching procedures to often produce a joint range of motion greater than that observed with static stretching must be explained by mechanisms other than the spinal processing of proprioceptive information. Studies reviewed indicate that changes in the ability to tolerate stretch and/or the viscoelastic properties of the stretched muscle, induced by PNF procedures, are possible mechanisms.

Elasticity↗
PubMed2000

Proprioception and stimulus-response compatibility.

Sixteen subjects pressed a left or right key in response to lateralized visual stimuli, in uncrossed (left index finger on left key, right finger on right key) and crossed conditions (left finger on right key and vice versa), with varying finger separations. Visual, tactile, or "efference copy" cues about relative finger positions were unavailable. Subjects had to press the key on the same side as (compatible group) or opposite side to the stimulus (incompatible group). Separate proprioceptive judgements of the relative finger positions were obtained. Findings of an overall reaction time (RT) advantage for compatible instructions and for uncrossed hands were replicated. With decreasing finger separation the RT advantage for compatible instructions decreased, and the probability of responding with either hand increased. The compatibility effect disappeared completely at the 6-cm crossed position, not at the position that was hardest to judge proprioceptively. This suggests that two forms of neural activation are summed: automatic activation of the anatomically same-side limb, and an integrated, rule-based activation. The results further demonstrate that independent proprioceptive cues from each limb, unassociated with skin contact between the limbs, can mediate the determination of relative position for response selection in stimulus-response compatibility tasks.

Adult↗
PubMed1993

Abnormal spatial localization with trigeminal-oculomotor synkinesis. Evidence for a proprioceptive effect.

We examined spatial localization, using open-loop pointing to visual targets, in a patient with a congenital trigeminal-oculomotor synkinesis. This patient demonstrated abnormal co-activation of the left medial rectus muscle when the left lateral pterygoid contracted. Because one eye could be deviated in the absence of a normal oculomotor innervational command, the efference copy (derived from monitoring of central oculomotor commands) could be dissociated from the proprioceptive afferent signal (determined by the mechanical state of the extraocular muscles). Under conditions of monocular viewing with the normal right eye, when the covered left eye was adducted by the aberrant trigeminal innervation, the patient pointed to the left of the actual position of the target. This finding indicates that proprioceptive afference from the adducted, covered left eye was used in the process of spatial localization. While synkinetic adduction produced a shift in pointing in the opposite direction of rotation of the non-viewing eye, previous studies using passive deviation of the non-viewing eye in normal subjects reported a shift in pointing in the same direction as eye rotation (Gauthier et al., 1990; Bridgeman and Stark, 1991). We propose that this discrepancy is due to the different effects of passive eye rotation and active muscle contraction on the tendon organs of the extraocular muscles. On this basis, we hypothesize that the tendon organs, rather than the muscle spindles, are primarily responsible for the transduction of proprioceptive information about eye position in the orbit.

Adolescent↗
PubMed1997

Proprioceptive control of wrist movements in Parkinson's disease. Reduced muscle vibration-induced errors.

The effects upon the trajectories of practised slow (approximately 9 degrees/s) voluntary wrist-extension movements of applying vibration to the tendon of an antagonist muscle (flexor carpi radialis) during the course of the movement have been studied in patients with idiopathic Parkinson's disease and age-matched healthy individuals. In both patient and control groups, flexor vibration elicited undershooting of wrist-extension movements. Wrist extensor and flexor surface EMG recordings indicated that, in patients and controls, such undershooting resulted principally from sustained reductions in extensor (prime mover) activity. Small vibration reflexes were commonly elicited in the wrist flexors which, in both Parkinson's disease and healthy subjects, were usually otherwise virtually quiescent during these slow extension movements. The amplitudes of such vibration reflexes did not differ systematically between patient and control groups and appeared inadequate to have exerted an appreciable braking action upon the extension trajectories. However, the extent of vibration-induced undershooting was, on average, significantly less in the Parkinson's disease group. In a subgroup of patients with asymmetrical parkinsonism the effects of antagonist vibration upon wrist movements of the more and less affected limb were compared. The degree of vibration-induced undershooting was significantly smaller on the more affected side. This finding suggests that disturbed proprioceptive guidance of voluntary movements in Parkinson's disease is related to the severity of clinical motor deficits. A small number Parkinson's disease patients were studied 'ON' and 'OFF' their routine anti-parkinsonian medication. A non-significant tendency was found for vibration-induced errors to be less marked in the 'OFF' state. In a separate series of experiments, under isometric conditions, vibration-induced EMG changes were recorded whilst subjects attempted to maintain a steady (15% maximum) voluntary wrist extensor effort. Results in control subjects suggested that prolonged flexor vibration produced significant tonic reflex reciprocal inhibition of the extensor muscles. However, the strength of reflex inhibition appeared sufficient to account for only a small fraction of the undershooting observed during the movement tasks. Thus, our results are consistent with the existence of an abnormality of higher-level proprioceptive integration in Parkinson's disease in which there is a mismatch of sensory (proprioceptive) and motor (corollary discharge) information.

Aged↗
PubMed2003

Influence of regular proprioceptive and bioenergetic physical activities on balance control in elderly women.

BACKGROUND: Balance disorders increase considerably with age due to a decrease in posture regulation quality, and are accompanied by a higher risk of falling. Conversely, physical activities have been shown to improve the quality of postural control in elderly individuals and decrease the number of falls. The aim of this study was to evaluate the impact of two types of exercise on the visual afferent and on the different parameters of static balance regulation. METHODS: Static postural control was evaluated in 44 healthy women aged over 60 years. Among them, 15 regularly practiced proprioceptive physical activities (Group I), 12 regularly practiced bioenergetic physical activities (Group II), and 18 controls walked on a regular basis (Group III). RESULTS: Group I participants displayed lower sway path and area values, whereas Group III participants displayed the highest, both in eyes-open and eyes-closed conditions. Group II participants displayed intermediate values, close to those of Group I in the eyes-open condition and those of Group III in the eyes-closed condition. Visual afferent contribution was more pronounced for Group II and III participants than for Group I participants. CONCLUSIONS: Proprioceptive exercise appears to have the best impact on balance regulation and precision. Besides, even if bioenergetic activity improves postural control in simple postural tasks, more difficult postural tasks show that this type of activity does not develop a neurosensorial proprioceptive input threshold as well, probably on account of the higher contribution of visual afferent.

Aged↗
PubMed1977

The effect of proprioceptive facilitation patterning upon reaction, response, and movement times.

The purpose of this study was to determine the effect of proprioceptive facilitation upon reaction time, movement time, and response time. Reaction time, response time-one (flexion at shoulder, extension at elbow); response time-two (flexion, adduction, external rotation at shoulder, elbow flexion), and movement time (response time-two minus reaction time), were measured before and following a training session. Fifteen women and 27 men were randomly assigned to one of the following training groups; weight training, target throwing, and proprioceptive facilitation patterning. Subjects engaged in three training sessions a week for six weeks. Analysis revealed a significant improvement for the proprioceptive facilitation patterning group in response time-two and movement time.

Elbow Joint↗
PubMed1998

Neuropsychological evidence of the functional integration of visual, auditory and proprioceptive spatial maps.

We infer the functional integration of the visual, auditory and proprioceptive spatial maps from the behaviour of a patient (G.A.) with left visual neglect, i.e. a derangement of visual space representation. G.A. was required to point manually to left, centre or right acoustic stimuli, under visual control or blindfolded, with the responding hand (left or right) located either on the left, centre or right space. G.A.'s manual pointing responses to left auditory stimuli were strongly influenced by the visual spatial information and by the proprioceptive spatial information related to the position of the responding effector. In the visual control condition, when the patient performed the task with the left effector located on the left, pointing responses to left auditory stimuli were shifted towards the right intact visual space. In contrast, when the visual spatial information was rendered less salient, i.e. in the blindfolded condition, and the effector was again located on the left, manual pointing responses were confined to the previously ignored left space. These findings are consistent with the view that the acoustic representation is modulated by the impaired visual representation and by the proprioceptive spatial map related to the position of the responding effector.

Acoustic Stimulation↗
PubMed1998

Vision influences tactile perception without proprioceptive orienting.

The perception of tactile stimuli is facilitated when subjects look towards the stimulated body site: this facilitation even takes place when visual information is unavailable, as when orienting in the dark. It is not known whether the facilitation is due entirely to such proprioceptive orienting of eye and head, or whether visual information of the body site can also facilitate touch. An experiment is reported which dissociates vision and proprioception, and demonstrates for the first time that vision of a body part, independent of proprioceptive orienting, can indeed effect somatosensation.

Adult↗
PubMed2002

Reducing the risk of falls through proprioceptive dynamic posture training in osteoporotic women with kyphotic posturing: a randomized pilot study.

OBJECTIVE: To assess the effect of a proprioceptive dynamic posture training program on balance in osteoporotic women with kyphotic posture. DESIGN: Subjects were randomly assigned to either a proprioceptive dynamic posture training program or exercise only group. Anthropometric measurements, muscle strength, level of physical activity, computerized dynamic posturography, and spine radiography were performed at baseline and 1 mo. RESULTS: At the 1-mo follow-up, three groups were formed on the basis of the baseline computerized dynamic posturography results. In general, groups 1 and 2 had no significant change at 1 mo, whereas group 3 improved balance significantly at 1 mo. CONCLUSION: The subjects who had abnormal balance and used the proprioceptive dynamic posture training program had the most significant improvement in balance. Improved balance could reduce the risk of falls.

Accidental Falls↗
PubMed2002

Joint proprioception before and after total knee arthroplasty.

To investigate the effects of total knee arthroplasty on joint proprioception, the absolute angular error of the knee in 38 consecutive patients before and after total knee arthroplasty for osteoarthritis and in 23 age-matched control subjects were examined. Varus and valgus laxity of the knee and muscle strengths of the thigh were measured using appropriate instruments. There were no significant differences in absolute angular error before and after total knee arthroplasty, independent of retaining or substituting the posterior cruciate ligament. The absolute angular error of the knee with a normal appearing anterior cruciate ligament was larger than that with a missing anterior cruciate ligament before total knee arthroplasty and decreased significantly after surgery. The absolute angular error correlated with the varus and valgus laxity of the knee, but did not correlate with the strength of thigh muscles after total knee arthroplasty. These results suggest that deficiency of the anterior cruciate ligament may not adversely affect proprioception in severe knee osteoarthritis. In addition, proper ligament balance may partly contribute to better proprioception after total knee arthroplasty.

Aged↗
PubMed2002

Influence of proprioceptive input on parkinsonian tremor.

Previous studies have shown a modification of parkinsonian tremor (PT) by proprioceptive input induced by passive joint movements. The authors investigated the impact of electrically evoked proprioceptive input on PT. In eight patients with PT they recorded surface EMG from the opponens pollicis muscle, and forearm extensors and flexors. Rhythmic electrical stimulation was applied to the ipsilateral median nerve at the wrist using a submaximal stimulus intensity and stimulus frequencies between two stimuli per second and five stimuli per second. The tremor frequency did not adapt to the stimulus frequency. Tremor frequency of parkinsonian resting tremor increased significantly in the directly stimulated opponens pollicis muscle (mean +/- standard deviation, 4.35 +/- 0.64 Hz without stimulation versus 4.53 +/- 0.68 Hz with stimulation; P < 0.05, paired t-test), the not directly stimulated forearm muscles (4.90 +/- 0.72 Hz versus 5.18 +/- 0.73 Hz, P < 0.001), and the upper arm muscles (5.13 +/- 0.61 Hz versus 5.36 +/- 0.68 Hz, P < 0.01). Furthermore, the parkinsonian postural tremor accelerated significantly during ipsilateral median nerve stimulation (5.31 +/- 0.99 Hz versus 5.44 +/- 1.03 Hz, P < 0.05). Parkinsonian resting tremor in the forearm muscles also accelerated significantly during ipsilateral ulnar nerve stimulation (4.85 +/- 0.57 Hz versus 5.05 +/- 0.65 Hz, P < 0.05). Contralateral median nerve stimulation had no significant effect. These results suggest a close interaction between proprioceptive input and PT generation.

Adult↗
PubMed2001

The effects of joint angle and reliability on knee proprioception.

PURPOSE: The purpose of this study was to examine the reliability and effects of knee angle on the detection and subsequent response to passive knee movement. METHODS: Twenty college-aged male and 20 female volunteers were evaluated for proprioception by a newly developed perturbation test. Subjects were in a prone position on an isokinetic chair with their right lower leg attached to a freely moving resistance adapter. The knee was placed in a starting position of 15, 30, or 60 degrees of flexion. While relaxed, the knee was dropped into extension, and the subjects were instructed to "catch their leg" when movement was perceived. Five trials were completed at each angle, in a random order. An electrogoniometer was secured to the lateral portion of the knee in order to measure angular displacement after perturbation in two specific phases: detection (displacement from leg release to movement cessation) and response (displacement from movement cessation to peak knee flexion). A three-factor ANOVA (two repeated factors (knee angle and proprioception phase) and one between factor (gender)) was performed on the average and standard deviation of the five trials for significant main effects and interactions. RESULTS: The results demonstrated a significant phase by angle interaction, and no gender effect. It was shown that at a more extended knee joint position (15 degrees), significantly less knee movement occurred before perception, followed by a greater response, than in a more flexed position (30 and 60 degrees). CONCLUSION: The major findings of this study suggest that the detection of passive knee movement, and the subsequent voluntary response, may be dependent on joint angle. Considerations of the present method for proprioception assessment are warranted to enhance test-retest reliability.

Adult↗
PubMed1992

Proprioceptive accuracy in idiopathic scoliosis.

Defects in proprioceptive postural control have been linked to the etiology of idiopathic scoliosis. In particular, a rearrangement of the internal representation of the body has been proposed in these cases. In this study, upper-extremity proprioceptive accuracy was compared among the following groups: 1) patients with idiopathic scoliosis (n = 25); 2) subjects with nonprogressive spinal asymmetry detected by screening in school (n = 23); 3) subjects undergoing behavioral training for nocturnal enuresis (n = 17); and 4) normal subjects (n = 134). A significant inaccuracy was found among the right-handed subjects of the scoliosis and spinal asymmetry groups as compared to the normal group. It is postulated that proprioceptive dysfunction, or borderline function, is a causative factor of spinal asymmetry, which is often observed in early adolescence and which in some cases may be progressive.

Adolescent↗
PubMed1997

Effects of fatigue on knee proprioception.

OBJECTIVE: To investigate the effects of muscular fatigue on knee joint proprioception. DESIGN: Prospective study. SETTING: Exercise physiology laboratory. PARTICIPANTS: Sixteen (eight men and eight women) healthy volunteers ages 19-27 years, with no history of neuromuscular disorders, vestibular disorders, or lower limb injuries (e.g., ligament/meniscus tear). INTERVENTION: Three separate fatigue protocols [ramp test (RT), continuous test (CT), and interval test (IT)] were performed. All tests consisted of lower limb cycling on a computer-driven cycle ergometer (Lode). The RT was used to calculate the maximal aerobic power (VO2max) and determine the work rates for the CT and IT. Work rate for the RT increased 20/25 W/min to maximal exhaustion. The CT consisted of cycling at 80% VO2max until maximal exhaustion. The IT consisted of cycling alternately at 120% VO2max and at 40% VO2max for 30 s each to the point of maximal exhaustion. MAIN OUTCOME MEASURE: In the standing position, subjects were instructed to perform a two-legged squat to specific knee flexion angles. The absolute angular error (AAE) was measured for each test angle using an electrogoniometer (Penny & Giles, Blackwood, Gwent, U.K.) placed laterally across the dominant knee joint. AAE was defined as the absolute difference between test angle and subject perceived angle of knee flexion. RESULTS: A statistically significant increase in AAE after the RT (1.0 +/- 0.66 degree, p < 0.01), CT (0.70 +/- 0.66 degree, p < 0.03), and IT (1.24 +/- 0.79 degrees, p < 0.01) protocols was observed in the male subjects. Female subjects reported a statistically significant increase in AAE after the CT (0.73 +/- 0.73 degree, p < 0.03) and IT (1.1 +/- 0.89 degrees, p < 0.01) protocols and a nonsignificant increase in AAE (0.19 +/- 0.70 degree, p > 0.5) after the RT protocol. CONCLUSION: These findings suggest that exercising to fatigue may produce a change in subjects' reproduction ability of knee joint angles. This may represent a decline in proprioceptive function after heavy exercise bouts. Whether this suggested proprioceptive decline is at the clinical significance level (e.g., significantly altering joint stability and motion) cannot be determined from the present findings.

Adult↗
PubMed1997

Comparisons of weight-bearing and non-weight-bearing tests of knee proprioception performed by patients with patello-femoral pain syndrome and asymptomatic individuals.

OBJECTIVE: To compare non-weight-bearing (sitting) and weight-bearing (standing, with approximately 95% of body weight on the test leg) tests of knee proprioception performed by patients with patello-femoral pain syndrome (PFPS) and asymptomatic individuals. DESIGN: A repeated measures design, repeated on two occasions. SETTING: Athletic injuries clinic. PARTICIPANTS: Seven men and 17 women with PFPS, and age- and sex-matched asymptomatic individuals. INTERVENTIONS: With their eyes closed, subjects extended their knee in sitting, or flexed their knees in standing, attempting to replicate target angles (15 degrees, 30 degrees, 45 degrees, and 60 degrees knee flexion) measured using an electrogoniometer. MAIN OUTCOME MEASURE: Observed angle of knee flexion during joint angle replication tests. RESULTS: Test-retest reliability coefficients (0.17-0.79) and between-session measurement error (+/-2.0 degrees to +/-6.4 degrees) varied widely. There was a tendency for reliability coefficients to be greater and between-session measurement error to be lower, for PFPS subjects, and for sitting tests. No significant differences were observed between the scores of the PFPS and asymptomatic subjects, at any of the four target knee angles. CONCLUSIONS: Scores in sitting should not be compared with those in standing. Clinically, the low reliability coefficients, large between-session measurement error, and finding of no statistically significant difference between PFPS and asymptomatic subjects suggest that the diagnostic value of the proprioceptive tests used is questionable. Further research is required to develop more precise tests of knee proprioception and to determine if the present results are applicable to other pathologies.

Adult↗