scholarly journals Dissociated Loss of Vibration, Joint Position and Discriminatory Tactile Senses in Disease of Spinal Cord and Brain

1991 ◽  
Vol 18 (3) ◽  
pp. 312-320 ◽  
Author(s):  
R.T. Ross
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Position Sense ◽  
Joint Position Sense ◽  
Primary Lesion ◽  
Posterior Column ◽  
Medial Lemniscus ◽  
Joint Position ◽  
Vibration Sense ◽  
Touch Sensation

ABSTRACT:The clinical functions of the posterior columns of the spinal cord and the signs of disease of these structures have been debated for years. Todd in 1847 and Schiff in 1858 knew the functions of the posterior columns and 10 years later Brown-Sequard knew as well. Reynolds, Romberg, and Duchenne, each described a posterior column syndrome based on a disease in which the primary lesion was not in the posterior columns. In the last 150 years almost every white matter structure of the cord has been credited with serving the sensations that we now know are a function of the posterior columns. Vibration, joint position and movement as well as discriminatory touch each seem to be served by separate fibres of the posterior columns and medial lemniscus. There is evidence of this in cat and man. These sensations may be lost individually, totally, or in certain stereotyped combinations. Vibration or joint sense is commonly lost alone. When a discriminatory touch sensation is lost with one other sense, it is almost inevitably joint position sense. Absent discriminatory touch and vibration sense with normal joint position sense appears to be unknown. This functional separation continues into the thalamus. At the highest level there is no evidence that vibration sense has any conscious somatosensory cortical affiliation, while joint position and discriminatory touch senses definitely do.

scholarly journals Timed Vibration Sense and Joint Position Sense Testing in the Diagnosis of Distal Sensory Polyneuropathy

2019 ◽  
Vol 10 (02) ◽  
pp. 273-277 ◽  
Author(s):  
Appaswamy Thirumal Prabhakar ◽  
Tharan Suresh ◽  
Dilu Susan Kurian ◽  
Vivek Mathew ◽  
Atif Iqbal Ahmed Shaik ◽  
...  
Keyword(s):  
Patient Group ◽  
Position Sense ◽  
Joint Position Sense ◽  
Control Group ◽  
Care Hospital ◽  
Joint Position ◽  
Great Toe ◽  
Vibration Sense ◽  
Female Ratio ◽  
Sensory Polyneuropathy

ABSTRACT Introduction: Distal sensory polyneuropathy (DSP) is one of the most common neurological disorders. Although several studies have studied the role of the neurological examination in DSP, there are only limited studies on the utility of timed vibration sense (VBS) and joint position sense (JPS) testing in the diagnosis of DSP. Objectives: The objective is to study the utility of timed VBS testing and JPS testing at the great toe in clinical detection of DSP. Methods: This study was prospectively conducted in the neurology department of a tertiary care hospital in India. Patients with DSP referred to the electrophysiology laboratory from August 2017 to December 2017 were screened. Patients with symptomatic DSP which was confirmed by electrophysiological studies were taken as cases and normal participants with no symptoms or electrophysiological findings suggestive of DSP served as controls. Results: We studied 127 patients and 194 controls. The mean age of the patients was 48.7 (14.5) years in the patient group and 39.7 (14.5) years in the control group. The male: female ratio was 77/50 in the patient group and 112/82 in the control group. Abnormal clinical examination was found in 95% of the patients with DSP. The most common abnormal examination components were impaired ankle reflexes (70%), vibration (85%), and JPS (39.6%) sensation. Using the receiver operating characteristic curve for the diagnosis of DSP, a vibratory response lasting <8 s at the great toe had a sensitivity of 85% and specificity of 42.8%. For JPS testing at the great toe, obtaining two or more incorrect responses had a sensitivity of 33% and specificity of 87.6%. Conclusion: VBS testing was more sensitive and JPS testing was more specific in making a clinical diagnosis of DSP. For timed VBS, duration of >8 s at the great toe was a useful test to rule out DSP, and for JPS testing at the great toe, obtaining two or more incorrect responses was a useful test in ruling in the diagnosis of DSP.

Somatosensory evoked potentials and neurological grades as predictors of outcome in acute spinal cord injury

1990 ◽  
Vol 72 (4) ◽  
pp. 600-609 ◽  
Author(s):  
Chen Li ◽  
David A. Houlden ◽  
David W. Rowed
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Spinal Cord Injuries ◽  
Position Sense ◽  
Joint Position Sense ◽  
Index Score ◽  
Joint Position ◽  
Content Type ◽  
Sensory Score ◽  
Fine Print

✓ An analysis of Motor Index score, pinprick sensory score, joint position sense score, somatosensory evoked potential (SSEP) grade in the ulnar (SSEPu) and posterior tibial (SSEPt) regions, and overall SSEP grade (mean SSEPu+t) was conducted in 36 patients with cervical spinal cord injuries to determine the relationship of these scores, both individually and in combination, to functional outcome (as determined using the Barthel Index) at 6 months after injury. The clinical and electrophysiological data were obtained on the same day within 2 weeks after injury. Nineteen patients underwent two SSEP tests 1 week apart within the first 3 weeks following injury in an attempt to identify mean SSEPu+t improvement. Somatosensory evoked potential grading was based on the presence or absence of the cortical evoked potential, the amplitude of the early cortically generated waveform (P22 or P37), and the interpeak latency across the lesion site. Mean SSEPu+t had the strongest individual relationship with outcome (R-square 0.75, p < 0.0001) and mean SSEPu+t improvement over a 1-week interval during the first 3 weeks after injury was associated with Motor Index score improvement over a 6 month period. Joint position sense score was the best clinical predictor of outcome (R-square 0.64, p < 0.0001). Mean SSEPu+t correlated with outcome more closely than the combination of Motor Index score and pinprick sensory score. Mean SSEPu+t in combination with all three clinical indicators produced the strongest correlation with outcome (R-square 0.87, p < 0.0001). This study confirms the prognostic value of quantitative SSEP analysis for patients with acute spinal cord injuries.

scholarly journals The sensorimotor effects of a lower limb proprioception training intervention in individuals with a spinal cord injury

2019 ◽  
Vol 122 (6) ◽  
pp. 2364-2371 ◽  
Author(s):  
Taha Qaiser ◽  
Gevorg Eginyan ◽  
Franco Chan ◽  
Tania Lam
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Limb ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
End Point ◽  
Cord Injury ◽  
Training Protocol ◽  
Precision Stepping

Proprioception is critical for movement control. After a spinal cord injury (SCI), individuals not only experience paralysis but may also experience proprioceptive deficits, further confounding motor recovery. The objective of this study was to test the effects of a robotic-based proprioception training protocol on lower limb proprioceptive sense in people with incomplete SCI. A secondary objective was to assess whether the effects of training transferred to a precision stepping task in people with motor-incomplete SCI. Participants with chronic incomplete SCI and able-bodied controls underwent a 2-day proprioceptive training protocol using the Lokomat robotic exoskeleton. The training involved positioning the test leg to various positions and participants were asked to report whether they felt their heel position (end-point position) was higher or lower compared with a reference position. Feedback was provided after each trial to help participants learn strategies that could help them discern different positions of their foot. Changes in end-point position as well as knee joint position sense were assessed pre- and posttraining. We also assessed the effects of proprioception training on the performance of a precision stepping task in people with motor-incomplete SCI. Following training, there were significant improvements in end-point and knee joint position sense in both groups. The magnitude of improvement was related to pretraining (baseline) proprioceptive sense, indicating that those who initially had better lower limb position sense showed greater changes. Participants also showed improvements in performance of a precision stepping task. NEW & NOTEWORTHY We show that it is possible to alter proprioceptive sense in people with incomplete SCI using a passive proprioception training protocol combined with feedback. Improvements in proprioceptive sense transferred from end-point to joint position sense and also to an untrained precision stepping task.

Limbs and Trunk

2016 ◽  
pp. 83-108
Author(s):  
Christopher H. Hawkes ◽  
Kapil D. Sethi ◽  
Thomas R. Swift
Keyword(s):  
Physical Examination ◽  
Position Sense ◽  
Joint Position Sense ◽  
Sensory Loss ◽  
Joint Position ◽  
Vibration Sense ◽  
Muscle Stretch ◽  
Stretch Reflexes ◽  
Patient’S History

This chapter emphasizes various clues apparent from the patient’s history and physical examination. Observation of how a patient walks, talks, and undresses is discussed as a means of discerning clues to a diagnosis. Miscellaneous aspects of the history, particularly sensory symptoms, such as tingling in the hands, feet, and face, shooting leg pains, and neuropathy are described, and clues to psychogenic disorder are elaborated. Also emphasized is the value of inspecting the limbs, skin, and joints. Shortcuts are listed for the traditional physical motor examination, which involves tone, power, coordination, muscle stretch reflexes, and Babinski response. Shortcuts are also described for the sensory examination, using joint position sense, vibration sense, and sensory loss. The chapter concludes with an outline of how to analyze coma.

The Analysis of Proprioception Alteration during First Five Months after Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 1 (84) ◽  
Author(s):  
Vilma Jurevičienė ◽  
Albertas Skurvydas ◽  
Juozas Belickas ◽  
Giedra Bušmanienė ◽  
Dovilė Kielė ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Angular Velocity ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Starting Position ◽  
Angular Velocities ◽  
Anterior Cruciate

Research  background  and  hypothesis.  Proprioception  is  important  in  the  prevention  of  injuries  as  reduced proprioception  is  one  of  the  factors  contributing  to  injury  in  the  knee  joint,  particularly  the  ACL.  Therefore, proprioception appears not only important for the prevention of ACL injuries, but also for regaining full function after ACL reconstruction.Research aim. The aim of this study was to understand how proprioception is recovered four and five months after anterior cruciate ligament (ACL) reconstruction.Research methods. The study included 15 male subjects (age – 33.7 ± 2.49 years) who had undergone unilateral ACL reconstruction with a semitendinosus/gracilis (STG) graft in Kaunas Clinical Hospital. For proprioceptive assessment, joint position sense (JPS) was measured on both legs using an isokinetic dynamometer (Biodex), at knee flexion of 60° and 70°, and at different knee angular velocities of 2°/s and 10°/s. The patients were assessed preoperatively and after 4 and 5 months, postoperatively.Research results. Our study has shown that the JPS’s (joint position sense) error scores  to a controlled active movement is significantly higher in injured ACL-deficient knee than in the contralateral knee (normal knee) before surgery and after four and five months of rehabilitation.  After 4 and 5 months of rehabilitation we found significantly lower values in injured knees compared to the preoperative data. Our study has shown that in injured knee active angle reproduction errors after 4 and 5 months of rehabilitation were higher compared with the ones of the uninjured knee. Proprioceptive ability on the both legs was  independent of all differences angles for target and starting position for movement. The knee joint position sense on both legs depends upon the rate of two different angular velocities and the mean active angle reproduction errors at the test of angular velocity slow speed was the highest compared with the fast angular velocity. Discussion and conclusions. In conclusion, our study shows that there was improvement in mean JPS 4 and 5 months after ACL reconstruction, but it did not return to normal indices.Keywords: knee joint, joint position sense, angular velocity, starting position for movement.

Sign in / Sign up

Export Citation Format

Share Document