scholarly journals Distinguishing Motor Weakness From Impaired Spatial Awareness: A Helping Hand!

2017 ◽  
Vol 10 ◽  
pp. 117954761770946
Author(s):  
Suneil A Raju ◽  
Charles R Swift ◽  
Karna Dev Bardhan
Keyword(s):  
Parietal Lobe ◽  
Rehabilitation Medicine ◽  
Position Sense ◽  
Joint Position Sense ◽  
Spatial Awareness ◽  
Motor Weakness ◽  
Computed Tomographic ◽  
Eyes Closed ◽  
Literature Evidence ◽  
Underlying Mechanisms

Our patient, aged 73 years, had background peripheral neuropathy of unknown cause, stable for several years, which caused some difficulty in walking on uneven ground. He attended for a teaching session but now staggered in, a new development. He had apparent weakness of his right arm, but there was difficulty in distinguishing motor weakness from impaired spatial awareness suggestive of parietal lobe dysfunction. With the patient seated, eyes closed, and left arm outstretched, S.A.R. lifted the patient’s right arm and asked him to indicate when both were level. This confirmed motor weakness. Urgent computed tomographic scan confirmed left subdural haematoma and its urgent evacuation rapidly resolved the patient’s symptoms. Intrigued by our patient’s case, we explored further and learnt that in rehabilitation medicine, the awareness of limb position is commonly viewed in terms of joint position sense. We present recent literature evidence indicating that the underlying mechanisms are more subtle.

Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis

2011 ◽  
Vol 45 (8) ◽  
pp. 660-672 ◽  
Author(s):  
Claire E Hiller ◽  
Elizabeth J Nightingale ◽  
Chung-Wei Christine Lin ◽  
Garrett F Coughlan ◽  
Brian Caulfield ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Sprain ◽  
Test Performance ◽  
Postural Sway ◽  
Meta Analysis ◽  
Position Sense ◽  
Joint Position Sense ◽  
Ankle Sprains ◽  
Eyes Closed ◽  
Recurrent Ankle Sprain

ObjectiveTo examine whether people with recurrent ankle sprain, have specific physical and sensorimotor deficits.DesignA systematic review of journal articles in English using electronic databases to September 2009. Included articles compared physical or sensorimotor measures in people with recurrent (≥2) ankle sprains and uninjured controls.Main outcome groupsOutcome measures were grouped into: physical characteristics, strength, postural stability, proprioception, response to perturbation, biomechanics and functional tests. A meta-analysis was undertaken where comparable results within an outcome group were inconsistent.ResultsFifty-five articles met the inclusion criteria. Compared with healthy controls, people with recurrent sprains demonstrated radiographic changes in the talus, changes in foot position during gait and prolonged time to stabilisation after a jump. There were no differences in ankle range of motion or functional test performance. Pooled results showed greater postural sway when standing with eyes closed (SMD=0.9, 95% CI 0.4 to 1.4) or on unstable surfaces (0.5, 0.1 to 1.0) and decreased concentric inversion strength (1.1, 0.2 to 2.1) but no difference in evertor strength, inversion joint position sense or peroneal latency in response to a perturbation.ConclusionThere are specific impairments in people with recurrent ankle sprain but not necessarily in areas commonly investigated.

scholarly journals Comparison of Ankle Proprioception Between Blind and Healthy Athletes

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0015
Author(s):  
Muhammet Özer ◽  
Haydar Kaynak ◽  
Aziz Atik ◽  
Mehtap Kaçmaz Şilil ◽  
Muammer Altun ◽  
...  
Keyword(s):  
Plantar Flexion ◽  
Position Sense ◽  
Joint Position Sense ◽  
Athletic Department ◽  
Eyes Closed ◽  
Eyes Open ◽  
Blind Persons ◽  
Ankle Proprioception ◽  
Blind Individuals

Objectives: The positive effect of the visual sensation on the proprioceptive quality is well known. Although other senses of the congenital blind individuals have been proven to be increased more than healthy ones, there has been no data about the proprioceptive quality of congenital blind persons. The aim of this study is to determine the quality of ankle proprioception in congenital blind athletes. Methods: 15 congenital blind athletes (10 males and 5 females) with a mean age of 24 ± 2.9 (ranging from 20 to 29), and 15 healthy athletes (10 males and 5 females) with a mean age of 24.6 ± 3.05 (ranging from 20 to 29), from the same athletic department, were included in the study. Proprioception was evaluated by using the technique of joint position sense, and absolut errors during the reproduction of six target angles (plantar flexion 100, dorsiflexion 50, inversion 100 and 200, eversion 100 and 200) were detected in dominant and nondominant ankles of both groups. Athletes were measured both eyes open and closed. Statistical analysis was done by using Mann-Whitney U and Wilcoxon Signed Ranks tests. Results: When dominant extremities were compared while eyes open, there was only a difference in 50 dorsiflexion measurements statistically in favor of blind ones (p<0.05). When dominant extremities were compared while eyes closed, blind athletes got less wrong in four of the six target angles statistically (p<0.01), when non-dominant extremities were compared while eyes closed, blind athletes got less wrong in all angles statistically (p<0.01). The ankle proprioception of the blind athletes were better then the normal athletes. The ankle propriceptions of the normal athletes further deteriorated when their eyes were closed. Conclusion: We found that the ankle proprioceptions of congenital blind athletes were better than the normal athletes. So additional closed-eyes exercises can help to reach a high proprioceptive level of athletes in a normal season which in terms may decrease accidental traumas.

Effects of Different Warm-Up Periods on Knee Proprioception and Balance in Healthy Young Individuals

2008 ◽  
Vol 17 (2) ◽  
pp. 186-205 ◽  
Author(s):  
Sevgi S. Subasi ◽  
Nihal Gelecek ◽  
Gazanfer Aksakoglu
Keyword(s):  
Outcome Measures ◽  
Absolute Error ◽  
Position Sense ◽  
Joint Position Sense ◽  
Limited Information ◽  
Warm Up ◽  
Positive Effects ◽  
Eyes Closed ◽  
Group 2 ◽  
Group 1

Context:There is limited information on the effects of different warm-up periods on proprioception and balance in the context of injury prevention.Objective:To determine the effects of warm-up exercises on knee proprioception and balance and to compare the effectiveness of warming up periods.Design:Pretest/posttest.Setting:Research laboratory.Participants:30 healthy subjects (19 women, 11 men; mean age 20.70 ± 0.99 years).Interventions:Exercise groups performed warm-up exercises (group 1, 5 minutes; group 2, 10 minutes). Joint Position Sense (JPS) was tested at 15°, 30°, and 60° knee flexion (KF) on a JPS device. Balance was measured using the Neurocom Balance Master System.Main Outcome Measures:JPS absolute error (AE) was measured at 15°, 30°, and 60° KF and postural control was measured.Results:After exercise, we found significant improvements for AE of JPSs of 30° right (R) KF, 15° left (L) KF, and 60° L KF in group 1. In group 2, AE of JPS values increased for all angles of both knees except 60° R KF. AE of JPS values of 15° R KF, 30° R KF, 15° L KF, 60° L KF were significantly different in group 2 compared with group 1. In balance measurements, there were significant improvements for standing on foam with eyes closed (EC) position, velocity and R-L unilateral stance EC in group 1. There were significant improvements for velocity, end point, maximum excursion, and L unilateral stance EC in group 2.Conclusions:Both warm-up periods have positive effects on knee proprioception and balance. The 10-minute warm-up exercise improved proprioception by a greater amount than the 5 minutes warm-up exercise.

scholarly journals A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249659
Author(s):  
Masood Mazaheri ◽  
Deepa Abichandani ◽  
Idsart Kingma ◽  
Julia Treleaven ◽  
Deborah Falla
Keyword(s):  
Meta Analysis ◽  
Absolute Error ◽  
Position Sense ◽  
Joint Position Sense ◽  
Standing Balance ◽  
Current Evidence ◽  
Joint Position ◽  
Cross Sectional ◽  
Eyes Closed ◽  
Whiplash Associated Disorder

Objective To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account. Data sources PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed. Study selection Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected. Data extraction Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version). Data synthesis Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24–0.62]) and extension (0.33 [95%CI: 0.08–0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05–0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22–0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37–0.88] and 0.78 [0.56–0.99], respectively) and EC (0.69 [0.46–0.91] and 0.80 [0.58–1.02]) conditions. Conclusion The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.

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.

Muscle Strength Deficit though Intact Proprioception after Lateral Ankle Sprain without Persistent Instability

2021 ◽  
Author(s):  
Adel M. Madkhali ◽  
Shibili Nuhmani
Keyword(s):  
Ankle Sprain ◽  
Peak Torque ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Cohen’S D ◽  
History Of ◽  
Cohen's D

Abstract Background Lateral ankle sprain is one of the most common injuries in competitive sports. Previous studies which investigated muscle strength and proprioception (joint position sense) focused on subjects who sustained ankle sprain with instability. It is also important to investigate strength deficits and proprioception in subjects with a history of ankle sprain without instability. Therefore the aim of the study is to investigate proprioception and muscle strength deficits in athletes with lateral ankle sprain. Methods Twenty-four male athletes with a history of lateral ankle sprain and 24 age-matched controls (mean age of 22.42±4.13 years, mean height of 173±5.73 cm, and mean weight of 71.20±7.55 Kg) participated in this cross-sectional study. Peak torque and peak torque ratio at speeds of 30 and 120°/s for concentric and eccentric ankle inversion/eversion were evaluated using an isokinetic dynamometer. The joint position sense of the ankle joint was evaluated using an active angle reproduction test. Result Peak torque produced was significantly less in subjects with history of ankle sprain in concentric inversion 30°/s(t(47)=4.11; p=0.000, Cohen’s d=1.29), concentric inversion 120°/s (t(47)=3.01; p=0.006, Cohen’s d=1.13), concentric eversion 30°/s (t(47)=3.85; p=0.001, Cohen’s d=1.24) and concentric eversion 120°/s (t(47)=3.15; p=0.005, Cohen’s d=1.09). At the same time there was no significant difference observed in eccentric eversion peak torque in both speed (eccentric eversion 30°/s p=0.079; eccentric eversion 120°/s p=0.867) between experimental and control group. No significant difference was found in the joint position sense in the maximal active inversion −5° position (p=0.312) and the 15° inversion position (P=0.386) between both group. Conclusion The study’s results reported a significantly less peak torque of invertors and evertors during concentric movements in athletes with history of ankle sprain. At the same time, no significant difference reported in the evertor/invertor peak torque ratio, and active joint position sense between the 2 groups.

Immediate effects of thoracic manipulation on cervical joint position sense in individuals with mechanical neck pain: A randomized controlled trial

2021 ◽  
pp. 1-9
Author(s):  
Emin Ulas Erdem ◽  
Banu Ünver ◽  
Eda Akbas ◽  
Gizem Irem Kinikli
Keyword(s):  
Neck Pain ◽  
Range Of Motion ◽  
Position Sense ◽  
Joint Position Sense ◽  
Position Error ◽  
Cervical Region ◽  
Joint Position ◽  
Cervical Range Of Motion ◽  
Arm Pain ◽  
Neck Function

BACKGROUND: Performing thoracic manipulations for neck pain can result in immediate improvements in neck function. OBJECTIVE: The aim of this study was to investigate the immediate effects of thoracic manipulation on cervical joint position sense and cervical range of motion in individuals with chronic mechanical neck pain. METHODS: Eighty male volunteers between 18–25 years and having chronic or recurrent neck or shoulder pain of at least 3 months duration with or without arm pain were randomized into two groups: Thoracic Manipulation Group (TMG:50) and Control Group (CG:30), with a pretest-posttest experimental design. The TMG was treated with thoracic extension manipulation while the CG received no intervention. Cervical joint position error and cervical range of motion of the individuals were assessed at baseline and 5 minutes later. RESULTS: There was no difference in demographic variables such as age (p= 0.764), Body Mass Index (p= 0.917) and Neck Pain Disability Scale (NPDS) scores (p= 0.436) at baseline outcomes between TMG and CGs. Joint position error outcomes between the two groups following intervention were similar in all directions at 30 and 50 degrees. Differences in range of motion following intervention in neck flexion (p< 0.001) and right rotation (p= 0.004) were higher in TMG compared to CG. CONCLUSIONS: A single session of thoracic manipulation seems to be inefficient on joint position sense in individuals with mild mechanical neck pain. However, thoracic manipulation might be an effective option to increase flexion and rotation of the cervical region as an adjunctive to treatment.

Shoulder Joint Position Sense Can Be Reduced by Sensory Reference Frame Transformations

2021 ◽  
pp. 003151252199304
Author(s):  
David Phillips ◽  
Albena Zahariev ◽  
Andrew Karduna
Keyword(s):  
Reference Frame ◽  
Constant Error ◽  
Sensory Information ◽  
Target Position ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Multiple Sources ◽  
Directional Bias

Joint position sense (JPS) is commonly evaluated using an angle replication protocol with vision occluded. However, multiple sources of sensory information are integrated when moving limbs accurately, not just proprioception. The purpose of this study was to examine different availability of vision during an active JPS protocol at the shoulder. Specifically, the effects of four conditions of vision availability were examined for three target shoulder elevation angles (50°, 70° & 90°): vision occluded continuously (P-P); vision available continuously (VP-VP); vision occluded only during target memorization (P-VP); and vision occluded only during target position replication (VP-P). There were 18 participants ( M age = 21, SD = 1 years). We used separate repeated ANOVAs to examine the effect of condition and target angle on participants’ absolute error (AE, a measure of accuracy) and constant error (CE, a measure of directional bias). We found a significant main effect for condition and angle for both dependent variables ( p < 0.01), and follow-up analysis indicated that participants were most accurate in the VP-VP condition and least accurate in the P-VP condition. Further follow-up analysis showed that accuracy improved with higher target elevation angles, consistent with previous research findings. Constant error results were similar, as there was a prominent tendency to overshoot the target. Unsurprisingly, participants performed best at the angle replication protocol with their eyes open. However, while accuracy was reduced when vision was occluded during target memorization, it was restored during target replication. This finding may have indicated an accuracy cost due to introduced noise when transforming sensory information from a proprioceptive reference frame into a visual reference frame.

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