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The effects of proprioceptive or strength training on the neuromuscular function of the ACL reconstructed knee: a randomized clinical trial.

OBJECTIVES: The purpose of this study was to determine the effects of a proprioceptive training program (PT) vs. a strength training (ST) program on neuromuscular function after anterior cruciate ligament (ACL) reconstruction. The second purpose was to establish the determinants of functional ability for the operated limb. METHODS: Ten participants with unilateral ACL reconstructions were randomly assigned to one of the following 12-week training protocols: (1) isotonic ST, and (2) PT. The outcome measures were: (1) peak torque time of the hamstring muscles (PeakTT), (2) average concentric and eccentric torques of the quadriceps and hamstring muscles, (3) one-legged single hop for distance (SLHD), (4) one-legged time hop (TH), and (5) subjective scores. RESULTS: : There was a significant group by time interaction effect for PeakTT (P = 0.017). The PT group demonstrated greater percent change in isokinetic torques than the ST group at the end of the 12 weeks (P < or = 0.05). Participants in both groups demonstrated similar significant gains in functional ability and subjective scores (P < or = 0.014). Quadriceps strength is a determinant of functional ability for the operated limb (R2 = 0.72). CONCLUSIONS: : Both training protocols influenced PeakTT. The beneficial effects of ST on PeakTT appear to be load-dependent, while sufficient practice may be crucial in maintaining PeakTT improvements induced by PT. Proprioceptive training alone can induce isokinetic strength gains. Restoring and increasing quadriceps strength is essential to maximize functional ability of the operated knee joint.

Adult↗

Weight differences in emotional responsiveness to proprioceptive and pictorial stimuli.

Two studies were conducted to investigate weight differences in emotional responsiveness to proprioceptive and pictorial stimuli. Contrary to past evidence that overweight persons are more emotional than normals, the emotional state of normal-weight subjects fluctuated with manipulations of their facial expression, whereas that of overweight subjects did not respond to these proprioceptive cues. Furthermore, whereas past research employing affectively loaded pictures had found overweight persons to be more emotionally responsive than normals to these external stimuli, no weight differences were obtained in the present studies, which employed less polarized pictures. Implications of these findings for generalizations about weight differences in emotionality are discussed.

Arousal↗

Believing what you feel: using proprioceptive feedback to reduce unilateral neglect.

Unilateral spatial neglect declines when participants reach to grip the center of long metal rods compared with when they point to the perceived center, suggesting that visuomotor control systems are less affected by neglect than other representational systems (I. H. Robertson, D. Nico, & B. Hood, 1995). In this study, 16 participants with unilateral left neglect actually picked up rods, and we predicted short-term improvements in neglect because of induced conflict between a phenomenally symmetrical visual world on the one hand and a proprioceptively conveyed rightward-biased world on the other. With participants serving as their own controls, significant short-term improvements in neglect were found on 2 out of 4 neglect tasks after participants experienced proprioceptive feedback discrepant from the judgments they made on the basis of visual information alone.

Aged↗

Runx3 controls the axonal projection of proprioceptive dorsal root ganglion neurons.

Dorsal root ganglion (DRG) neurons specifically project axons to central and peripheral targets according to their sensory modality. The Runt-related genes Runx1 and Runx3 are expressed in DRG neuronal subpopulations, suggesting that they may regulate the trajectories of specific axons. Here we report that Runx3-deficient (Runx3(-/-)) mice displayed severe motor uncoordination and that few DRG neurons synthesized the proprioceptive neuronal marker parvalbumin. Proprioceptive afferent axons failed to project to their targets in the spinal cord as well as those in the muscle. NT-3-responsive Runx3(-/-) DRG neurons showed less neurite outgrowth in vitro. However, we found no changes in the fate specification of Runx3(-/-) DRG neurons or in the number of DRG neurons that expressed trkC. Our data demonstrate that Runx3 is critical in regulating the axonal projections of a specific subpopulation of DRG neurons.

Animals↗

Proprioceptive training in haemophilia.

Joint and muscle injury associated with direct damage to the tissues and muscle atrophy may ensue following immobility. Rehabilitation of the injury is linked with the return to normal functional values such as range of motion, muscle strength, and muscle tone. It is, however, likely that subtle changes or differences still exist in the site of injury or haemarthrosis. In particular proprioception may be distorted due to the direct injury of sensory receptors and to feedback systems. The implications of such damage are important, where proprioception plays an important part in the control, timing and organisation of coordinated bodily actions.

Adult↗

Production and perception of grip force without proprioception: is there a sense of effort in deafferented subjects?

We assessed the ability of healthy subjects (n = 7) and a patient deprived of proprioception (GL) to produce and assess different levels of isometric forces. They first produced a target force with one hand (the reference control hand) and then, after a delay of 3 s, they attempted to match it with the other hand (the experimental matching hand). Despite abnormal variations in motor outputs, we found that GL could, as could the control subjects, maintain a constant relationship between the force exerted by the control hand and the force exerted by the experimental hand. As GL was deprived of proprioceptive cues, these results suggest that she indirectly perceived muscular force through central effort. Interestingly, when carrying out the task the patient reported neither feelings of fatigue nor awareness of how hard she tried to perform the matches. Hence, under certain circumstances (such as in our motor task), it seems possible to assess and scale muscular force on the basis of endogenous signals only. However, internally generated signals related to the size of the motor command may need to interact with afferent input to gain full access to consciousness.

Adult↗

[Peak torque and proprioception at the ankle of dancers in professional training].

The ankle is a frequent site of injury for dancers. The aim of the controlled study was to examine the proprioceptive and sensorimotor control of the ankle in a group of dancers in professional training and to compare it with persons unused to physical training. The purpose was to investigate whether dance training influences the torque ratio of plantar flexion to dorsiflexion (PF/DF) and the proprioceptive performance compared to controls. 42 dancers (31 f, 11 m) in professional training and 40 sex- and age-matched controls performed a isokinetic peak torque test, a passive angle-reproduction test (Biodex System 3), and a single-limb-standing test. The female dancers showed a significantly higher peak torque ratio PF/DF at 30 degrees/s. The difference between male dancers and the controls did not reach a significant level. The dancers did not demonstrate lower absolute errors in passive angle-reproduction (5 degrees and 25 degrees PF) than controls. In the single-limb-standing test, the dancers achieved significantly better results than controls. Dancers could profit from special training of the dorsiflexors. In view of the balance deficits, coordinative exercises should be integrated into school and recreational sports more frequently.

Adolescent↗

[Proprioception of the shoulder joint in young tennis players].

In 60 adolescent volunteers aged 8 to 16 years we assessed the proprioceptive capability of the shoulder complex by an angle reproduction test. The purpose of the study was to evaluate the proprioceptive capability of adolescent tennis players. 40 were tennis players, 20 non tennis players served as a control group. Documentation of the reproduced angle was performed by a motion analyzing system with passive markers. Angle reproduction of all volunteers was best in the midrange of motion (100 degrees flexion, 100 degrees abduction, neutral rotation in 90 degrees abduction). The worst results were documented below shoulder level (50 degrees flexion, 50 degrees abduction, internal rotation in 90 degrees abduction). A correlation to sex or dominant extremity could not be found. Subjects older than 12 years showed a tendency for better angle reproduction compared to the younger subjects. Tennis players older than 12 years demonstrated significant better capabilities for angle reproduction in some movements of the shoulder complex.

Adolescent↗

[The effect of proprioception on functional stability of the upper ankle joint with special reference to stabilizing aids].

Both ankle joints of 14 uninjured volunteers and 16 patients with unstable ankle joints were tested regarding their proprioceptive capabilities. Three tests were used for the study: single-leg stance test, single-leg jumping course test, angle-reproduction test. The influence of three stabilization devices (lace-on-brace, stirrup-brace, taping) on the proprioceptivity of stable and unstable ankle joints were evaluated as well. The scores of the single-leg jumping course test without any stabilizing device (category "standard") ranged between 8.06 and 13.68 (10.65 +/- 1.29). In the categories "mikros" (9.85 +/- 0.99), "aircast" (9.99 +/- 1.14) and with the tape bandage (category "taping") (10.27 +/- 0.81) the scores were lower. In general, the scores of all trials with orthoses were lower compared to the category "standard". The differences of the categories "standard-mikros" and "standard-aircast" revealed a significant reduction of the scores when applicating these orthoses (p < 0.01). The differences of the category "standard-taping" as well as the single scores between the categories "mikros" and "aircast" were not statistically significant. According to the results of the single-leg stance test the error rate was within the range of 0-16 (5.12 +/- 2.85) for the category "standard", it was lower for the categories "mikros" (3.65 +/- 2.65) and "aircast" (4.17 +/- 2.59). The error rate was highest in the group with applicated tape bandage (5.79 +/- 3.53). The differences between the categories "standard"-"mikros" as well as "standard"-"aircast" were statistically significant (p < 0.01). There was also a significant difference between these categories regarding injured and uninjured ankle joints (p < 0.01). The pair differences of the categories "standard" and "taping" were below the significance level as well as the error rates of the categories "mikros" and "aircast". The ankle-reproduction-test showed higher values for the category "standard" (2.36 degrees +/- 0.97) in comparison to the categories "mikros" (1.46 degrees +/- 0.72). "aircast" (1.62 degrees +/- 0.91) and "taping" (1.84 degrees +/- 0.41). In the category "standard" the reproduction error of the uninjured ankle joints was lower (2.30 degrees +/- 1.04) compared to the group of unstable ankle joints (2.44 degrees +/- 0.81), whereas in all other categories the reproduction error was higher in the group of uninjured joints. The differences in all findings between the categories "standard"-"mikros" and "standard"-"aircast" were statistically significant (p < 0.01). The results of the three tests showed a statistically highly significant difference between injured and uninjured ankle joints (p < 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Ankle Injuries↗

[Age dependence of the interaction between proprioception and vision--a posturographic study].

BACKGROUND: The influence of fixation on the vestibulo-ocular reflex and the synergistic stabilising effect of vision on the body equilibrium are well known. In this study interactions between the visual and the proprioceptive systems in patients of different ages are analysed. We tried to find out whether body equilibrium reactions, recorded by posturography, are influenced qualitatively and quantitatively by visual inputs. METHODS AND PATIENTS: 349 neurotologic patients aged between 3 and 80 years were included in this study. We applied different optical patterns by means of a videoscreen to the patients standing on a posturographic platform. The patients were asked to follow the pattern with their centre of the gravity, which was also shown on the video screen. The patterns consisted of a line that had to be followed in the anterior-posterior and in the lateral plane and of a circle which had to be followed clockwise and counterclockwise. RESULTS: We recognised definite age-related changes in all tests used. The precision to follow a visual target with the body equilibrium increased with increasing age to the age of forty. With the beginning fifth decade this postural ability decreases slowly and decreases particularly markedly in patients of over 70 years of age. CONCLUSIONS: Posturography in combination with visual feedback is a valuable technique for testing visual-proprioceptive interactions. It can be employed over a large age bracket.

Adolescent↗

The effect of instability and subsequent anterior shoulder repair on proprioceptive ability.

Proprioceptive ability was prospectively evaluated in patients with recurrent traumatic anterior instability who subsequently underwent anterior shoulder repair. Thirty consecutive patients were evaluated for passive position sense and detection of motion with the shoulder in flexion, abduction, and external rotation 1 week before surgery. They were then retested at 6 and 12 months postoperatively. A significant deficit in proprioception was found when the unstable side was compared with the uninvolved side before surgery. Six months after surgical repair, position sense showed an improvement of approximately 50% but was still found to be significantly different on the involved side; detection of motion was no longer significantly different from the uninvolved shoulder. One year after open anterior shoulder repair, both position sense and detection of motion were equivalent to those of the uninvolved shoulder.

Adolescent↗

Visual proprioception and postural stability in infancy. A developmental study.

The effect of conflicting visual, and mechanical proprioceptive information on postural stability was compared in two groups of infants. The older group could sit or stand unsupported, while the younger group could sit but could not yet stand. The results suggest that visual proprioception functions to maintain postural stability before infants have learned to stand.

Female↗

Ames's window in proprioception.

When holding a small-scale model of Ames's trapezoidal window with the arms fully extended, several observers experience a striking proprioceptive distortion (eg one hand appears farther from the other, or one arm appears longer than the other). However, data from a matching experiment suggest that the proprioceptive misalignment of the hands is, in fact, rather less than the apparent slant of the window when this is not held. This finding argues against a 'visual-capture' account, supports an explanation in terms of bimodal integrative processes, and underscores the importance of supplementing phenomenological observations with objective measures.

Arm↗

Effects of visual deprivation on space representation: immediate and delayed pointing toward memorised proprioceptive targets.

Congenitally blind, late-blind, and blindfolded-sighted participants performed a pointing task at proximal memorised proprioceptive targets. The locations to be memorised were presented on a sagittal plane by passively positioning the left index finger. A 'go' signal for matching the target location with the right index finger was given 0 or 8 s after left-hand demonstration. Absolute distance errors were smaller in the blind groups, with both delays pooled together; signed distance and direction errors were underestimated with the longer delay, and were overestimated by blind groups, whereas the blindfolded-sighted group underestimated them. Elongation of the scatters was stretched but not affected by delay or group. The surface scatter was greater with the longer delay; and orientation of the main axis of the pointing ellipses shows the use of an egocentric frame of reference by the congenitally blind group for both delays, the use of egocentric (0 s) and exocentric (8 s) frame of reference by the blindfolded-sighted group, with the late-blind group using an intermediate frame of reference for both delays. Therefore, early and late visual-deprivation effects are distinguished from transient visual-deprivation effects as long-term deprivation leads to increased capabilities (absolute distance estimations), unaltered organisation (for surface and elongation), and altered organisation (amplitude and direction estimations, orientation of pointing distribution) of the spatial representation with proprioception. Besides providing an extensive exploration of pointing ability and mechanisms in the visually deprived population, the results show that cross-modal plasticity applies not only to neural bases but extends to spatial behaviour.

Adult↗

Age-related differences in vision and proprioception in a lower limb interceptive task: the effects of skill level and practice.

This study examined age-related differences in the role of visual proprioception during a lower limb interceptive action and how this varies as a function of skill and practice. In Experiment 1, skilled and less-skilled 8-, 10-, and 12-year-old boys controlled a soccer ball using their preferred foot under full vision and when sight of the effector was occluded. With the exception of the high-skilled 12-year-olds and low-skilled 8-year-olds, participants showed a decrement in peformance when denied access to visual proprioception. In Experiment 2, the effect of practicing under different informational constraints was examined for 12 year-old boys. Children performed varying amounts of practice under full vision, or in a condition where sight of the foot was occluded, before being transferred to the alternative viewing condition. Participants who practiced under occluded viewing conditions showed greater relative improvement in performance over practice and transfer sessions compared with a full vision control group. Some support is provided for the manipulation of visual informational constraints as an effective pedagogical approach to motor learning.

Age Factors↗

A comparison of traditional prosthetic training versus proprioceptive neuromuscular facilitation resistive gait training with trans-femoral amputees.

Reports in the rehabilitation literature suggest that patients with trans-femoral amputation ambulate well after suitable prosthetic treatment. The effects of exercise protocols on function, however, have not been documented in this population. This study was conducted to compare the outcome of traditional and proprioceptive neuromuscular facilitation (PNF) techniques on weight bearing and gait. Fifty unilateral trans-femoral amputees who were attending for their first prosthesis, participated in this study. Amputees were randomly assigned into groups receiving the traditional training or PNF. Traditional treatment was consisted of weight-shifting, balancing, stool-stepping and gait exercises. In the other group the same activities were given by PNF. Amputees were trained 30 minutes daily, for a total of 10 treatments. Pre- and post-training assessment included weight bearing measurements by using two bathroom scales and time-distance characteristics of gait from footprints. A statistically significant difference was found in all parameters within the groups due to pre- and post-training evaluation data (p<0.05), but more obvious improvement was observed in the group who received PNF (p<0.05). The results of the study suggest that the prosthetic training based on proprioceptive feedback was more effective to improve weight bearing and gait when compared with a traditional programme.

Adult↗

Quadriceps function, proprioceptive acuity and functional performance in healthy young, middle-aged and elderly subjects.

BACKGROUND: Muscle functions to generate force-producing movement and also has a role in proprioception. If ageing compromises these sensorimotor functions of muscle, the ability of older subjects to detect and correct postural sway may be impeded, resulting in impairment of functional performance. METHOD: To see if age-related changes occurred and, if so, what their effects might be. Quadriceps strength, proprioception, postural stability and functional performance were assessed in young (n = 20, mean age 23 years), middle-aged (n = 10, mean age 56 years) and elderly (n = 15, mean age 72 years) subjects. RESULTS: With increasing age there were decreases in quadriceps strength (r = -0.511; P < 0.001), acuity of joint position sense (r = -0.603; P < 0.001) and postural stability (ANOVA < 0.002) during stance conditions which placed a greater reliance on muscle proprioceptors. These changes may decrease postural stability confidence, resulting in impaired performance of common activities of daily living (r = 0.635; P < 0.001). CONCLUSIONS: The age-related deterioration in sensorimotor function of muscle may contribute to the increased fear and frequency of falls in elderly subjects, thereby decreasing independence.

Accidental Falls↗

Subjective body orientation in neglect and the interactive contribution of neck muscle proprioception and vestibular stimulation.

Three patients with a right, predominantly parietal lesion and marked left-sided neglect without visual field defects were asked to direct a laser point to the position which they felt to lie exactly 'straight ahead' of their bodies' orientation. Whereas in both light and darkness, the subjective body orientation was close to the objective body position in the control groups, the three neglect patients localized the body's sagittal midplane approximately 15 degrees to the right of the objective orientation. No relevant differences of 'straight ahead' were found between the neglect patients and controls in the vertical plane. The neglect patients' horizontal displacement of sagittal midplane to the right could be compensated for either by neck muscle vibration or by caloric vestibular stimulation on the left side. When vestibular stimulation was combined with neck muscle vibration, the horizontal deviation linearly combined by adding or neutralizing the effects observed when both types of stimulation were applied exclusively in the control groups as well as in the neglect patients. Moreover, data analysis revealed that the neglect patients' ipsilesionally displaced subjective body orientation does not result from a disturbed primary perception or disturbed transmission of the vestibular or proprioceptive input from the periphery. The present results support the hypothesis that the essential aspect leading to neglect in brain-damaged patients is a disturbance of those cortical structures that are crucial for transforming the sensory input coordinates from the peripheral sensory organs--here the retina, neck muscle spindles and cupulae--into an egocentric, body-centred coordinate frame of reference. In neglect patients the coordinate transformation seems to work with a systematic error and deviation of the spatial reference frame to the ipsilesional side leading to a corresponding displacement of subjective localization of body orientation. It can be concluded further that neck muscle proprioception and vestibular stimulation directly interact in contributing to the subject's mental representation of space. The data suggest that the afferent information from these different input channels is used simultaneously for computing egocentric, body-centred coordinates that allow us to determine our body position in space.

Adult↗