Impaired Joint Position Sense Research Articles

Factors affecting the performance of the deep cervical flexors in young people using smartphones

ABSTRACT Objective To determine the factors affecting the performance of the deep cervical flexors (DCFs) in young people using smartphones. Methods Eighty-six individuals were enrolled in this study. Joint position sense errors, forward head and protracted shoulder posture, DCFs, and the superficial cervical muscles were evaluated. Smartphone Addiction Scale, State-Trait Anxiety Inventory, and International Physical Activity Questionnaire were used. Results Regression analysis indicated that smartphone addiction and superficial cervical muscle strengths affect the performance of DCFs independently (p < 0.05). SAS was correlated with JPSE-flexion (r = 0.408), DCF activity/performance score (r = −0.453/r = −0.431), forward head posture (r = −0.412), and cervical flexor/extensor muscle strengths (r = −0.313/r = −0.319). Conclusion Smartphone addiction and cervical superficial muscles are related to the performance of the DCFs in young people. Using smartphones causes impaired joint position sense in flexion, decreased DCF activity, and forward head posture.

Reliability of joint position sense measured in the knee using the level function of the iPhone "Measure" application.

An impaired joint position sense (JPS) causes activity limitations, postural imbalance, and falls. This study compares the reliability of knee JPS measurements between the iPhone’s “Measure” application and VICON motion capture system. Eleven healthy participants were recruited for the study. To conduct the study measures, the blindfolded participant, with an iPhone fixed to the lower non-dominant leg, was seated with their lower limbs in a relaxed position. The examiner held the participant’s leg at the target angle (30°/60° from initial position) for 5 s before releasing it. The participant was then instructed to move the leg to the same target angle and hold it for 5 s (replicated angle). Absolute angular error (AAE), i.e., the difference between the target and replicated angles, was measured. Intraclass and Pearson correlation coefficients established statistically significant relationships. The study comprised 6 males and 5 females of mean age 27.6±5.6 years, mean height 1.67±0.10 m, and mean body weight 60.7±10.3 kg. Strong correlations existed between iPhone and VICON 30° (ICC = 0.969, r = 0.960, P < 0.001) and 60° AAEs (ICC 0.969, r = 0.960, P < 0.001). Bland-Altman plots showed a mean difference of 0.43° and 0.20° between the AAE measurements at 30° and 60°, respectively. The iPhone’s “Measure” application is a simple and reliable method for measuring JPS in clinical practice and sports/fitness settings.

Joint position sense in individuals with anterior knee pain.

BackgroundAnterior knee pain (AKP) commonly affects both physically active and sedentary individuals and the aetiology is unknown. Altered joint position sense (JPS) impacts accurate motor action and knee joint stability. It is unclear whether people with AKP have altered JPS.ObjectiveThe aim of our study was to investigate JPS in the knees of individuals with AKP.MethodA descriptive cross-sectional study measured JPS in 25 participants with unilateral or bilateral AKP. JPS was measured using active JPS testing during single leg squat (SLS) and active knee extension (AKE) in sitting. Target angles (TA) were self-determined based on each participant’s capabilities. The absolute error (AE) was the main outcome measure. Impaired JPS was classified as an AE equal to or greater than five degrees.ResultsThere were no significant differences in JPS when comparing the affected and unaffected knees in participants with AKP (p > 0.05). However, a subgroup of participants with altered knee JPS was identified. There was a tendency towards greater knee flexion in the TAs of knees without AKP.ConclusionOur results showed that JPS is not significantly more impaired in knees with AKP compared with knees without AKP in a group of individuals with AKP. A subgroup with altered JPS in knees with and without AKP was identified. This finding could be because of compensatory gait patterns and the precision of the Vicon 3D motion analysis system.Clinical implicationsJoint position sense should be assessed bilaterally in individuals with AKP.

Characteristics of the joint position sense in children with developmental dyslexia.

[Purpose] Developmental dyslexia is a disorder in which reading and writing of characters is difficult. The present study investigated age-dependent joint position sense of the forearm and wrist and whether children with developmental dyslexia have less joint position sense than typically developing children. [Participants and Methods] The participants were comprised of 84 typically developing elementary school students, 12 university students, and 2 children with developmental dyslexia. Joint position sense was evaluated using the reproduction method based on four tasks. The participants were divided into three age groups. The children with developmental dyslexia were compared with the typically developing children in the same age group. [Results] Significant negative correlations were found between the reproduction error of the typically developing children and that of the university students in most tasks. The children with developmental dyslexia showed increased reproduction error relative to the reproduction error of the typically developing children in the same age group in 4 of the 8 tasks. [Conclusion] The accuracy of the joint position sense improved with development. However, the joint position sense of the children with developmental dyslexia was lower than that of the typically developing children in the same age group. The difficulty in writing experienced by children with developmental dyslexia may be related to joint position sensing impairment due to impaired joint position sense.

A long-term effect of distal radius fracture on the sensorimotor control of the wrist joint in older adults

IntroductionSensorimotor control can be disturbed because of pain and trauma. There is scarce comprehension about which component of the sensorimotor system would benefit the most from treatment in distal radius fracture (DRF). Purpose of the StudyThe purpose of this study was to determine whether the sensorimotor control of subjects with a history of DRF impaired compared with healthy subjects. If so, which component of the sensorimotor system is most affected. MethodsNine healthy participants and 11 participants with a DRF history executed posture and reproduction tasks in interaction with a robotic wrist manipulator. A posture task with force perturbations assess sensorimotor control. Position and force reproduction tasks assessed sensory feedback. Electromyography recorded the muscle activity to study the motor part of the sensorimotor system. Study DesignCross-sectional case-control. ResultsThe results showed that the motor responses to the perturbations during the posture task did not differ significantly, whereas the position reproduction did significantly differ between the 2 groups. Moreover, participants with a DRF history did not adapt to the changed dynamics of the environment during the posture task, whereas the controls did. DiscussionThe results of this study imply that processing of sensory position feedback is impaired in people with a DRF history while sensorimotor control during a posture task is unaffected. A possible explanation for these results is that different neural networks are involved during reproduction and posture tasks. ConclusionsA history of DRF is related to disturbed processing of sensory feedback of the sensorimotor system, especially the Joint Position Sense, which leads to an impairment in detecting a changed environment and adapting to it. Impaired Joint Position Sense and thereby the inability to adapt adequately to a changing environment should be taken into account during the rehabilitation of patients with DRF.

Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial

BackgroundImpaired cervical joint position sense and balance are associated with neck pain. Specific therapeutic exercise and manual therapy are effective for improving neck pain and functional ability but their effects on joint position sense and balance impairments remain uncertain. Changes in the joint position sense and balance may need to be addressed specifically. The primary objective is to investigate the most effective interventions to improve impaired cervical joint position sense and balance in individuals with neck pain. The secondary objective is to assess the effectiveness of the interventions on pain intensity and disability, pain location, dizziness symptoms, cervical range of motion, gait speed, functional ability, treatment satisfaction and quality of life.MethodsA 2 × 2 factorial, single blind RCT with immediate, short- and long-term follow-ups. One hundred and sixty eight participants with neck pain with impaired joint position sense and balance will be recruited into the trial. Participants will be randomly allocated to one of four intervention groups: i) local neck treatment, ii) local treatment plus tailored sensorimotor exercises, iii) local treatment plus balance exercises, and iv) local treatment plus sensorimotor and balance exercises. Participants receive two treatments for 6 weeks. Primary outcomes are postural sway and cervical joint position error. Secondary outcomes include gait speed, dizziness intensity, neck pain intensity, neck disability, pain extent and location, cervical range of motion, functional ability, perceived benefit, and quality of life. Assessment will be measured at baseline, immediately after treatment and at 3, 6, 12 month-follow ups.DiscussionNeck pain is one of the major causes of disability. Effective treatment must address not only the symptoms but the dysfunctions associated with neck pain. This trial will evaluate the effectiveness of interventions for individuals with neck pain with impaired cervical joint position sense and balance. This trial will impact on clinical practice by providing evidence towards optimal and efficient management.Trial registrationClinicalTrials.gov (NCT03149302). May 10, 2017.

Relationship Between Functional Knee Joint Position Sense and Functional Performance Scores Following Anterior Cruciate Ligament Reconstruction (Pilot Study)

Objectives:The aim of this study was to assess the relationship between functional knee joint position sense (JPS) and functional performance following ACL reconstructionMethods:Seven male patients (mean age=32,66 ±6,47) who had undergone ACL reconstruction and 10 male healthy control subjects participated in the study. Knee joint position sense was evaluated by reproduction of 20° knee flexion angle in weight-bearing position with single and bilateral limb movement into flexion and extension. The deviations in the angle were recorded and compared to both noninjured side and healthy controls’. Functional performance was evaluated with Single Leg Hop Test in both injured and non-injured sides. The scores were also compared with healthy controls and non-injured sides. Relationship between measured values was tested with Spearman Correlation Analysis.Results:There was no significant difference in knee joint position sense in functional position between the operated and uninjured knees of patients or between patients and healthy controls (p>0,05). However, there is significant difference in Single Leg Hop test scores between operated and non-operated or between patients and healthy controls (p=0,037; p<0,05). There was no significant correlation between Single Leg Hop test scores and knee joint position sense (p>0,05).Conclusion:There was no evidence of impaired joint position sense in weight-bearing positions in subjects with ACL reconstruction but there was a decrease in functional performance. This decrease in functional performance may depend on the other parameters except proprioceptive deficits.

Effects of Ankle Proprioceptive Interference on Locomotion After Stroke

Lin S-I, Hsu L-J, Wang H-C. Effects of ankle proprioceptive interference on locomotion after stroke. ObjectiveTo examine the effects of vibration-induced ankle proprioceptive interference on the locomotion of patients with stroke with intact and impaired ankle joint position sense (JPS). DesignCross-sectional. SettingRehabilitation department in a tertiary hospital. ParticipantsAmbulatory patients (N=35) with unilateral stroke received an ankle joint repositioning test and were classified into intact (n=16) or impaired (n=19) JPS group. InterventionsNone. Main Outcome MeasuresThe plantar sensitivity and leg muscle strength were tested. Patients were instructed to walk at a self-selected pace on a computerized pressure sensor walkway under 3 conditions: no, affected, or unaffected Achilles' tendon vibration. The stride characteristics of the affected limb were analyzed. ResultsPatients with intact and impaired JPS did not differ in their plantar sensitivity or leg muscle strength. The differences in the stride characteristics were nonsignificant between vibration and nonvibration conditions. Shorter single support and longer swing phase were found with the affected side vibration compared with the unaffected side vibration. Patients with intact and impaired JPS did not respond to the proprioceptive interference differently. ConclusionsAfter stroke, there could be changes in the central sensory regulation for locomotion control and vibration-induced afferent inputs from the ankle might be viewed as sensory disturbances. Further studies that manipulate other sensory inputs are needed to gain a better understanding of the central sensory integration for locomotion control after stroke.

Comparison of thoracic kyphosis degree, trunk muscle strength and joint position sense among healthy and osteoporotic elderly women: A cross-sectional preliminary study

Increased thoracic kyphosis is one of the most disfiguring consequences of osteoporotic spine fractures in the elderly. However, mechanisms involved in the increasing of the kyphosis degree among osteoporotic women are not completely understood. Then, the aims of this cross-sectional preliminary study were comparing thoracic kyphosis degree, trunk muscle peak torque and joint position sense among healthy and osteoporotic elderly women and investigating possible factors affecting the kyphosis degree. Twenty women were selected for 2 groups: healthy (n=10) and osteoporotic (n=10) elderly women. Bone mineral density (BMD), thoracic kyphosis degree, trunk muscles peak torque and joint position sense were measured. Differences among groups were analyzed by Student's Test T for unpaired data. Correlations between variables were performed by Pearson's coefficient correlation. The level of significance used for all comparisons was 5% (p≤0.05). We observed that the osteoporotic women demonstrated a significantly higher degree of kyphosis and lower trunk extensor muscle peak torque. Moreover, it was found that the BMD had a negative correlation with the thoracic kyphosis degree. Kyphosis degree showed a negative correlation between extensor muscle strength and joint position sense index. This study suggests that lower BMD may be associated to higher degree of kyphosis degree, lower trunk extensors muscle strength and an impaired joint position sense. It is also suggested that lower extensor muscle strength may be a factor that contributes to the increasing in kyphosis thoracic degree.

The effects of impaired joint position sense on the development and progression of pain and structural damage in knee osteoarthritis

Although cross-sectional studies have reported impaired proprioceptive acuity in people with osteoarthritis (OA), there have been no longitudinal studies to evaluate whether those with such impairments increase the risk of OA or its worsening. We studied subjects from the Multicenter Osteoarthritis Study study, a longitudinal study of people with or at high risk of knee OA. At baseline, we quantified acuity as the amount of a subject's error when attempting to reproduce a test knee flexion angle (a measure of joint position sense). We tested proprioception 10 times in the right leg and used a person's worst score as their proprioceptive acuity. At baseline and the 30-month followup, we assessed the presence of frequent pain, obtained Western Ontario and McMasters Universities OA Index (WOMAC) scores, and acquired posteroanterior and lateral weight-bearing knee radiographs read for Kellgren/Lawrence grade and individual radiographic features. We examined the relation of baseline proprioceptive acuity in quartiles with baseline knee pain (frequent pain yes/no), WOMAC pain score, self-reported physical function, and radiographic OA, and with changes from baseline in pain, physical function, and radiographic OA adjusted for age, sex, body mass index, and quadriceps strength. At baseline, proprioceptive acuity was associated with the presence and severity of knee pain but not with the presence of radiographic OA. However, among the 2,243 subjects with baseline acuity assessments and 30-month followup, there were no strong associations between proprioceptive acuity and development of adverse OA outcomes. Acuity was not significantly associated with the new onset of frequent knee pain. Those with the worst acuity at baseline had slightly greater worsening of WOMAC pain scores (0.47 on a 20-point scale) and physical function scores (by 1.5 points on a 0-68-point scale) compared with those with the best proprioceptive acuity, whose pain and physical function score deteriorated less (for pain P = 0.05; for physical function P = 0.02). Radiographic worsening was not significantly associated with proprioceptive acuity. Proprioceptive acuity as assessed by the accuracy of reproduction of the angle of knee flexion had modest effects on the trajectory of pain and physical functional limitation in knee OA.

Reduced scapular muscle control and impaired shoulder joint position sense in subjects with chronic shoulder stiffness

The purpose of the present study was to determine (1) if joint position sense (JPS) in subjects with shoulder stiffness (SS) differs from that in controls; (2) if, when JPS is reduced in SS, it is related to scapular muscular activities in the mid/end ranges of motion; and (3) if a person’s function is associated with his or her level of JPS. Eighteen subjects with unilateral SS and 18 controls were included. Each subject performed abduction by self-selecting an end/mid range position. The electromagnetic motion-capturing system collected kinematic data while surface electromyography collected muscle activities (upper trapezius, lower trapezius, and serratus anterior muscles). Subjects were asked to move the upper limb to the target position (end/mid range) accurately without visual guidance. Reduced JPS was observed in subjects with SS (2.7 degrees in mid range, p < 0.05). The JPS was enhanced by an increased scapula muscular activation level in the end range of motion ( R = −0.61 for SS and −0.41 for controls) and by coordination among muscles’ activation in the mid-range of motion ( R = −0.87 for SS and R = −0.53 for controls). Impaired JPS was also related to self-reported functional status ( R = −0.56) in subjects with SS. Shoulder JPS in subjects with chronic SS is impaired in comparison with controls. In the mid-range motion, the coordination of scapula muscular activation is related to shoulder JPS. Impaired JPS is also function-related in subjects with SS. These findings suggest that the coordination among scapula muscles’ activation were important to consider in the rehabilitation of patients with chronic SS.

Changes in joint position sense after conservatively treated chronic lateral ankle instability

Improvement of ankle proprioception through physiotherapy (a.k.a. proprioceptive training) is a widely accepted conservative treatment modality of chronic functional lateral ankle instability. Clinical studies provided controversial data on its proprioceptive effect. Aim of this study was to gain evidence on the efficacy of proprioceptive training on ankle joint position sense. Ten patients (five males and five females, aged 23.3+/-5.4 years) were treated conservatively for chronic lateral ankle instability with a special training programme over 6 weeks. For the assessment of joint position sense we used the slope-box test, first applied and described by Robbins et al. (Br J Sports Med 29:242-247, 1995). The test was performed before the start and after the end of the training programme, measuring joint position sense on 11 different slope amplitudes in four directions (anterior, posterior, lateral and medial) in random order each on both ankles. Comparisons were made between pre- and post-training results as well as versus a control-group of ten healthy athletes. Overall the proprioceptive sensory function of the studied group has improved, but this improvement was not significant in all directions. Only two patients have shown significant improvement of joint position sense in all directions (mean estimate error improvement: 2.47 degrees ), while conservative treatment was partially successful in five others (mean estimate error improvement: 0.73 degrees ). The follow-up results of these seven patients were comparable with the values measured in the control-group. Three patients did not show any improvements (mean estimate error improvement: -0.55 degrees ) (overall difference between improving and non-improving patients: P<0.0001). Mean absolute estimate error profiles of the seven improving patients became similar to the profiles of healthy athletes, while these changes could not be observed in the case of the three non-improving participants. Proprioceptive rehabilitation programme can be an effective method in order to improve impaired joint position sense function. After 6 weeks non-responding patients can be well identified, and considered for other treatment modalities. The determination of the effective length of the programme however needs further evaluation. Still, changes in the proprioceptive sensory function of the ankle plantarflectors indicate the preventive effect of the training programme. Furthermore, our results support the theory of simultaneous function of different mechanoreceptor-systems.

Postural hypotension in a patient with cervical myelopathy due to cranio-vertebral anomaly

We report a patient with craniovertebral anomaly leading to cervical cord compression who presented with disabling postural hypotension. A 60-year-old electrician presented with progressive weakness of the upper and lower limbs, which had started 7 years previously. He had difficulty in holding urine for the previous year and had blacked out on standing for the past 3 months. He had upper limb wasting and lower limb spasticity, with impaired joint position sense. Autonomic dysfunctions included postural hypotension, absence of sinus arrhythmia, impaired Valsalva ratio, and lack of increase in blood pressure on cold immersion and isometric contraction. Cervical spine radiograph and magnetic resonance imaging revealed atlantoaxial dislocation, Klippel-Feil syndrome and osteophytes, resulting in cord compression at C2-C4. Partial and selective damage to the descending autonomic fibres may be responsible for postural hypotension in this patient.

Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee.

BACKGROUND: Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this...

膝位置覚検査の臨床応用

This study determines if an examination of knee joint position sense using electrogoniometers could serve as an indicator for one aspect of knee function. The reliability of this examination was obtained by using the test-retest method. Effects of knee problems, local anaesthesia, two different kinds of training, and knee bracing on knee position sense were evaluated. Thirty-one normal subjects and 31 patients with knee complaints were examined to investigate the influence of knee problems. The latter was also examined before and after local anaesthesia at arthroscopy. Ten students were examined before and after 8-week muscle strength training or dynamic joint control training. Another 10 students were examined before and after 8-week knee bracing. There was an impairment in joint position sense after local anaesthesia and 8-week knee bracing (p<0.05). Patients with knee problems did not have impaired joint position sense. Subjects with 8-week muscle strength training and dynamic joint control training showed an enhanced joint position sense (p<0.05), but did not show a significant difference between these training groups. It is proposed that the examination of joint position sense of the knee could be used for evaluating knee function.

Joint proprioception in normal, osteoarthritic and replaced knees

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.