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Lack of correlation between different measurements of proprioception in the knee

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Current methods of measurement of proprioceptive function depend on the ability to detect passive movement (kinaesthesia) or the awareness of joint position (joint position sense, JPS). However, reports of proprioceptive function in healthy and pathological joints are quite variable, which may be due to the different methods used. We have compared the validity of several frequently used methods to quantify proprioception. Thirty healthy subjects aged between 24 and 72 years underwent five established tests of proprioception. Two tests were used for the measurement of kinaesthesia (KT1 and KT2). Three tests were used for the measurement of JPS, a passive reproduction test (JPS1), a relative reproduction test (JPS2) and a visual estimation test (JPS3). There was no correlation between the tests for kinaesthesia and JPS or between the different JPS tests. There was, however, a significant correlation between the tests for kinaesthesia (r = 0.86). We conclude therefore that a subject with a given result in one test will not automatically obtain a similar result in another test for proprioception. Since they describe different functional proprioceptive attributes, proprioceptive ability cannot be inferred from independent tests of either kinaesthesia or JPS.
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614 THE JOURNAL OF BONE AND JOINT SURGERY
K. R. Grob, MD
M. S. Kuster, MD, PD, PhD
Department of Orthopaedic Surgery, Kantonsspital, CH 9001 St Gallen,
Switzerland.
S. A. Higgins
D. G. Lloyd, PhD
Department of Human Movement and Exercise Science, The University of
Western Australia, Perth, Australia.
H. Yata
Department of Human Sciences, Wako University, Tokyo, Japan.
Correspondence should be sent to Dr K. R. Grob.
©2002 British Editorial Society of Bone and Joint Surgery
0301-620X/02/411241 $2.00
Lack of correlation between different
measurements of proprioception in the knee
K. R. Grob, M. S. Kuster, S. A. Higgins, D. G. Lloyd, H. Yata
From Kantonsspital, St. Gallen, Switzerland
C
urrent methods of measurement of proprioceptive
function depend on the ability to detect passive
movement (kinaesthesia) or the awareness of joint
position (joint position sense, JPS). However, reports
of proprioceptive function in healthy and pathological
joints are quite variable, which may be due to the
different methods used. We have compared the
validity of several frequently used methods to quantify
proprioception.
Thirty healthy subjects aged between 24 and 72
years underwent five established tests of
proprioception. Two tests were used for the
measurement of kinaesthesia (KT1 and KT2). Three
tests were used for the measurement of JPS, a passive
reproduction test (JPS1), a relative reproduction test
(JPS2) and a visual estimation test (JPS3).
There was no correlation between the tests for
kinaesthesia and JPS or between the different JPS
tests. There was, however, a significant correlation
between the tests for kinaesthesia (r = 0.86). We
conclude therefore that a subject with a given result in
one test will not automatically obtain a similar result
in another test for proprioception. Since they describe
different functional proprioceptive attributes,
proprioceptive ability cannot be inferred from
independent tests of either kinaesthesia or JPS.
J Bone Joint Surg [Br] 2002;84-B:614-8.
Received 6 April 2000; Accepted after revision 4 April 2001
Proprioception is the sum of kinaesthesia and joint position
sense. Kinaesthesia is defined as the awareness of joint
movement and is dynamic. Joint position sense (JPS) is
restricted to the awareness of the position of a joint in space
and is a static phenomenon. Proprioception can also be
defined as the cumulative neural input to the central nerv-
ous system from specialised nerve endings called mechano-
receptors. These are located in the joint capsules,
ligaments, muscles, tendons, and skin. Some of these recep-
tors (for example, Pacinian corpuscles) are stimulated in
the initial and terminal stages of the range of movement of
joints as well as during rapid changes in velocity and
direction (kinaesthesia). On the other hand the Ruffini end
organ-like receptors and Golgi tendon organ-like receptors
have been associated with a response to the relative posi-
tion of muscles and joints (joint position sense). However,
in the literature the terms kinaesthesia, joint position sense
and proprioception are often used synonymously.
Depending on the type of proprioceptive test used, dif-
ferent results have been observed in the same subject
groups. For example, Barrett
2
showed that JPS was sig-
nificantly improved by reconstruction of the cruciate liga-
ments. MacDonald et al,
3
however, found that in patients
with reconstruction of the anterior cruciate ligament (ACL)
proprioception did not improve when measured by a kin-
aesthesia test. Barrett, Cobb and Bentley
4
found an
improvement in JPS after total knee replacement while
Skinner et al
5
were unable to find any such improvement
using a different JPS test and a kinaesthesia-based test.
In a series of studies Skinner et al
5
used the same testing
device for a healthy control group and the results differed
by as much as 100%.
6-9
Various authors have made definite
conclusions about overall proprioception using only either
JPS tests or kinaesthesia tests.
2,4,10-20
Because of these
contradictory results, the question arises as to whether
overall proprioceptive ability can be ascertained by a single
method. Our aim therefore was to compare frequently used
tests of proprioception and to evaluate the correlation
between them.
Patients and Methods
Thirty healthy volunteers (12 women, 18 men) with a mean
age of 41 years (
SD
13.5; range 24 to 72) participated in the
study. None had a history of injury to the lower limb or
vestibular or neuromuscular disorders. The subjects were
tested using their dominant leg for five different tests of
proprioception.
In all five tests visual clues were eliminated using a
blindfold. For JPS1 and KT1 the subject’s leg was allowed
to hang freely over the side of the table at a distance of 5 to
10 cm proximal to the popliteal fossa. Soft-cast compres-
sion splints (soft scotch-cast; 3M Healthcare, St Paul,
Minnesota) were fitted above and below the knee. Elastic
bandages were applied over the soft scotch-cast as tightly
as possible to neutralise cutaneous sensation (Fig. 1). For
JPS2, JPS3 and KT2 the subject’s leg was fitted in an
adjustable splint (Fig. 2). To neutralise the slight vibration
615LACK OF CORRELATION BETWEEN DIFFERENT MEASUREMENTS OF PROPRIOCEPTION IN THE KNEE
VOL. 84-B, N
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. 4, MAY 2002
Fig. 1
Photograph of the testing device used for JPS1 and KT1: (1) motor; (2) motor control box; (3) vibrator; (4)
compression splint; (5) wire; (6) on-off switch of the control box.
Fig. 2
Photograph of the testing device used for JPS1, JPS3 and KT2: (1) motor; (2) motor control box; (3) vibrator;
(4) adjustable splint; (5) wire; (6) electrogoniometer; (7) on-off switch of the control box.
created by the testing motor a vibration device was fitted on
the splint for tests JPS1, KT1 and KT2. In a pilot study we
also found that patients very often could tell whether
movement occurred by the slight vibration of the starting
stepper motor rather than the movement itself. In order to
eliminate this clue the vibrator was used which is a recom-
mended procedure for measurement of proprioception.
3
Furthermore, the present results compare well with those in
the literature and we therefore can confidently conclude
that the slight vibrations at the splint (and not at the skin)
did not significantly affect the results and conclusions.
Additionally, in KT1 and KT2 tests the auditory clues were
eliminated by using industrial earmuffs with music
playing.
Joint position sense test 1 (JPS1). This test measured the
ability to reproduce passively the position of the lower leg
using a slow-speed motor (Proprioception 2000; Automated
Motion Systems, Perth, Western Australia) for reposition-
ing (Fig. 1).
8,12,18
Starting at a free-hanging position of 90°,
the motor moved the subject’s leg at a rate of 12°/s to three
randomly selected angles between 60° and 80°, 30° and 55°
and 5° and 25° of flexion. The leg was held in this position
for a few seconds and the subject was asked to concentrate
on its position. The knee was returned to the starting
position and then moved again by the motor at a speed of
5°/s. When the subject thought that the leg was in the same
position as before, he or she stopped the motor by using the
on-off switch of the motor control box. The absolute angu-
lar error was measured. This procedure was repeated nine
times, three times for each angle, and a mean value of
angular error was recorded for each subject.
Joint position sense test 2 (JPS2). This test measured
the ability of a subject to reproduce the knee angle using
a hand-held electrogoniometer as a visual analogue mod-
el.
2,4,10,13-15,20-22
Starting at a free-hanging position of
90°, the examiner moved the dominant leg by raising the
splint to angles of 17°, 34°, 50° and 67° of flexion. An
electrogoniometer was attached to the splint and recorded
the position of the leg to an accuracy of 0.05°. The
subject was instructed to concentrate on the location of
the leg while maintaining the position for a few seconds.
The leg was then returned to its original position. The
subject then represented the perceived angle of flexion by
the hand on a visual analogue electrogoniometer (Fig. 3).
This procedure was repeated 12 times, three times for
each angle, and the mean angular error was recorded for
each subject.
Joint position sense test 3 (JPS3). This test measured the
reproduction of a knee angle using the contralateral leg as
the gauge.
8,23
The subject’s splinted leg was moved to four
angles of 17°, 34°, 50° and 67° of flexion. After a few
seconds the leg was returned to its original position. The
subject then was asked to place the contralateral leg in the
same position as the tested leg before. An electrogoni-
ometer was attached to both legs to measure the angular
error. This procedure was repeated 12 times, three times for
each angle, and the mean angular error was recorded for
each subject.
Kinaesthesia test 1 (KT1). The threshold of detection of a
passive leg movement was measured.
5,7-9,11,16,19,24
A wire,
wound up by the slow-speed motor, was attached to the
compression splint and moved the subject’s leg (Fig. 1).
From a starting position of 60° of knee flexion, and with
the tension to counter gravity already applied, the serv-
ometer slowly pulled the subject’s leg into extension at
0.5°/s. The onset of the servomotor movement had a ran-
dom delay which varied between 5 and 60 s after the
subjects were prepared for the task. The subject was given
a control box with an on-off switch to stop the motor when
a change was perceived in the position of the tested leg.
The linear movement of the wire was measured and con-
verted to angular deflection.
8
This procedure was repeated
ten times and the mean threshold angle to detect passive
movement was recorded for each subject.
Kinaesthesia test (KT2). This test was similar to KT1 in
that the awareness of movement of the joint was measured.
In contrast to KT1, the subject’s leg was fitted into an
adjustable and not a compression splint (Fig. 2).
25,26
Addi-
tionally, an electrogoniometer was attached to the splint
and recorded the position of the leg with an accuracy of
0.05°. This procedure was repeated ten times and the mean
threshold angle was recorded for each subject.
Statistical analysis. Descriptive statistics (mean and stand-
ard deviation) were used to determine the performance of
all subjects in each proprioceptive test. Pearson correlation
tests were used to determine the relationships between the
measures of proprioception. In addition, subjects were
ranked according to their performance in each of the tests
and rank-correlation coefficients of the different tests were
calculated.
616 K. R. GROB, M. S. KUSTER, S. A. HIGGINS, D. G. LLOYD, H. YATA
THE JOURNAL OF BONE AND JOINT SURGERY
Fig. 3
Hand-held electrogoniometer used for
JPS2.
Results
The confidence intervals, the mean and the maximum and
minimum angular error for the JPS tests and for threshold
angles to detect passive movement are given in Table I. The
mean threshold angles from KT1 and KT2 were signifi-
cantly different (p = 0.01).
Table II presents the correlation between the different
proprioception tests. There was no correlation between the
different tests for JPS or between the kinaesthesia and the
JPS tests, but there was a significant correlation (r = 0.86)
between the two tests for kinaesthesia, KT1 and KT2. The
subjects were then ranked according to their performance in
each test and the correlation between the ranks of the
different tests established (Table III). The only significant
correlation of the ranks again was between the two kinaes-
thesia tests.
Discussion
The absolute values for kinaesthesia and JPS tests in our
study were similar to those previously reported. For exam-
ple, in the JPS test which used visual estimation (JPS2),
Barrett
2
recorded a mean angular error of 2.5° and Warren
et al
20
10.6°; our value was 9.7°. For KT1 our value was
2.07° and for KT2 1.38° which is within the reported range
of 0.76°
25
to 3.9°.
6
There are various tests for kinaesthesia and JPS in the
literature all of which have conclusions regarding the over-
all proprioceptive ability.
4-6,8,13,23,26
Our main findings
were that there is no significant correlation between the
kinaesthesia and JPS tests, or between the different JPS
tests. This suggests that there is no single test which
quantifies proprioception. Instead, each assesses one facet
of proprioception only and does not represent the overall
functional ability.
The lack of correlation between the kinaesthesia and the
JPS tests agrees with a study by Fridén et al.
27
They
evaluated proprioception in 16 patients at different times
after acute injury to a knee ligament by using two tests for
JPS and one for kinaesthesia. Loss of proprioception was
found in the kinaesthesia test but not in the JPS tests. This
lack of correlation may also explain several contradictory
results in the current literature. For example, Barrett
2
found
that proprioception was significantly improved by recon-
struction of the cruciate ligaments after using a joint posi-
tion visual estimation test, but MacDonald et al
3
found no
such improvement using a kinaesthesia test. Skinner et al
5
measured proprioception in a group of patients before and
after total knee replacement using a JPS and a kinaesthesia
test. They were unable to find a difference in propriocep-
tion between knees with osteoarthritis and those with a
prosthesis. On the other hand, Barrett et al
4
used a joint
position visual estimation test and found that knee replace-
ment improved joint proprioception.
No conclusions can be drawn as to which test is the most
sensitive for detecting possible changes in proprioception.
Some investigators prefer the threshold tests to the JPS
tests because previous results for kinaesthesia measure-
ments are more constant than for JPS tests.
27
For example,
a loss of proprioception after injury to the ACL was found
in all six studies which used kinaesthesia tests,
8,11,24,25,27,28
but in only three of eight studies employing JPS
tests.
2,8,24,27-29
Likewise, our study showed a good correla-
tion only between the two threshold tests. This could be
because the difference in the testing device between these
two tests was minimal.
Nevertheless, even the small methodological change
such as using a tightly-fitted compression splint (KT1) to
diminish cutaneous sensory information significantly influ-
enced the threshold angle. Hence, information from other
sensory pathways may explain contradictory findings such
as a reported threshold angle of 2.4° for elderly patients
after knee arthroplasty
11
and 2.7° for young dancers.
6
Also,
when apparently the same tests were used by different
authors opposing results may be explained by minor meth-
odological changes. For example, Barrack et al
7
found a
significantly higher kinaesthesia threshold angle in subjects
with injuries to the ACL while Wright et al
30
found no
difference after ACL injury using the ‘same’ proprioceptive
tests.
Proprioception depends on the cumulative neural input to
the central nervous system from mechanoreceptors
1,31
617LACK OF CORRELATION BETWEEN DIFFERENT MEASUREMENTS OF PROPRIOCEPTION IN THE KNEE
VOL. 84-B, N
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Table I. Summary of the results (degrees) for the JPS and kinaesthesia
tests
JPS1 JPS2 JPS3 KT1 KT2
Number of cases 30 30 30 30 30
Minimum 4.30 4.10 3.30 1.08 0.78
Maximum 24.44 25.30 26.50 3.72 2.58
Mean 13.75 9.27 10.71 2.07 1.38
95% confidence interval (upper) 15.71 10.82 12.72 2.33 1.54
95% confidence interval (lower) 11.79 7.73 8.70 1.80 1.23
Standard deviation 5.24 4.14 5.37 0.71 0.41
Table II. Intercorrelation (r) between all the tests
JPS1 JPS2 JPS3 KT1 KT2
JPS1 1
JPS2 -0.20 1
JPS3 0.16 0.49 1
KT1 0.18 0.13 0.30 1
KT2 0.07 0.24 0.32 0.86 1
Table III. Intercorrelation (r) between the ranks of the
different tests
JPS1 JPS2 JPS3 KT1 KT2
JPS1 1
JPS2 -0.25 1
JPS3 0.30 0.20 1
KT1 0.20 0.14 0.33 1
KT2 0.13 0.18 0.31 0.87 1
located in the muscles, ligaments, joint capsules, tendons
and skin. Most JPS tests also involve efferent pathways.
The lack of correlation between different JPS tests may be
due to some of the final measurements being dependent
upon both the function of the knee being tested and also on
the sensory input from the other leg (JPS3) and the visual-
cognitive-spatial ability (JPS2). The JPS1 was the only JPS
test which was independent of secondary sensory inputs,
suggesting that JPS1 may be the most objective JPS test.
Finally, we only used healthy subjects. Most researchers
use these tests to distinguish between normal and patho-
logical conditions. Our conclusions may not apply to patho-
logical conditions and this needs further investigation.
Our study and others have assessed the conscious per-
ception of joint position and/or movement. However, the
symptom of instability suffered by patients after joint injury
does not reflect the conscious perception of where the joint
is in space, but the reflex control of its activity by its
musculature.
32,33
Therefore the measurement of JPS or
kinaesthesia is not necessarily the right approach to reveal
a neurological defect after joint injury. Tests of muscle co-
ordination such as standing balance may be of more value
in assessing instability after ligament injury.
34
We conclude that there remains no comprehensive meth-
od for measuring proprioception. The results of studies
which use only either JPS tests or kinaesthesia tests must be
interpreted with care. Furthermore, the terms propriocep-
tion, kinaesthesia and JPS should not be used
synonymously.
No benefits in any form have been received or will be received from a
commercial party related directly or indirctly to the subject of this
article.
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618 K. R. GROB, M. S. KUSTER, S. A. HIGGINS, D. G. LLOYD, H. YATA
THE JOURNAL OF BONE AND JOINT SURGERY
... These methods often provide tactical, visual or auditory cues that have a confounding effect on the measurement and therefore need to be eliminated during testing. However, despite the widespread use of joint position testing, the reliability and validity of these methods have rarely been evaluated against different controls in research (13) (14). ...
... The use of a simple goniometer is considered the industry standard for clinical use to measure joint angle, due to its small size, low cost, availability, usability and prevalence in literature (13). However, the greatest limitation with a manual goniometer is the intra-and inter-rater variability. ...
... However, the greatest limitation with a manual goniometer is the intra-and inter-rater variability. Studies have also reported variable reliability using a simple or universal goniometer, with change in direction of motion (13) (14) (15). As such, an isokinetic dynamometer is often used due to increased reliability and is commonly used for laboratory studies. ...
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Objective: Measurement of joint angles is usually performed using a simple goniometer, which can often be time-consuming and inaccurate, however smartphones can measure angles, this technology could be used to measure joint position. Studies of smartphone applications for this purpose lack consistency and homogeneity. The aim of the current study is to analyse the reliability and accuracy of 3 inertial motion unit-based smartphone applications for goniometric measurement, using 3 different industry standards as external controls. Methods: In the first 2 phases of the study, measurements of angles between 90° and 165° (simulating knee extension) using 3 smartphone applications were analysed against the 3 industry standards. In the third phase, the smartphone's raw data was individually analysed against a digital inclinometer across the x, y and z axes. Results and conclusion: Results from the 3 phas-es of this study indicate a high degree of reliability and validity of the applications compared with the industry standards, with no clinically significant deviations. Thus, this technology could be used in a clinical setting. However, further clinical research, focussing on joint motions with greater than a single degree of freedom, is required before the use of such applications for joint position measurement in clinical practice.
... Proprioception can be quantified by measuring (1) joint position detection accuracythe ability of the individual to reproduce a predetermined joint angle by actively moving the limb (active JPS) or by reporting when the target angle is reached when the limb is moved passively (passive JPS); (2) the threshold needed to detect passive motion -which is the ability of an individual to detect the initiation and direction of passive joint movement; or (3) passive motion direction discrimination -which requires the individual to report whether the limb moves in a positive or negative direction relative to the defined plane of motion [9]. Detection of joint position is the most common method of detecting JPS [9][10][11]. Various methods have been used to assess JPS including model position replication, image capture, digital inclinometer, and electrogoniometer as well as using dynamometers and angular motion chairs [11]. ...
... Initially, the dynamometer was calibrated by measuring knee zero flexion (complete extension) with a standard universal plastic 360°goniometer. Then, passive JPS was tested three times at the following ranges: starting from 5°and ending at 25°, starting from 30°and ending at 55°, and starting from 60°and ending at 80°of knee flexion [10]. These angles were selected to cover the whole range of daily activities. ...
... Then, the target position was held for 7 s so that the participant could memorize it before the machine returned the knee to the initial starting position. The isokinetic dynamometer then moved the knee again at the same speed and the participant was asked to press the stop button when he/she felt the predetermined target angle was reached [10]. The same procedures were repeated with active JPS, except for the active participation of the subject who actively moved the leg at 10°/s, close to the velocity used by Marks and Quinney [24]. ...
Article
Background Quantifying proprioception deficit in patients with osteoarthritis (OA) may be important in evaluating treatment effectiveness. This study investigated the concurrent and known-groups validity as well as test–retest reliability of a smartphone application in assessing joint position sense (JPS) in asymptomatic individuals and patients with knee OA. Methods Sixty-four knees, from 16 asymptomatic controls and 16 patients with bilateral OA, were assessed twice with a 1-week interval in between. The smartphone Goniometer Pro application and isokinetic dynamometer simultaneously quantified JPS, in terms of absolute repositioning error (RE) angle, during active and passive limb movements at selected angles. Results Both devices showed moderate to almost perfect correlations in measuring JPS; whether active (intra-class correlation coefficient (ICC) >0.87) or passive (ICC >0.97). The mean RE angle differences between the two devices were <0.77° (passive JPS) and <2.76° (active JPS). Both devices were capable of distinguishing patients and asymptomatic controls at 55° and 80°. The smartphone showed moderate test–retest reliability of active JPS measurement (ICC = 0.51) in the two groups, similar to that of the isokinetic dynamometer (ICC = 0.62), but with a high measurement error. Conclusions Smartphone application is a valid alternative to the isokinetic dynamometer in assessing JPS in patients with knee OA and asymptomatic controls. The two devices could distinguish patients and asymptomatic volunteers during passive JPS measured at 55° and 80°. Both devices have moderate reliability in quantifying active JPS, but reliability results should be considered with caution.
... Kinesthesia, joint position sense and the sense of force, effort and heaviness have been suggested as submodalities of proprioception [5,6]. Kinesthesia is the sense of movement and the direction of the movement [7][8][9]. Joint position sense (JPS) is the awareness of the location of a joint in space [9]. Although, both kinesthesia and JPS share inputs from muscle spindles [8], they should be viewed as separate subdivisions of proprioception [10] since there is evidence that movement and position are processed through different mechanisms in the CNS [11] and distinct sites in the motor cortex [12]. ...
... Kinesthesia is the sense of movement and the direction of the movement [7][8][9]. Joint position sense (JPS) is the awareness of the location of a joint in space [9]. Although, both kinesthesia and JPS share inputs from muscle spindles [8], they should be viewed as separate subdivisions of proprioception [10] since there is evidence that movement and position are processed through different mechanisms in the CNS [11] and distinct sites in the motor cortex [12]. ...
Article
Objectives: Deficits in proprioception and postural control are common in patients with different musculoskeletal pain syndromes. It has been proposed that pain can negatively affect proprioception and postural control at a peripheral level, however research is limited to animal studies. Human studies have shown that it is more likely, that the link between pain and proprioceptive deficits, lies within changes in the central nervous system where noxious and non-noxious stimuli may overlap. In clinical studies, causality cannot be determined due to other factors which could confound the assessment such as pathophysiological features of the underlying musculoskeletal disorder and different psycho-social influences especially in patients with chronic pain. On the other hand, experimentally induced pain in healthy participants is able to control most of these confounding factors and perhaps offers an assessment of the effects of pain on proprioception and postural control. The aim of this paper is to critically appraise the literature related to the effect of experimentally induced pain on proprioception and postural control. Results from these studies are discussed and limitations are highlighted for future research. Methods: A search of databases (Medline, Scopus, PubMed) was conducted as well as reference check from relevant articles published since 2000. Fifteen studies which explored the effect of experimentally induced pain on postural control and ten studies which explored the effect of experimentally induced pain on proprioception were included. Results: We found that in the majority of the studies, postural control was negatively affected by experimentally induced pain. Results for proprioception were mixed depending on the body region and the way the painful stimuli were delivered. Kinesthesia was negatively affected in two studies, while in one study kinesthesia was enhanced. Joint position sense was not affected in four out of five studies. Finally, force sense was affected in three out of four studies. Conclusions: From a clinical point of view, findings from the available literature suggest that experimentally induced pain impairs postural control and could potentially increases the risk for falls in patients. Interventions aiming to reduce pain in these patients could lead to preservation or improvement of their balance. On the other hand, the same conclusion cannot be drawn for the effect of experimentally induced pain on kinesthesia and joint position sense due to the limited number of studies showing such an effect.
... Proprioception is the general term used for kinesthesia and joint position sense. Joint position sense refers more specifically to the awareness of joint position in space and relies on various receptors called mechanoreceptors [1], found in the joint capsule, ligaments, meniscus, musculotendinous units, and skin [2]. To assess joint position sense, universal goniometers are used, in addition to various proprioception evaluation devices and written evaluation scales [3,4]. ...
... The device can transfer the obtained data to a computer or smartphone via a Bluetooth 1 connection. 1 The aim of this study was to determine the validity and reliability of the KFORCE Sens 1 electrogoniometer for the evaluation of wrist proprioception. ...
Article
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The aim of this study was to determine the validity and reliability of the KFORCE Sens® electrogoniometer in the evaluation of wrist proprioception. Wrist position sense was assessed on a Baseline® 360° universal goniometer and a KFORCE Sens® device. The validity and reliability of the KFORCE Sens® device for wrist position sense evaluation were investigated by comparing the two data sets. Fifty-three healthy volunteers (39 female, 14 male) with a mean age of 22.83 ± 1.28 years (range, 21-27 years) were included. Joint position sense test-retest reliability (intra-class correlation coefficient) on KFORCE Sens® was “very good” for all wrist movements. There was a very strong correlation between flexion-extension movements on the dominant side (r = 0.955), and a strong correlation between ulnar-radial deviation movements (r = 0.745). There was also a very strong (r = 0.863) correlation between flexion-extension movements on the non-dominant side and a strong correlation (r = 0.690) between ulnar-radial deviation movements (p < 0.05). Our results showed that the KFORCE Sens® device was a valid and reliable evaluation means of assessing wrist position sense.
... With respect to joint-related proprioceptive accuracy, a number of measurement paradigms were developed (Han et al., 2016). Studies investigating the association between different tests in one joint (Barrack et al., 1984;Grob et al., 2002;Jong et al., 2005;Elangovan et al., 2014;Li et al., 2016;Niespodziński et al., 2018;Yang et al., 2020) consistently report that accuracy is test-specific. The same conclusion can be drawn with respect to cardioception: accuracy scores obtained by heartbeat discrimination methods that use forcedchoice methods and methods that use heartbeat tracking (i.e., counting) typically show no or only weak associations (Pennebaker and Hoover, 1984;Weisz et al., 1988;Phillips et al., 1999;Schaefer et al., 2012;Hart et al., 2013;Schulz et al., 2013;Michal et al., 2014;Garfinkel et al., 2015a,b;Forkmann et al., 2016;Ring and Brener, 2018). ...
... We replicated the findings of Ferentzi et al. (2018), namely that cardioceptive accuracy, as assessed with the mental heartbeat tracking task, does not correlate with measures of proprioceptive accuracy (joint position reproduction and weight discrimination tests in this study). Moreover, in accordance with the findings of other studies (Barrack et al., 1984;Grob et al., 2002;Jong et al., 2005;Elangovan et al., 2014;Li et al., 2016;Niespodziński et al., 2018;Yang et al., 2020), no association between accuracies with respect to two proprioceptive modalities was found. This lack of association might reflect the actual independence of the two abilities; however, conceptual differences (i.e., the weight discrimination test does not involve a reproduction element and it was measured with a forced choice paradigm) can also explain this finding. ...
Article
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Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs (visceroception) and the motor system (proprioception). Dimensions of interoception include (1) interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, (2) confidence rating with respect to perceived performance in an actual behavioral test, and (3) interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with affect are scarcely studied. In the present study, undergraduate students (N = 105, 53 males, age: 21.0 ± 1.87 years) filled out questionnaires assessing positive and negative affect (Positive and Negative Affect Schedule), interoceptive sensibility (Body Awareness Questionnaire), and body competence (Body Competence Scale of the Body Consciousness Questionnaire). Following this, they completed a behavioral task assessing cardioceptive accuracy (the mental heartbeat tracking task by Schandry) and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles (weight discrimination task) and the angular position of the elbow joint (joint position reproduction task). Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states (PANAS) are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities.
... Proprioception plays an important role in smooth, coordinated activation of the extremities. Sensory information for proprioception is collected at the nerve endings and neural impulses subsequently travel toward the cerebral cortex via the posterior columns of the spinal cord 22,25 . Any disorder within these neural pathways, such as DCM, can impair proprioception. ...
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This study aimed to evaluate the subclinical gait abnormalities and the postoperative gait improvements in patients with degenerative cervical myelopathy using three-dimensional gait analysis. We reviewed the gait analysis of 62 patients who underwent surgical treatment for degenerative cervical myelopathy. The asymptomatic gait group included 30 patients and the gait disturbance group included 32 patients who can walk on their own slowly or need assistive device on stairs. The step width (17.2 cm vs. 15.9 cm, P = 0.003), stride length (105.2 cm vs. 109.1 cm, P = 0.015), and double-limb support duration (13.4% vs. 11.7%, P = 0.027) improved only in the asymptomatic gait group. Preoperatively, the asymptomatic gait group exhibited better maximum knee flexion angle (60.5° vs. 54.8°, P = 0.001) and ankle plantarflexion angle at push-off (− 12.2° vs. − 6.5°, P = 0.001) compared to the gait disturbance group. Postoperatively, maximum knee flexion angle (62.3° vs. 58.2°, P = 0.004) and ankle plantarflexion angle at push-off (− 12.8° vs. − 8.3°, P = 0.002) were still better in the asymptomatic gait group, although both parameters improved in the gait disturbance group ( P = 0.005, 0.039, respectively). Kinematic parameters could improve in patients with gait disturbance. However, temporospatial parameters improvement may be expected when the operative treatment is performed before apparent gait disturbance.
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Background: Proprioceptive accuracy refers to the individual's ability to perceive proprioceptive information, that is, the information referring to the actual state of the locomotor system, which originates from mechanoreceptors located in various parts of the locomotor system and from tactile receptors located in the skin. Proprioceptive accuracy appears to be an important aspect in the evaluation of sensorimotor functioning; however, no widely accepted standard assessment exists. In this systematic review, our goal was to identify and categorize different methods that are used to assess different aspects of proprioceptive accuracy. Methods: A literature search was conducted in 5 different databases (PubMed, SPORTDiscus, PsycINFO, ScienceDirect, and SpringerLink). Results: Overall, 1139 scientific papers reporting 1346 methods were included in this review. The methods assess 8 different aspects of proprioception: (a) the perception of joint position, (b) movement and movement extent, (c) trajectory, (d) velocity, and the sense of (e) force, (f) muscle tension, (g) weight, and (h) size. They apply various paradigms of psychophysics (i.e., the method of adjustment, constant stimuli, and limits). Conclusion: As the outcomes of different tasks with respect to various body parts show no associations (i.e., proprioceptive accuracy is characterized by site-specificity and method-specificity), the appropriate measurement method for the task needs to be chosen based on theoretical considerations and/or ecological validity.
Article
Background: Altered spinal postures and altered motor control observed among people with non-specific low back pain have been associated with abnormal processing of sensory inputs. Evidence indicates that patients with non-specific low back pain have impaired lumbo-pelvic proprioceptive acuity compared to asymptomatic individuals. Objective: To systematically review seated lumbo-pelvic proprioception among people with non-specific low back pain. Methods: Five electronic databases were searched to identify studies comparing lumbo-pelvic proprioception using active repositioning accuracy in sitting posture in individuals with and without non-specific low back pain. Study quality was assessed by using a modified Downs and Black's checklist. Risk of bias was assessed using an adapted tool for cross-sectional design and case-control studies. We performed meta-analysis using a random effects model. Meta-analyses included subgroup analyses according to disability level, directional subgrouping pattern, and availability of vision during testing. We rated the quality of evidence using the GRADE approach. Results: 16 studies met the eligibility criteria. Pooled meta-analyses were possible for absolute error, variable error, and constant error, measured in sagittal and transverse planes. There is very low and low certainty evidence of greater absolute and variable repositioning error in seated tasks among non-specific low back pain patients overall compared to asymptomatic individuals (sagittal plane). Subgroup analyses indicate moderate certainty evidence of greater absolute and variable error in seated tasks among directional subgroups of adults with non-specific low back pain, along with weaker evidence (low-very low certainty) of greater constant error. Discussion: Lumbo-pelvic proprioception is impaired among people with non-specific low back pain. However, the low certainty of evidence, the small magnitude of error observed and the calculated "noise" of proprioception measures, suggest that any observed differences in lumbo-pelvic proprioception may be of limited clinical utility. Prospero-id: CRD42018107671.
Chapter
This chapter summarizes the methodological issues and empirical findings on the acuity of perception of interoceptive information, dubbed interoceptive accuracy. Both homeostatic (classic visceroceptive channels, thermosensation, itch, pain, affective touch, muscle fatigue, chemical senses), and somatosensory (exertion of muscles, position and movement of joints, vestibular, and tactile information) modalities are discussed. It is concluded that interoceptive accuracy cannot be generalized across modalities; thus, no single modality should be used as the indicator of general interoceptive ability. Moreover, affective evaluation plays a substantial role in the perception for many modalities, such as pain, itch, affective touch, and indicates the salience of the information better than the sensory-discriminative aspect. Therefore, it should be assessed in a more systematic way in future studies.
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We measured joint position sense in the knee by a new method which tests the proprioceptive contribution of the joint capsule and ligaments. The leg was supported on a splint, and held in several positions of flexion. The subjects' perception of the position was recorded on a visual analogue model and compared with the actual angle of flexion. Eighty-one normal and 45 osteoarthritic knees were examined, as were 10 knees with semi-constrained and 11 with hinged joint replacements. All were assessed with and without an elastic bandage around the knee. There was a steady decline in joint position sense with age in subjects with normal knees. Those with osteoarthritic knees had impaired joint position sense at all ages (p less than 0.001). Knee replacement improved the joint position sense slightly (p less than 0.02); semi-constrained replacement had a greater effect than hinged replacement. The effect of an elastic bandage in subjects with poor position sense was dramatic, improving accuracy by 40% (p less than 0.001). It is proposed that reduced proprioception in elderly and osteoarthritic subjects may be responsible for initiation or advancement of degeneration of the knee.
Article
Injury to the anterior cruciate ligament (ACL) is thought to disrupt joint afferent sensation and result in proprioceptive deficits. This investigation examined proprioception following ACL reconstruction. Using a proprioceptive testing device designed for this study, kinesthetic awareness was assessed by measuring the threshold to detect passive motion in 12 active patients, who were 11 to 26 months post-ACL reconstruction, using arthroscopic patellar tendon autograft (n=6) or allograft (n=6) techniques. Results revealed significantly decreased kinesthetic awareness in the ACL reconstructed knee versus the uninvolved knee at the near-terminal range of motion and enhanced kinesthetic awareness in the ACL reconstructed knee with the use of a neoprene orthotic. Kinesthesia was enhanced in the near-terminal range of motion for both the ACL reconstructed knee and the contralateral uninvolved knee. No significant between-group differences were observed with autograft and allograft techniques.
Article
Falls lead to significant morbidity and mortality in persons older than 65 years of age. Impaired proprioception may be a contributing factor to falls, and this may be influenced by the level of habitual physical activity. The primary purpose of this study was to investigate knee joint proprioception among young volunteers and active and sedentary elderly volunteers. Knee joint proprioception was measured through reproduction of static knee angles using a Penny and Giles™ electrogoniometer. The secondary purpose of this investigation was to test the reproducibility of the Penny and Giles™ electrogoniometer in measuring static knee angles. Sixteen young subjects (age range, 19-27 years) and 24 elderly subjects (age range, 60-86 years) participated. Subjects were given a screening history and physical examination to exclude neuromuscular or vestibular disorders or lower limb injuries. Knee joint proprioception was measured two times during one week. The elderly group was separated into active and sedentary subgroups based on their level of activity during the past year. The electrogoniometer was placed laterally across the dominant knee joint. From the prone position each subject attained one of ten randomly predetermined knee joint angles from 10° to 60°. The subject then returned to the starting position and reproduced the test angle. The absolute angular error (the absolute difference between the test angle and subject perceived angle of knee flexion) was determined. A positive correlation was found between control visits for all subjects (r = 0.88), and significant differences were observed between young (mean, 2.01 ± 0.46°) and active-old (mean, 3.12 ± 1.12°; P < 0.001), young and sedentary-old (mean, 4.58 ± 1.93°; P < 0.001), and active-old and sedentary-old (P < 0.03). These findings demonstrate that the Penny and Giles™ electrogoniometer is a reproducible device for measuring knee joint angles in both young and elderly subjects. Furthermore, we found that proprioception is diminished with age and that regular activity may attenuate this decline. One strategy to reduce the incidence of poor proprioception and fall with ageing may be regular exercise.
Article
Proprioception was measured in the knees of 20 subjects with instability of the anterior cruciate ligament and compared with 17 age-matched control subjects. There was diminished position sense and threshold for movement detection in the injured patients compared with the control group. The proprioceptive deficit recorded from the injured knee showed a significant correlation with the hamstring/quadriceps power ratio recorded from the injured leg.
Article
We have assessed 45 patients who had undergone anterior cruciate reconstruction by a modified MacIntosh-Jones method. The results, using standard knee scores and clinical ligament testing, correlated poorly with the patient's own opinion and with the functional result. However, measurement of proprioception in the knee correlated well with both function (r = 0.84) and with patient satisfaction (r = 0.9). This study indicates that proprioception, rather than the clinical excellence of the repair, is a major factor in the outcome of anterior cruciate ligament reconstruction.
Article
Proprioception was quantified in a group of patients who had documented complete ACL tears. Threshold to detection of passive change in position of the knee was measured using a well-described test. Eleven pa tients with arthroscopically proven complete ACL tears and findings consistent with moderate to severe anter olateral rotatory instability were tested. Testing was done within the 30° to 40° range of knee flexion. Patients were blindfolded and the injured and uninjured knees were tested in random sequence so that the normal knee could serve as an internal control. Testing was also done in a blind manner, i.e., the examiner did not know which knee had been injured. An age- matched control group underwent identical testing. Po tentially significant variables such as age, time from injury, and degree of rehabilitation as measured by thigh circumference and isokinetic testing of the knee were included in a multivariate analysis. Control subjects demonstrated virtually identical threshold values between their two knees, the mean variation being less than 2%. The test group, however, showed a significantly higher mean threshold value for the injured versus the noninjured knee (P < 0.01), the mean variation being over 25%. Multivariate analysis demonstrated that changes recorded in the propriocep tion of the injured knee were attributable to the loss of the ACL rather than to other variables. Patients who have complete ACL tears and moderate to severe rotatory instability may also experience a decline in proprioceptive function of their knee.
Article
Currently used measures of knee stability and function for ACL reconstructed knees have not gained universal acceptance. Clinical test results often are given more value than the patient's subjective evaluation of the surgical outcome. This study was designed to identify specific knee stability and function variables that were most predictive of the patient's rating of knee function following one of two types of combined (intraarticular and extraarticular) ACL reconstruction procedures. Individual measures of knee stability and function were also evaluated for differences between contralateral operated and nonoperated limbs. Postoperative and healthy contralateral knees of 51 male and female patients aged 18 to 49 years (mean, 23.7 years) were evaluated on a battery of tests at an average of 48.0 months after surgery (range, 24 to 101 months). All subjects possessed a normal contralateral knee for comparative purposes. The results of this retrospective study indicated that the variables selected were not highly correlated with, nor could they effectively predict, the patients' perceptions of postoperative knee status as measured by the Knee Function Rating Form (KFR). Statistically significant differences (P less than 0.001) between operated and nonoperated knees were found for 9 of 11 variables analyzed. The data suggest that patients' perceptions of postoperative knee status were independent of the results of static and dynamic clinical tests commonly used to assess knee stability and function. Postoperative deficits of up to 30% between the surgically reconstructed and normal contralateral knees on specific measures of knee stability and function did not greatly influence the patients' perceptions of knee function. Development of new, more specific dynamic tests may be necessary before stronger relationships between clinical test results and patients' perceptions of knee status in the ACL reconstructed knee can be realized.
Article
This study was designed to test position sense of the knee joint before and after fatigue in order to determine whether muscle or capsular receptors are the primary sensors for joint position sense. Reproduction of passive positioning and detection of the onset of motion (kinesthesia) were employed to measure joint position sense. Eleven subjects underwent joint position sense measurement before and after a fatigue protocol. A significant worsening of reproduction of knee joint angle after fatigue was noted (p less than 0.05). Threshold (kinesthesia) showed no statistically significant change after fatigue. A significant correlation of reproduction measurements and threshold measurements prior to fatigue (p less than 0.01) demonstrated that the same neural mechanism is applicable in the rested state, but these variables did not correlate significantly after fatigue. There was a significant correlation between reproduction measurements before and after fatigue (p = 0.018), while no correlation was seen for the pre- and postfatigue threshold measurements, suggesting a change in the neural path after fatigue. Since both tests of joint position sense are affected by fatigue, we conclude that muscle receptors are a prominent, if not primary, determinant of joint position sense, and capsular receptors may have a secondary role. Reproduction ability is decreased, presumably through the loss of efficiency of muscle receptors. The threshold data suggest a change in the mechanism of appreciation after fatigue, possibly due to increased sensitivity of capsular receptors from muscle-fatigue-induced laxity.