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PubMed2002

Strategies for enhancing proprioception and neuromuscular control of the knee.

Proprioception and neuromuscular control of the knee are compromised after ligament injury and must be regained if the athlete is to return to high level sports at a normal injury risk level. The anterior cruciate ligament deficient and reconstructed knee will be used as a model to describe differences in proprioception and neuromuscular control to those of an uninjured knee. The purpose of the current review is threefold. First, the basic science of proprioception and neuromuscular control specific to the knee will be summarized and reviewed. The review will include an overview of terminology, neurophysiology, and the effects of injury on the function of both lower limbs. Second, tools used for assessment and rehabilitation of proprioceptive deficits will be evaluated. Specific rehabilitation procedures that incorporate prophylactic conditioning that focus on transitioning the injured athlete back into sport will be presented. Finally, the literature with respect to gender variation in proprioception and neuromuscular control will be evaluated. The goal of the current review is to provide the clinician and the clinical scientist with sufficient background information for the development of quantitative methods to evaluate a patient's functional capacity and to assist in preventative, preoperative, and postoperative decision-making strategies.

Anterior Cruciate Ligament↗
PubMed2000

The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle.

PURPOSE: A common explanation for the tendency for ankle inversion sprains to recur is that proprioception is impaired by the initial sprain. It is further hypothesized that the application of tape prevents further sprains by enhancing proprioceptive acuity. The purpose of this study was to determine whether proprioception was impaired in people with recurrent ankle inversion sprain, and whether taping the ankle provided enhanced proprioceptive ability. METHODS: We compared the ability to perceive passive plantarflexion and dorsiflexion movements imposed at the relaxed ankle in 25 subjects with recurrent ankle inversion sprain, with a group of 18 healthy control subjects, matched for age, height, weight, and activity level. Subjects were tested with the ankle both taped and untaped. Detection thresholds were determined at three velocities, 0.1 degrees x s(-1), 0.5 degrees x s(-1), and 2.5 degrees x s(-1). Velocity of the imposed movements and testing of the taped and untaped conditions were randomized. RESULTS: There was no significant difference in the ability to perceive ankle movements between subjects with sprains and healthy controls at any velocity of movement tested. In addition, there was no significant difference in movement perception between the taped and untaped conditions for either subject group at any velocity. CONCLUSION: The ability to detect passive plantarflexion and dorsiflexion movements is not impaired in subjects with recurrent ankle inversion sprain. Furthermore, the protective effect of taping was shown not to arise from enhanced proprioception in the dorsiflexion-plantarflexion plane.

Adolescent↗
PubMed1983

A review of proprioception in extraocular muscles.

The controversial literature concerning the presence or absence of extraocular muscle proprioception is reviewed under the headings of anatomical, physiological, and psychophysical evidence. The principal area of confusion, namely whether to expect conscious awareness of proprioceptive information, is a problem also faced by researchers dealing with general skeletal muscle proprioception. It is unlikely that extraocular muscle proprioception will be understood in isolation from the proprioceptive mechanisms of the rest of the body.

Abducens Nerve↗
PubMed2006

Hip and knee proprioception in elite, amateur, and novice tennis players.

OBJECTIVES: The purposes of this study were: (1) to show the differences of lower limb proprioception in three different groups of normal male subjects-elite, amateur, and novice tennis players-and between the skill-dominant and stance-dominant hip and knee and (2) to test the sensitivity of closed-chain reposition test in the three groups. DESIGN: There were 22, 20, and 20 subjects in the three groups, respectively. Proprioception was tested with the closed-chain reposition method. Absolute error and variable error were calculated. One-way analysis of variance and Tukey's test were used to test the differences. RESULTS: The proprioception of the hip joints of the elite players was significantly better than that of the other two groups in absolute error (P < 0.0167). In variable error analysis, the proprioception of the stance-dominant leg of the elite players was significantly better than that of the novice players (P < 0.0033). CONCLUSIONS: Findings of this study supported that the proprioception of elite players was the best. The closed-chain reposition test had good discriminating power between the elite players and the others.

Adult↗
PubMed1983

Proprioceptive sensation at the terminal joint of the middle finger.

This paper extends previous work (Gandevia & McCloskey, 1976) on proprioception in the terminal joint of the middle finger. By positioning the finger in appropriate ways proprioceptive acuity at the joint can be assessed when no muscular afferents could contribute, or when afferents in the flexor but not the extensor could contribute, or when afferents from both muscles could contribute. Digital nerve block anaesthetizes joint and cutaneous receptors and so was used to study the contributions from muscle afferents in isolation. Displacements (10 degrees) at various angular velocities were better detected when muscle afferents from both flexor and extensor muscles could contribute. This was so whether joint and cutaneous receptors were also available, or after digital anaesthesia. Performance when only muscle afferents are available is, however, inferior to that when all sensory mechanisms are intact. It is concluded that muscle afferents contribute to kinaesthesia, and that a full complement of such receptors from agonist and antagonist muscles gives superior acuity to that achieved when only the receptors of one of the muscle groups is available. The angular displacements necessary for 70% correct detection were determined at angular velocities between 0.25 degrees and 160 degrees/s. Proprioceptive performance was optimal with all proprioceptive mechanisms intact over the range of angular velocities 10 degrees -80 degrees/s: 70% correct detection of displacements of 0.8 degrees-1.2 degrees occurred in this range. Performance deteriorated slightly at higher velocities of displacement. Performance was significantly poorer when only joint and cutaneous receptors could contribute (in the absence of intramuscular receptors), and when only intramuscular receptors could contribute (in the absence of joint and cutaneous receptors). Full proprioceptive acuity depends upon the availability of receptors in muscles and in skin and/or joints.

Finger Joint↗
PubMed2002

Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis.

OBJECTIVE: To investigate whether alleviation of knee pain influences quadriceps function, proprioceptive acuity, and postural stability in patients with knee osteoarthritis (OA). METHODS: A crossover, within-subject, double blind study design involving 68 subjects with painful knee OA. Each subject received an intra-articular injection into one or both knees (both if symptomatic) of either 5 ml 0.5% bupivacaine or 5 ml 0.9% saline. Two weeks later they received an injection of the alternative agent. Subjects and observer were unaware of the order of injection, which was randomly assigned. Knee pain (100 mm visual analogue scale), static postural sway, knee proprioceptive acuity, maximum voluntary contraction (MVC), and percentage activation of the quadriceps were assessed immediately before and one hour after each injection. RESULTS: Significant pain reduction was achieved one hour post-bupivacaine (mean difference as a percentage change 56.85, 95% CI 31.01 to 73.65; p<0.001) and post-saline (mean difference as a percentage change 41.94, 95% CI 11.57 to 76.66; p< 0.001), with no significant difference between the two. Both MVC and activation increased significantly post-bupivacaine (mean percentage differences 18.83, 95% CI -31.79 to -0.26, and -11.90, 95% CI -39.53 to 2.97, respectively; both p<0.001) and post-saline (mean percentage differences -7.64, 95% CI -21.96 to 4.73, and -10.71, 95% CI -25.19 to 2.60 respectively; both p<0.001). Proprioception worsened after bupivacaine (mean percentage difference -28.15%, 95% CI -83.47 to 19.74; p=0.009), but there was no effect on postural sway; saline injection had no effects. There was no order effect, and comparison of median percentage changes showed no significant differences between injections for change in MVC, activation, proprioception, or sway. CONCLUSION: Reduction in knee pain through either peripheral (local anaesthetic) or central (placebo) mechanisms resulted in increased MVC. This increase, however, did not result in improvements in proprioception or static postural stability, suggesting that other mechanisms play a part in these functions, at least in this acute model.

Adult↗
PubMed1995

Proprioceptive sensory codes mediating movement trajectory perception: human hand vibration-induced drawing illusions.

To study the organization of the proprioceptive sensory codes subserving movement trajectory perception, complex hand drawing illusions were elicited using various vibration patterns applied to the wrist muscles of nine human subjects. It was established that it is possible to elicit kinesthetic illusions involving spatially oriented lines and geometrical shapes such as rectilinear or curvilinear figures by activating four groups of muscle tendons at the wrist level. The vibration sequences specifically evoking each shape were determined by varying the vibration frequency, the duration of each stimulus applied, and the vibrator onsets, and by applying the vibrations either successively or simultaneously. The proprioceptive coding of a trajectory can be modelled in terms of a series of vectors, the direction of which depends on the anatomical sites of the muscles that are stretched and shortened during the movement. The vector giving the spatial path of a movement is the sum vector of the vectors determined on the basis of the proprioceptive inputs originating from each muscle, and the modulus of the resulting vector is the instantaneous velocity of the movement. In line with previous cortical data, our results suggest that the perception of the spatial paths of limb segment movements is coded in joint space kinematic coordinates on the basis of the relevant ongoing proprioceptive information. It therefore emerges from the results of this study that muscle proprioception is able to generate spatiotemporal afferent patterns that may mediate complex cognitive operations such as those involved in the memorizing and recognition of motor forms.

Female↗
PubMed2006

Proprioceptive guidance of saccades in eye-hand coordination.

The saccade generator updates memorized target representations for saccades during eye and head movements. Here, we tested if proprioceptive feedback from the arm can also update handheld object locations for saccades, and what intrinsic coordinate system(s) is used in this transformation. We measured radial saccades beginning from a central light-emitting diode to 16 target locations arranged peripherally in eight directions and two eccentricities on a horizontal plane in front of subjects. Target locations were either indicated 1) by a visual flash, 2) by the subject actively moving the handheld central target to a peripheral location, 3) by the experimenter passively moving the subject's hand, or 4) through a combination of the above proprioceptive and visual stimuli. Saccade direction was relatively accurate, but subjects showed task-dependent systematic overshoots and variable errors in radial amplitude. Visually guided saccades showed the smallest overshoot, followed by saccades guided by both vision and proprioception, whereas proprioceptively guided saccades showed the largest overshoot. In most tasks, the overall distribution of saccade endpoints was shifted and expanded in a gaze- or head-centered cardinal coordinate system. However, the active proprioception task produced a tilted pattern of errors, apparently weighted toward a limb-centered coordinate system. This suggests the saccade generator receives an efference copy of the arm movement command but fails to compensate for the arm's inertia-related directional anisotropy. Thus the saccade system is able to transform hand-centered somatosensory signals into oculomotor coordinates and combine somatosensory signals with visual inputs, but it seems to have a poorly calibrated internal model of limb properties.

Adult↗
PubMed1983

Role of proprioceptive reflexes in control of feeding muscles of Aplysia.

Stretching the muscles of the buccal mass of Aplysia evoked proprioceptive reflexes. These consisted of a direct reflex in which the stretched muscle contracted and a crossed reflex in which the contralateral homolog of the stretched muscle contracted as well. Both reflexes were accompanied by corresponding changes in neural activity in the buccal nerves. The muscle contraction and efferent neural activity were abolished by blocking synaptic transmission in the buccal ganglia. Blocking neuromuscular transmission blocked the contractions but not the stretch-induced afferent neural activity. Proprioceptive responses were obtained from isolated buccal nerve-muscle preparations. Both tonic on- and on-off responses were observed. These responses persisted after blocking synaptic transmission at the muscle, indicating that they were due to afferent fibers rather than peripheral interneurons. Proprioceptive neurons with centrally located cell bodies were found. These included previously identified neurons B4 and B5 as well as small cells. Proprioceptive neurons responded to muscle stretch with peripherally initiated axonal spikes that conducted into the central nervous system (CNS) and preceded their somatic spikes. These responses persisted after blocking synaptic transmission in the CNS. Several motor neurons were found. When intracellularly stimulated, these evoked contractions of their target muscle even after blocking synaptic transmission in the CNS. The motor neurons responded synaptically to stretching the ipsilateral muscle. Some responded to stretching of the contralateral homologous muscle as well. The motor neurons differed in their axonal projections, with some projecting only ipsilaterally, others bilaterally. The majority of motor neurons were inhibited by muscle stretch due to inhibitory monosynaptic input from the proprioceptive cells B4 and B5. The stretch reflex occurred when the motor neurons fired due to postinhibitory rebound. The synaptic organization of the reflex was considered.

Animals↗
PubMed1999

Proprioceptive and retinal afference modify postsaccadic ocular drift.

Drift of the eyes after saccades produces motion of images on the retina (retinal slip) that degrades visual acuity. In this study, we examined the contributions of proprioceptive and retinal afference to the suppression of postsaccadic drift induced by a unilateral ocular muscle paresis. Eye movements were recorded in three rhesus monkeys with a unilateral weakness of one vertical extraocular muscle before and after proprioceptive deafferentation of the paretic eye. Postsaccadic drift was examined in four visual states: monocular viewing with the normal eye (4-wk period); binocular viewing (2-wk period); binocular viewing with a disparity-reducing prism (2-wk period); and monocular viewing with the paretic eye (2-wk period). The muscle paresis produced vertical postsaccadic drift in the paretic eye, and this drift was suppressed in the binocular viewing condition even when the animals could not fuse. When the animals viewed binocularly with a disparity-reducing prism, the drift in the paretic eye was suppressed in two monkeys (with superior oblique pareses) but generally was enhanced in one animal (with a tenotomy of the inferior rectus). When drift movements were enhanced, they reduced the retinal disparity that was present at the end of the saccade. In the paretic-eye-viewing condition, postsaccadic drift was suppressed in the paretic eye and was induced in the normal eye. After deafferentation in the normal-eye-viewing state, there was a change in the vertical postsaccadic drift of the paretic eye. This change in drift was idiosyncratic and variably affected the amplitude and velocity of the postsaccadic drift movements of the paretic eye. Deafferentation of the paretic eye did not affect the postsaccadic drift of the normal eye nor did it impair visually mediated adaptation of postsaccadic drift. The results demonstrate several new findings concerning the roles of visual and proprioceptive afference in the control of postsaccadic drift: disconjugate adaptation of postsaccadic drift does not require binocular fusion; slow, postsaccadic drift movements that reduce retinal disparity but concurrently increase retinal slip can be induced in the binocular viewing state; postsaccadic drift is modified by proprioception from the extraocular muscles, but these modifications do not serve to minimize retinal slip or to correct errors in saccade amplitude; and visually mediated adaptation of postsaccadic drift does not require proprioceptive afference from the paretic eye.

Adaptation, Physiological↗
PubMedDate not supplied

The role of proprioception in the management and rehabilitation of athletic injuries.

Rehabilitation continues to evolve with the increased emphasis on patient management and proprioceptive training. Proprioception can be defined as a specialized variation of the sensory modality of touch that encompasses the sensation of joint movement (kinesthesia) and joint position (joint position sense). Numerous investigators have observed that afferent feedback to the brain and spinal pathways is mediated by skin, articular, and muscle mechanoreceptors. Examining the effects of ligamentous injury, surgical intervention, and proprioceptively mediated activities in the rehabilitation program provides an understanding of the complexity of this system responsible for motor control. It appears that this neuromuscular feedback mechanism becomes interrupted with injury and abnormalities, and approaches restoration after surgical intervention and rehabilitation. Rehabilitation programs should be designed to include a proprioceptive component that addresses the following three levels of motor control: spinal reflexes, cognitive programming, and brainstem activity. Such a program is highly recommended to promote dynamic joint and functional stability. Thus far, current knowledge regarding the basic science and clinical application of proprioception has led the profession of sports medicine one step closer to its ultimate goal of restoring function.

Adaptation, Physiological↗
PubMed2002

Proprioception of the ankle: a comparison between female teenaged gymnasts and controls.

Proprioceptive mechanisms appear to play a role in stabilizing the joints and may serve as a means for interplay between static stabilizers and dynamic muscular restraints. The purpose of our study was to investigate whether or not gymnastic training has any effect on the balance and on proprioception in an ankle, as seen in gymnasts and in nongymnasts. We evaluated the proprioceptive ability of the ankle using four different tests (a one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test). Proprioception of the ankle was measured in 40 subjects who were assigned to two experimental groups. Group 1 (n: 20) were healthy control subjects, and group 2 (n: 20) were teenaged female gymnasts. The sense of position of a joint was actively measured using a Cybex NORMTM isokinetic dynamometer and measured passively with a proprioception-testing device. A Mann-Whitney U test was used to compare mean values of the gymnasts to the controls. Results revealed statistically significant differences (p<0.05) between two groups. We found no statistically significant differences between the dominant and nondominant ankle in volunteers or in gymnasts, in all tests. The results of this study suggest that gymnastic training has a positive influence on sense of position of the ankle joint and on balance, in addition to increasing muscle tone.

Adolescent↗
PubMed1993

Lack of a proprioceptive deficit after dorsal column lesions in monkeys.

Previous psychophysical examinations of the effects of dorsal column (DC) lesions on proprioception of the lower extremity have not revealed disturbances in proprioception, and there have been no similar experiments for the upper extremity. To evaluate the effect of DC lesions on upper extremity proprioception, we tested two monkeys with a variation of the typical clinical test for position sense. This test required the monkeys to detect the direction of a passive displacement of the finger. We identified proprioceptive deficits in one monkey following a DC lesion, but only when the finger was displaced with a small (< 14 degrees), slow (< 7 degrees/sec) movement. When we included displacements of all sizes and velocities in the analysis, performance was unaffected by the DC lesions in either monkey. Since the standard test for proprioception does not specify the speed and size of movements, we conclude that this test is not a valid method for estimating damage to the DCs.

Animals↗
PubMed1998

Proprioception of the ankle and knee.

Proprioception and accompanying neuromuscular feedback mechanisms provide an important component for the establishment and maintenance of functional joint stability. Neuromuscular control and joint stabilisation is mediated primarily by the central nervous system. Multisite sensory input, originating from the somatosensory, visual and vestibular systems, is received and processed by the brain and spinal cord. The culmination of gathered and processed information results in conscious awareness of joint position and motion, unconscious joint stabilisation through protective spinal-mediated reflexes and the maintenance of posture and balance. Clinical research aimed at determining the effects of articular musculoskeletal injury, surgery and rehabilitation, on joint proprioception, neuromuscular control and balance has focused on the knee and ankle joints. Such studies have demonstrated alterations in proprioception subsequent to capsulo-ligamentous injury, partial restoration of proprioceptive acuity following ligamentous reconstruction, and have suggested beneficial proprioceptive changes resulting from comprehensive rehabilitation programmes.

Ankle Joint↗
PubMed1999

Functional roles of the proprioceptive system in the control of goal-directed movement.

This article explored functional roles of the proprioceptive system during the control of goal-directed movements. Proprioceptive information contributes to the control of movement through both reflex and central connections. Spinal and transcortical reflex loops establish a servomechanism which provides automatic corrections of unexpected changes in muscle length and allows compensation for undesirable irregularities in the mechanical properties of muscles by modulating limb stiffness at the subconscious level. Central connections provide the control system with information about peripheral states which is used in voluntary components of movement control. Before the initiation of movement, proprioceptive information about initial limb orientation becomes a basis for the programming of motor commands. During a movement, proprioceptive input about velocities and angular displacements of a limb is used to regulate movement by triggering planned sequences of muscle activation and modulating motor commands. After movement, feedback produced by responses is compared with previously stored information, verifying the quality of the movement. Considering potential roles of the reflex and central connections, the proprioceptive system seems to constitute an important aspect of motor control mechanisms, providing the control system with efficiency and flexibility in the regulation of goal-directed movements.

Biomechanical Phenomena↗
PubMed2001

Review of knee proprioception and the relation to extremity function after an anterior cruciate ligament rupture.

Several tests of human conscious knee proprioception have been described, but there is no consensus or reference standard established. Difficulties remain in the separation of information originating from muscles, tendons, and joints, and the tests cannot discriminate between loss of afferent signals or altered activity in the remaining receptors. There is convincing evidence from several descriptive studies that the afferent information is altered after a knee ligament injury and severely disturbed in some patients with anterior cruciate ligament (ACL) injuries. However, an inherent inferior proprioceptive ability may also exist in some individuals, which makes them vulnerable to injuries. The deficits in proprioception have mostly been studied and related to the consciously registered sense, whereas the extent of possible disturbances of the unconscious or reflectory mechanisms is largely unknown. The latter may, at least from a theoretical point of view, be predominantly contributing to the overall afferent regulation, and a possibility for major defects thus exists, since there is no knowledge of the quantified relation between the conscious and unconscious part. The clinical importance of the altered afferent information has not been evaluated properly, and the role of proprioception that contributes to function has yet to be investigated. A higher physiological sensitivity to detecting a passive joint motion closer to full extension has been found both experimentally and clinically, which may protect the joint due to the close proximity to the limit of joint motion. Proprioception has been found to have a relation to subjective knee function, and patients with symptomatic ACL deficiency seem to have larger deficits than asymptomatic individuals. Little is known about whether training can restore defects in sensory information or by which mechanisms possible compensatory pathways are established. In rehabilitation, each patient must, however, create muscle strength, alertness, and stiffness in harmony with the disturbed mechanics of the knee, which are present both after nonoperative treatment of the ACL and after a reconstruction of the ACL.

Anterior Cruciate Ligament Injuries↗
PubMed2002

Thoracolumbar proprioception in individuals with and without low back pain: intratester reliability, clinical applicability, and validity.

STUDY DESIGN: Repeated measures design of active spinal position sense in individuals with and without low back pain (LBP). OBJECTIVES: Reproducibility and validity evaluation of thoracolumbar proprioception measurement. BACKGROUND: Proprioception studies in peripheral joints and the spine suggest that there may be proprioception deficits due to injury, pain, or degeneration. Kinesthetic retraining may be useful in rehabilitation of patients with LBP, but appropriate measures are required to objectively quantify spinal proprioception. METHODS AND MEASURES: Active-target reproduction in the sagittal, horizontal, and coronal planes was assessed (3 separate occasions for 18 asymptomatic volunteers and 2 occasions for 62 patients with LBP). Repositioning accuracy was expressed as absolute errors (AE) and variable errors (VE). Reliability was analyzed with intraclass correlation coefficient (ICC) and precision with standard error of measurement (SEM) and calculation of the smallest detectable difference (SDD) index. Repeated measures ANOVA and correlations were used for within-group comparisons and discriminant analysis for between-group comparisons. RESULTS: Reproducibility was better for the asymptomatic group, with AE for flexion and rotation being the most reliable (ICC = 0.76-0.80, SEM = 0.91 degrees-1.34 degrees). SDDs were high for all tests, suggesting limited clinical applicability. Reproducibility for the same tests was poor-moderate (ICC = 0.31-0.64, SEM = 0.45 degrees-3.90 degrees) for the patient group. AE for right-side rotation could discriminate between subject groups with 83.3% specificity but only 54.8% sensitivity. CONCLUSIONS: Proprioception testing, with the methods employed, did not demonstrate good measurement properties in a sample of patients with recurrent LBP. Neither could it sufficiently discriminate between individuals with and without LBP. Possible reasons for these findings are discussed.

Adult↗
PubMed2005

Visual and proprioceptive representations in spatial memory.

It has been shown that spatial information can be acquired from both visual and nonvisual modalities. The present study explored how spatial information from vision and proprioception was represented in memory, investigating orientation dependence of spatial memories acquired through visual and proprioceptive spatial learning. Experiment 1 examined whether visual learning alone and proprioceptive learning alone yielded orientation-dependent spatial memory. Results showed that spatial memories from both types of learning were orientation dependent. Experiment 2 explored how different orientations of the same environment were represented when they were learned visually and proprioceptively. Results showed that both visually and proprioceptively learned orientations were represented in spatial memory, suggesting that participants established two different reference systems based on each type of learning experience and interpreted the environment in terms of these two reference systems. The results provide some initial clues to how different modalities make unique contributions to spatial representations.

Adolescent↗