Robot-aided assessment and associated brain lesions of impaired ankle proprioception in chronic stroke.

BACKGROUND: Impaired ankle proprioception strongly predicts balance dysfunction in chronic stroke. However, only sparse data on ankle position sense and no systematic data on ankle motion sense dysfunction in stroke are available. Moreover, the lesion sites underlying impaired ankle proprioception have not been comprehensively delineated. Using robotic technology, this study quantified ankle proprioceptive deficits post-stroke and determined the associated brain lesions. METHODS: Twelve adults with chronic stroke and 13 neurotypical adults participated. A robot passively plantarflexed a participant's ankle to two distinct positions or at two distinct velocities. Participants subsequently indicated which of the two movements was further/faster. Based on the stimulus-response data, psychometric just-noticeable-difference (JND) thresholds and intervals of uncertainty (IU) were derived as measures on proprioceptive bias and precision. To determine group differences, Welch's t-test and the Wilcoxon-Mann-Whitney test were performed for the JND threshold and IU, respectively. Voxel-based lesion subtraction analysis identified the brain lesions associated with observed proprioceptive deficits in adults with stroke. RESULTS: 83% of adults with stroke exhibited abnormalities in either position or motion sense, or both. JND and IU measures were significantly elevated compared to the control group (Position sense: + 77% in JND, + 148% in IU; Motion sense: +153% in JND, + 78% in IU). Adults with stroke with both impaired ankle position and motion sense had lesions in the parietal, frontal, and temporoparietal regions. CONCLUSIONS: This is the first study to document the magnitude and frequency of ankle position and motion sense impairment in adults with chronic stroke. Proprioceptive dysfunction was characterized by elevated JND thresholds and increased uncertainty in perceiving ankle position/motion. Furthermore, the associated cortical lesions for impairment in both proprioceptive senses were largely overlapping.

Assessment of proprioception, muscle strength and endurance during dynamic isokinetic test in patients with breast cancer-related lymphedema.

BACKGROUND: Breast cancer-related lymphedema is a common complication after breast cancer treatment.This study examined isokinetic proprioception, muscular strength, and endurance by comparing extremity with lymphedema and the extremity without lymphedema in women with breast cancer-related lymphedema. METHODS: A total of 15 individuals aged between 35 and 70 years participated in this study. Cybex Humac NORM Isokinetic dynamometer (CSMi, Stoughton, MA) were used to assess upper extremity passive proprioception, active proprioception, kinesthesia, muscle strength, and muscle endurance. The upper extremity lymphedema was measured with the water displacement arm volumetry test using a volumeter. FINDINGS: All isokinetic measurements demonstrated a statistically significant difference between the extremity with lymphedema and the extremity without lymphedema, suggesting lower scores in the extremity with lymphedema (p < .05). There was a positive correlation between passive internal rotation in the extremity with lymphedema and the time after mastectomy (r= 0.628, p = .012) and a moderate positive relationship was found between the time after lymphedema and passive internal rotation (r = 0.577; p = .024), and active external rotation position sense (r = 0.540; p = .038) in the extremity with lymphedema. Also, a unidirectional positive moderate (r = 0.594; p = .020) relationship was found between the lymphedema stage and passive external rotation in the extremity with lymphedema. INTERPRETATION: The difference in proprioception, muscle strength, and endurance between the extremity with lymphedema and the extremity without lymphedema in women with breast cancer-related lymphedema will provide valuable information in terms of prioritizing these parameters in treatment.

Proprioceptive Acuity Assessment in Multiple Directions Across Multiple Joints in the Upper Limb.

Proprioception is essential for precise movement as it helps the body transmit important data about its surroundings to the central nervous system for maintaining body posture and position. This study aimed to investigate the effect of direction and joint angle on upper limb proprioception. Thirty individuals (all males) completed a position reproduction activity in 13 directions and three joint angles. It was discovered that upper limb proprioception is dependent on joint angle, direction, and range of motion. The position reproduction error was found to be dependent on the direction, which had a significantly lower accuracy in the direction with a larger range of motion. In addition, upper limb repositioning errors increased at greater limb elevation angles. Our findings also showed that the joint angle did not significantly affect the absolute error of elbow flexion. With an increase in the elbow flexion, the increase of the gravitational moment of the upper arm and hand coupled with the increase of the muscle arm of the biceps brachii possibly causes slight changes in muscle length perceived by spindles or muscular force perceived by Golgi tendon organs.

Reliability, validity and clinical usability of a robotic assessment of finger proprioception in persons with multiple sclerosis.

BACKGROUND: Multiple sclerosis often leads to proprioceptive impairments of the hand. However, it is challenging to objectively assess such deficits using clinical methods, thereby also impeding accurate tracking of disease progression and hence the application of personalized rehabilitation approaches. OBJECTIVE: We aimed to evaluate test-retest reliability, validity, and clinical usability of a novel robotic assessment of hand proprioceptive impairments in persons with multiple sclerosis (pwMS). METHODS: The assessment was implemented in an existing one-degree of freedom end-effector robot (ETH MIKE) acting on the index finger metacarpophalangeal joint. It was performed by 45 pwMS and 59 neurologically intact controls. Additionally, clinical assessments of somatosensation, somatosensory evoked potentials and usability scores were collected in a subset of pwMS. RESULTS: The test-retest reliability of robotic task metrics in pwMS was good (ICC=0.69-0.87). The task could identify individuals with impaired proprioception, as indicated by the significant difference between pwMS and controls, as well as a high impairment classification agreement with a clinical measure of proprioception (85.00-86.67%). Proprioceptive impairments were not correlated with other modalities of somatosensation. The usability of the assessment system was satisfactory (System Usability Scale ≥73.10). CONCLUSION: The proposed assessment is a promising alternative to commonly used clinical methods and will likely contribute to a better understanding of proprioceptive impairments in pwMS.

Where Are We on Proprioception Assessment Tests Among Poststroke Individuals? A Systematic Review of Psychometric Properties.

BACKGROUND AND PURPOSE: Proprioception is often impaired in poststroke individuals. This is a significant issue since altered proprioception is associated with poorer physical function outcomes poststroke. However, there is limited consensus on the best tools for assessing proprioception and support for their widespread use by clinicians. The objective is to appraise the psychometric properties of each test used to assess proprioception in poststroke individuals. METHODS: A systematic search was performed according to PRISMA guidelines using the databases MEDLINE, Cochrane Library, PEDro, DiTa, and BioMedicalCentral for articles published up to January 2021. RESULTS: Sixteen studies of low methodological quality were included. Sixteen different proprioception assessment tests were extracted. The proprioception portion of the Fugl-Meyer Assessment Scale was found to be the most valid and reliable tool for screening patients in clinical settings. Although no real gold standard exists, the technological devices demonstrated better responsiveness and measurement accuracy than clinical tests. Technological devices might be more appropriate for assessing proprioception recovery or better suited for research purposes. DISCUSSION AND CONCLUSIONS: This review revealed low-quality articles and a paucity of tests with good psychometric properties available to clinicians to properly screen and assess all subcomponents of proprioception. In perspective, technological devices, such as robotic orthoses or muscle vibration, may provide the best potential for assessing the different subcomponents of proprioception. Further studies should be conducted to develop and investigate such approaches.Video, Supplemental Digital Content 1, available at:http://links.lww.com/JNPT/A388.

Proprioceptive and Clinical Outcomes after Remnant Preserved Anterior Cruciate Ligament Reconstruction: Assessment with Minimal Confounding Factors.

OBJECTIVE: To evaluate the proprioceptive and clinical function of the knee joint after anterior cruciate ligament reconstruction (ACLR) with various amounts of remnant preserved with as few confounding factors as possible. METHODS: This retrospective study included 46 patients who underwent ACLR with remnant preservation between March 2013 and February 2019. These patients had less than 6 months injury-to-surgery interval and no concomitant injuries. The researchers divided these subjects into two groups based on the length of the remnant preserved after ACLR, with group A defined as having more than 1/3 of the original length preserved and group B defined as less than 1/3 of the original length preserved. Clinical scores were obtained using the Lysholm knee scoring scale and the Tegner activity scale. The Lysholm score was calculated preoperatively, at 3, 6, and 12 months postoperatively, and at the last follow up. The Tegner score was calculated preoperatively, at 12 months postoperatively and at the last follow up. Anterior laxity was measured using the KT2000 arthrometer preoperatively and at 12 months postoperatively. Proprioceptive function was evaluated through reproduction of passive positioning (RPP) and threshold to detection of passive motion (TDPM). Both RPP and TDPM were measured at the angle of 15° at 3, 6, and 12 months postoperatively. Unpaired t-tests were performed to investigate the difference in each parameters between the two groups. RESULTS: In the present study, 20 patients were classified into group A and 26 into group B. All patients were followed up for an average of 34.70 ± 12.79 months. All 46 patients were satisfied with the outcome of the surgery and no complications were reported at the end of the study. No significant differences were found between the two groups in terms of the Lysholm score and anterior laxity by KT2000 at all time points. The Tegner score was significantly higher in group A at 12 months postoperatively and at the final follow-up. In addition, group A's RPP was significantly better than that of group B's when tested at the angles of 15° and 30° at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively. Group A's TDPM was also significantly better than that of group B's at all three tested angles at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively. CONCLUSION: Patients with ACLR with more than 1/3 of the original length preserved demonstrated a higher activity level 12 months postoperatively and better proprioceptive function at 15° of extension at 3 and 6 months postoperatively.

Sensorimotor Performance and Reference Values for Fall Risk Assessment in Community-Dwelling Adults: The Yishun Study.

OBJECTIVE: This study sought to answer the following questions: What are the reference values of sensorimotor performance for fall risk in community-dwelling adults? How do population norms compare with that of other populations? Are younger adults at risk of falls? METHODS: In a cross-sectional study design, sensorimotor functions and fall risk scores of community-dwelling adults were assessed and calculated to derive corresponding fall risk categories. Reference values were determined using the average scores by age group. A total of 542 community-dwelling adults were recruited (21-90 years old) across 10-year (21-60 years) and 5-year age groups (>60 years) to obtain a representative sample of community-dwelling adults in Singapore. Five physiological domains were assessed: vision, proprioception, muscle strength, reaction time, and postural balance according to the Physiological Profile Assessment (PPA). Fall risk scores and the corresponding fall risk profiles were generated from an online calculator. RESULTS: Sensorimotor performance and PPA fall risk scores were significantly worse for increasing age categories. Females had significantly slower reaction time, lower muscle strength, and higher fall risk. The representative sample of older adults (≥65 years) performed poorer in postural sway (z = -0.50) and reaction time (z = -0.55), but better in proprioception (z = 0.29) and vision (z = 0.23) compared with Caucasian norms. Among younger adults (21-59 years), 36.8% appeared to exhibit higher fall risk. CONCLUSION: This study presents important reference data and compared sensorimotor functions and physiological fall risk across age groups of community-dwelling adults in a Southeast Asian population. Poor sensorimotor performance and fall risk appear already pertinent in younger adults. Further studies are warranted to improve understanding of fall risk among younger adults. IMPACT: In physical therapist practice, PPA reference values can aid clinicians in the development of targeted interventions tailored towards an individual's physiological risk profile, addressing specific physiological systems that require particular attention.

Upper Limb Proprioceptive Acuity Assessment Based on Three-Dimensional Position Measurement Systems.

The aim of the current work was to verify three-dimensional directional effects on the reproduction error precision of the human upper limb position. Thirty male subjects without history of upper limb pathology were recruited from Renmin University of China. A three-dimensional position reproduction task in six directions (up, down, left, right, far, and near) was performed by each subject. The results suggested that the proprioceptive sense of upper limb position depends on the direction, with smaller absolute errors in Directions 4 (right) and 5 (far) than in Directions 1 (up), 2 (down), 3 (left), and 6 (near). Proprioception near the end of the elbow joint range of motion may be more reliable and sensitive. Subjects reproduced fewer ranges in the horizontal plane (Directions 3, 5, and 6) and they overshot the target position along the z-axis (vertical direction) except for Direction 6. Overestimations of position in the z-axis may be caused by overestimations of force.

Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton.

BACKGROUND: Motor impairment after stroke interferes with performance of everyday activities. Upper limb spasticity may further disrupt the movement patterns that enable optimal function; however, the specific features of these altered movement patterns, which differentiate individuals with and without spasticity, have not been fully identified. This study aimed to characterize the kinematic and proprioceptive deficits of individuals with upper limb spasticity after stroke using the Kinarm robotic exoskeleton. METHODS: Upper limb function was characterized using two tasks: Visually Guided Reaching, in which participants moved the limb from a central target to 1 of 4 or 1 of 8 outer targets when cued (measuring reaching function) and Arm Position Matching, in which participants moved the less-affected arm to mirror match the position of the affected arm (measuring proprioception), which was passively moved to 1 of 4 or 1 of 9 different positions. Comparisons were made between individuals with (n = 35) and without (n = 35) upper limb post-stroke spasticity. RESULTS: Statistically significant differences in affected limb performance between groups were observed in reaching-specific measures characterizing movement time and movement speed, as well as an overall metric for the Visually Guided Reaching task. While both groups demonstrated deficits in proprioception compared to normative values, no differences were observed between groups. Modified Ashworth Scale score was significantly correlated with these same measures. CONCLUSIONS: The findings indicate that individuals with spasticity experience greater deficits in temporal features of movement while reaching, but not in proprioception in comparison to individuals with post-stroke motor impairment without spasticity. Temporal features of movement can be potential targets for rehabilitation in individuals with upper limb spasticity after stroke.

Assessment of bimanual proprioception during an orientation matching task with a physically coupled object.

Assessing proprioception is important for understanding and treating sensorimotor impairments. Many daily tasks require bimanual manipulation of objects, but state of the art methods for the assessment of proprioception are far away from bimanual activities, and instead evaluate sensorimotor integrity in oversimplified and often unimanual goal-directed tasks. Here, we developed a new device and method to assess proprioception and force production by simulating a realistic bimanual behavior. Twelve healthy participants held a physically coupled object - a sensorized box - and matched target orientations about the three principal axes without and with added weights. Our preliminary findings indicate that bimanual proprioception during orientation matching depends on the axis of rotation. For example, in rotations about the lateral axis of the body, underestimation and overestimation of the target angle depends on its orientation in a body-centered reference frame: participants tended to underestimate targets that required rotation far away from the body and overestimated angles that required rotation towards the body. We also found that for the same rotation axis, the larger were the rotations, the higher was the force applied. Moreover, we also found that fatigue causes undershoot in orientation matching. In the future, this tool could be adopted for assessment and treatment of sensorimotor deficits in bimanual functional tasks.

Assessment of core and lower limb muscles for static/dynamic balance in the older people: An ultrasonographic study.

BACKGROUND: sufficient research has not been conducted to determine the role of core and lower limb muscles in providing balance in older people. OBJECTIVE: to investigate the relationships between the thickness of core/lower limb muscles and static/dynamic balance in older people. METHODS: the study included a total of 68 older people (≥ 65 years) and 68 gender-matched young subjects, aged 20-40 years. Balance, knee proprioception sense, regional and total muscle measurements and grip strength were assessed using a force platform system, isokinetic dynamometer, ultrasound imaging, bioelectrical impedance analysis and Jamar dynamometer, respectively. RESULTS: all the static (postural sway) parameters were higher and all the dynamic (limits of stability) parameters were lower in the older adults compared to the young adults (all P<0.05). The diaphragm was thicker and all the other muscles (except for multifidus and tibialis anterior) were thinner in the older group (all P<0.05). A higher error of knee proprioception sense was determined at 45 and 70 degrees in the older subjects (both P<0.001). According to the multivariate analyses, significant predictors for balance were age, gender, height, and rectus femoris, vastus intermedius and diaphragm muscle thicknesses in the older group, and age, gender, height, grip strength, and rectus abdominis, internal oblique, longissimus, tibialis anterior and soleus muscle thicknesses in the young group (all P<0.05). CONCLUSIONS: the thickness of core/lower limb muscles are important determinants of balance in both older and young adults. These findings could provide a strong rationale for strengthening specific (abdominal and quadriceps) muscles to prevent falls and regional sarcopenia, and to improve posture/balance in the older population. CLINICAL TRIAL REGISTRATION NUMBER: NCT03791047. ETHICS COMMITTEE APPROVAL: Hacettepe University Non-interventional Clinical Research Ethics Board. Decision number:GO 18/506-39.

Clinical assessment of cervical movement sense in those with neck pain compared to asymptomatic individuals.

BACKGROUND: A simple clinical test involving subject tracing zigzag (ZZ) and figure of eight (F8) patterns with a head mounted laser device in determining cervical movement sense has proven reliability and feasibility. However, its validity in comparing individuals with and without neck pain (NP) has not been examined. METHODS: Seventy-six subjects (38 NP and 38 asymptomatic subjects) performed both patterns while motion of their laser point was videoed. Independent examiners subsequently rated the videos (real-time) to record the time needed and the number of errors when completing each task. Sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for various cut-offs to optimise clinical interpretation were determined. Comparisons between 25 subjects with idiopathic neck pain versus 13 with whiplash-associated disorders were also undertaken. RESULTS: All outcome variables except ZZ time were significantly different between individuals with NP and controls. Optimal cut-offs of 9 and 10 errors yielded LR+/LR- of 3.67/0.17 (F8) and 3.00/0.38 (ZZ). Whiplash patients performed the ZZ task faster with similar errors to those with idiopathic neck pain. CONCLUSION: The clinical utility of this inexpensive measure to assess cervical movement sense in people with NP is supported. Moderate LRs+ were demonstrated for number of errors for both patterns. Individuals with NP generated significantly more errors while tracing each pattern. Optimal cut offs of 9 errors for ZZ and 10 errors for F8 were established. Overall, these tests appear to be clinically suitable to determine altered cervical movement sense in those with NP.

Lower Extremity Position Test: A new clinical quantitative assessment tool of proprioception post stroke.

OBJECTIVE: To develop a quantitative, inexpensive and easy to use tool, for assessing proprioception of the lower extremity of individuals post-stroke, and examine its test-retest reliability and known-groups validity. METHODS: The Lower Extremity Position Test was developed. Testing procedure: seated subjects were asked to reproduce 12 cm or 22 cm distances on a plastic surface, by verbally stopping passive movement of the foot produced by the tester. The deviation from the target point was measured as the mismatch score. Fifty one subjects post-stroke (n = 51) participated in prospective test-retest assessment. The tests were performed one week apart by a single assessor, in physical therapy out-patient clinics. The t-test, ICC and Bland-Altman tests were used to determine known-groups validity by determining leg differences and test-retest reliability. RESULTS: Post-stroke involved foot demonstrated significantly higher mismatch scores then the uninvolved foot did (p < 0.0001). Good test-retest reliability was demonstrated for the involved leg for both 12 cm and 22 cm distances (ICC = 0.79 and 0.85, respectively). The 95% repeatability ranges were leg related. CONCLUSIONS: The Lower Extremity Position Test (LEPT) is a newly-developed testing tool with good clinical utility, reliable in post-stroke population and has known-group validity (involved versus uninvolved foot).

Shoulder and elbow joint position sense assessment using a mobile app in subjects with and without shoulder pain - between-days reliability.

OBJECTIVES: To determine between-days reliability and the minimal detectable change for shoulder and elbow joint position sense assessment using a validated mobile app, in subjects with and without shoulder pain. DESIGN: Reliability study. SETTING: Clinical measurement. PARTICIPANTS: Subjects with (n = 25) and without shoulder pain (n = 29). MAIN OUTCOME MEASURES: Subjects were assessed by the same examiner in two sessions, with one-week interval. Active joint repositioning tests of shoulder flexion and scaption and elbow flexion were assessed at the target-angles of 50°, 70°, 90° and 110°. Intra-class correlation coefficient, standard error of measurement and minimal detectable change were calculated for constant, absolute, total and variable errors. RESULTS: Good to excellent reliability was found for constant, absolute and total errors at the target-angle of 50° of scaption for healthy subjects; at 110° of shoulder flexion and all target-angles for elbow for both groups. CONCLUSIONS: The mobile app is a reliable tool and may be useful for assessing shoulder joint position sense mainly at 110° of flexion and for elbow between 50° and 110° of flexion in subjects with and without shoulder pain. Minimal detectable changes were demonstrated and may help clinicians to follow-up rehabilitation and researchers to interpret findings of studies.

Balance Assessment in Traumatic Brain Injury: A Comparison of the Sensory Organization and Limits of Stability Tests.

Balance problems are common after a traumatic brain injury (TBI). Symptoms of dizziness, unsteadiness, or imbalance have been most frequently attributed to sensory organization problems involving the use of visual, proprioceptive, and/or vestibular information for postural control. These problems can be assessed with the Sensory Organization Test (SOT). However, as head trauma can affect any brain region, areas responsible for voluntary control of movements involved in dynamic balance tasks, such as the motor cortex and its projections, could also be compromised, which would likely affect one's limits of stability. The Limits of Stability (LOS) balance test has received little attention in TBI. In the present study, we compared the prevalence of SOT versus LOS abnormalities in a cohort of 48 patients, the majority classified as having mild or moderate chronic TBI. Compared with a normative database provided by the balance testing manufacturer, a larger portion of our cohort presented abnormalities in the LOS test. Dizziness Handicap Inventory (DHI) results indicated mild disability, with the five activities most frequently endorsed as problematic being: looking up, performing quick head movements, performing ambitious such as sports or dancing activities, feeling frustrated, and performing strenuous house/yard work. Although regression analysis revealed that both tests significantly predicted subjective scores on the DHI, more LOS than SOT testing variables were important predictors of DHI results indicating disability. These results suggest that the LOS test is an informative tool that should be included in any objective balance evaluations that screen TBI patients with balance complaints.

The use of electromyography for the assessment of sense of muscular effort: a test-retest reliability study.

This study sought to examine the test-retest reliability to measure sense of muscular effort with electromyography (EMG). The EMG activity of the tibialis anterior muscle from 23 participants was recorded. Targets of EMG amplitudes produced at 10 and 20% of the maximum voluntary contraction (MVC) were calculated. Participants matched the target EMG level with and without visual feedback (FB). With NFB, the reliability was good to excellent when errors were represented as the average standard deviation (SD) of the error from the target (ICC1,2 = 0.75 and 0.69 for 10 and 20% targets, respectively). Also, reliability was good when errors were presented as the average SD as a percentage of the MVC EMG (intraclass correlation coefficient (ICC1,2) = 0.67 and 0.66, respectively, for 10 and 20% targets). Standard deviation around the target was the most reliable method to represent the error. This approach could be used as a simple cost-effective method to assess the sense of muscular effort.

Senso de posição articular, força e distribuição de carga entre os membros inferiores em amputação transtibial-estudo transversal / Assessment of Sense of joint position, strength and load distribution among lower limbs in amputated patients at transtibial level

A amputação é definida como a retirada, geralmente cirúrgica, total ou parcial de um membro do corpo. As amputações traumáticas correspondem a aproximadamente 20% das amputações de membros inferiores não eletivas, sendo a amputação no nível transtibial o tipo mais frequente. Estudos anteriores já demonstraram alterações na sensibilidade do coto de amputação e quadro de hipotrofia muscular causada pelo desuso, tendo como principal consequência a deficiência de força. Diante disso, é importante identificar a influência da amputação na propriocepção, força e distribuição de carga entre os membros de pacientes com amputação transtibial de etiologia traumática. Objetivo: Avaliar alterações na distribuição de carga, propriocepção e capacidade de produção de força muscular dos músculos do joelho em indivíduos usuários de prótese devido à amputação no nível transtibial de origem traumática. Métodos: Estudo transversal no qual participaram 16 voluntários amputados, protetizados há mais de um ano e 16 indivíduos não amputados, que compuseram o grupo-controle. Os grupos foram avaliados através dos questionários de Perfil de Atividade Humana e Escala de Tegner para avaliar o perfil de atividade física. Os pacientes foram também avaliados em relação à distribuição de carga entre os membros, propriocepção, através do senso de posição articular, e força isométrica, na flexão e extensão dos joelhos. Resultados: Este estudo demonstrou que o grupo de pacientes amputados apresenta maior debilidade física. Observou-se que o membro amputado recebe menos peso corporal, não possui deficiência na propriocepção e apresenta força da musculatura isquiotibial maior quando comparados com os demais grupos. Conclusão: A amputação não provoca deficiência na propriocepção, mas acarreta um quadro de limitação física. Apesar disso, os músculos isquiotibiais apresentam mais força quando comparados com os demais grupos avaliados, o que torna interessante o desenvolvimento de mais estudos sobre a influência da amputação na biomecânica do ser humano

Amputation is generally defined as the surgical, total or partial removal of a body member. Traumatic amputations account for about 20% of non-elective lower limb amputations, with amputation at the transtibial level being the most frequent type. Previous studies have already shown changes in sensitivity of the amputation stump and muscle hypotrophy caused by disuse, with the main consequence being the strength deficit. Therefore, it is important to gain further insight into influence of amputation on proprioception, strength and load distribution among members of the transtibial amputee of traumatic etiology. Objective: To evaluate changes in load distribution, proprioception and muscle strength production capacity of knee muscles in prosthesis users due to amputation at transtibial level of traumatic origin. Methods: The study included 16 amputee volunteers who had been prosthetized for more than one year, and 16 non-amputees, who comprised the control group. The groups were submitted to the Human Activity Profile (HAP) and Tegner Scale questionnaires to assess their physical activity profile in addition to tests who evaluated load distribution, proprioception, through the sense of articular position, and isometric force, in flexion and knee extension. Results: Our study showed that the amputee group is physically impaired. We also noted that amputated limb receives less body weight, has no proprioceptive deficit, and has greater hamstring muscle strength when compared to other groups. Conclusion: Amputation does not cause proprioceptive deficit but causes physical limitation. Nevertheless, the hamstring muscles are stronger when compared to the other groups evaluated which makes interesting the development of further studies on the influence of amputation on human physiology

Assessment of the Impact of Kinesiology Taping Application Versus Placebo Taping on the Knee Joint Position Sense. Preliminary Report.

BACKGROUND: Kinesiology Taping is a very popular physiotherapy method. It is used in both healthy people and orthopaedic patients in order to relieve pain, increase range of motion and for other purposes. Many researchers claim that these applications will also improve proprioception and sensorimotor efficiency, which are important for recovery after injuries and orthopaedic surgeries, especially on the knee joint. The aim of this study was to determine the effect of the muscle application of Kinesiology Taping on knee joint position sense in active motion. MATERIAL AND METHODS: The study involved 50 healthy people (30 men and 20 women). Mean age was 23.2 years (range 18-30 years). The exclusion criteria were past knee injuries and knee surgery that could affect the test results. The participants were divided randomly into two equal groups. The first group (KT group) had a Kinesiology Taping muscle application placed, whereas a placebo application of an adhesive tape was used in the remaining participants (placebo group). Both applications were supposed to support quadriceps muscle activity. Joint position sense (JPS) was evaluated by measuring the error of active reproduction of the joint position (EARJP) of the knee in 45° flexion. The test was performed prior to applying the patch, after the patch was applied, then after 24 hours of wearing it and after removing the tape. The interval between trials before and after application of the patch was not less than 30 minutes. Statistical analysis was performed using Statistica 12.0. Distribution characteristics were calculated and the Wilcoxon test, Friedman's ANOVA and Mann-Whitney U test were performed. RESULTS: The average test scores of JPS in the KT group and the placebo group before applying the KT patch were 3.48° and 5.16° respectively, compared to 4.84° and 4.88°, respectively, with the patch on, 5.12° and 4.96°, respectively, after 24 hours of wearing the tape, and 3.84° and 5.12°, respectively, after removing the patch. Within-group differences at any two time points were not statistically significant. There were also no significant differences between the groups. CONCLUSIONS: 1. Kinesiology Taping application to the quadriceps muscle had no significant effect on knee joint proprioception. Its use in order to improve sensorimotor skills therefore seems unreasonable. 2. The results are the basis for future prospective, randomised trials of larger experimental groups and involving the use of other Kinesiology Taping applications as well as including individuals with lesions of knee joint structures.

Reliability, validity, and clinical feasibility of a rapid and objective assessment of post-stroke deficits in hand proprioception.

BACKGROUND: Proprioceptive function can be affected after neurological injuries such as stroke. Severe and persistent proprioceptive impairments may be associated with a poor functional recovery after stroke. To better understand their role in the recovery process, and to improve diagnostics, prognostics, and the design of therapeutic interventions, it is essential to quantify proprioceptive deficits accurately and sensitively. However, current clinical assessments lack sensitivity due to ordinal scales and suffer from poor reliability and ceiling effects. Robotic technology offers new possibilities to address some of these limitations. Nevertheless, it is important to investigate the psychometric and clinimetric properties of technology-assisted assessments. METHODS: We present an automated robot-assisted assessment of proprioception at the level of the metacarpophalangeal joint, and evaluate its reliability, validity, and clinical feasibility in a study with 23 participants with stroke and an age-matched group of 29 neurologically intact controls. The assessment uses a two-alternative forced choice paradigm and an adaptive sampling procedure to identify objectively the difference threshold of angular joint position. RESULTS: Results revealed a good reliability (ICC(2,1) = 0.73) for assessing proprioception of the impaired hand of participants with stroke. Assessments showed similar task execution characteristics (e.g., number of trials and duration per trial) between participants with stroke and controls and a short administration time of approximately 12 min. A difference in proprioceptive function could be found between participants with a right hemisphere stroke and control subjects (p<0.001). Furthermore, we observed larger proprioceptive deficits in participants with a right hemisphere stroke compared to a left hemisphere stroke (p=0.028), despite the exclusion of participants with neglect. No meaningful correlation could be established with clinical scales for different modalities of somatosensation. We hypothesize that this is due to their low resolution and ceiling effects. CONCLUSIONS: This study has demonstrated the assessment's applicability in the impaired population and promising integration into clinical routine. In conclusion, the proposed assessment has the potential to become a powerful tool to investigate proprioceptive deficits in longitudinal studies as well as to inform and adjust sensorimotor rehabilitation to the patient's deficits.

The reactive leg drop: a simple and novel sensory-motor assessment to predict fall risk in older individuals.

There is need for a functional ability test that appropriately assesses the rapid integration of the sensory and motor systems required for older adults to recover from a slip. The purpose of this study was to assess the efficacy and reliability of a novel test, the reactive leg drop, for assessing sensory-motor function in older adults. Fourteen young (YW; mean age = 20 yr) and 11 older women (OW; mean age = 76 yr) participated in this study. For each drop, the leg was passively moved to full extension and then released. The subjects had to recognize their leg was free-falling and reactively kick up as quickly as possible during varying sensory conditions. To assess the leg drop's reliance on proprioception, other proprioceptive tests (e.g., patellar tendon reflexes and balance) were separately performed. Leg drops performed with the eyes closed ( P = 0.011) and with a blocked view of the leg ( P = 0.033) showed significant differences in drop angle between YW and OW. Significant relationships between leg drop conditions and balance were observed in OW that were not present within YW. When collapsed across groups, reflex latency was correlated with drop angle when the eyes were closed. The reactive leg drop was age sensitive, reliable, and likely reliant on proprioception, as shown by relationships to other sensory-motor assessments, such as balance and the patellar reflex. Although more research is needed, we propose that the reactive leg drop is an effective tool to assess sensory-motor integration in a manner that may mimic fall recovery. NEW & NOTEWORTHY The reactive leg drop was age sensitive and was significantly related to other sensory-motor assessments. The ability to accurately assess sensory-motor integration may aid clinicians, practitioners, and researchers in developing new interventions. The reactive leg drop presented in the current study is a potentially effective tool to assess sensory and motor integration in a manner that may mimic fall recovery.