Kinesthetic Deficits Research Articles

A scoping review of shoulder kinesthetic function in individuals with diabetes mellitus, with and without frozen shoulder

Abstract Background: Kinesthesia, the ability to perceive movements, is diminished in individuals with type II diabetes mellitus. People with frozen shoulders also experience kinesthetic deficits. Thus, obtaining accurate information on shoulder kinesthetic function in individuals with diabetes mellitus, both with and without a frozen shoulder, will aid in developing preventive and therapeutic strategies to optimize shoulder function. Aim: The study aims to investigate kinesthetic deficits in the shoulder among individuals with diabetes mellitus, both with and without frozen shoulder. Materials and Methods: A thorough literature search was performed using PubMed, Cochrane, CINAHL, and Science Direct. Free full-text articles in English, published from 2010 to October 2020, were identified using keywords and MeSH terms. Inclusion and exclusion criteria were developed based on the PICO format. The search results were then screened to identify relevant articles for this scoping review. Results: This review included fourteen articles, encompassing systematic reviews, cross-sectional studies, and prospective studies. Six studies examined the impact of diabetes mellitus on shoulder kinesthesia. These kinesthetic deficits adversely affected basic daily activities, recreational pursuits, and occupational tasks. Conclusion: Reduced kinesthetic function in the shoulder is attributed to structural changes such as capsular tightness, alterations in the fascicle length of rotator cuff muscles, the long head of the biceps, and glenohumeral joint laxity. Factors contributing to the loss of kinesthetic function include muscular fatigue from repetitive shoulder motion, limited joint mobility, blood glucose levels, and decreased muscle strength. This study provides valuable insights for clinicians to design rehabilitation programs, enhance shoulder function, and prevent re-injury risk.

Dynamic Neuro-Cognitive Imagery Improves Mental Imagery Ability, Disease Severity, and Motor and Cognitive Functions in People with Parkinson's Disease.

People with Parkinson's disease (PD) experience kinesthetic deficits, which affect motor and nonmotor functions, including mental imagery. Imagery training is a recommended, yet underresearched, approach in PD rehabilitation. Dynamic Neuro-Cognitive Imagery (DNI™) is a codified method for imagery training. Twenty subjects with idiopathic PD (Hoehn and Yahr stages I–III) were randomly allocated into DNI training (experimental; n = 10) or in-home learning and exercise program (control; n = 10). Both groups completed at least 16 hours of training within two weeks. DNI training focused on anatomical embodiment and kinesthetic awareness. Imagery abilities, disease severity, and motor and nonmotor functions were assessed pre- and postintervention. The DNI participants improved (p < .05) in mental imagery abilities, disease severity, and motor and spatial cognitive functions. Participants also reported improvements in balance, walking, mood, and coordination, and they were more physically active. Both groups strongly agreed they enjoyed their program and were more mentally active. DNI training is a promising rehabilitation method for improving imagery ability, disease severity, and motor and nonmotor functions in people with PD. This training might serve as a complementary PD therapeutic approach. Future studies should explore the effect of DNI on motor learning and control strategies.

Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton

BackgroundKinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task.MethodsTwenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task.ResultsWe evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]).ConclusionsThe robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying kinesthesia after stroke.

Kinesthetic deficits after perinatal stroke: robotic measurement in hemiparetic children

BackgroundWhile sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools. Robotic technology offers the potential to objectively measure complex sensorimotor function but has been understudied in perinatal stroke. The present study aimed to quantify kinesthetic deficits in hemiparetic children with perinatal stroke and determine their association with clinical function.MethodsCase–control study. Participants were 6–19 years of age. Stroke participants had MRI confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction, and symptomatic hemiparetic cerebral palsy. Participants completed a robotic assessment of upper extremity kinesthesia using a robotic exoskeleton (KINARM). Four kinesthetic parameters (response latency, initial direction error, peak speed ratio, and path length ratio) and their variabilities were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of sensorimotor function.ResultsForty-three stroke participants (23 arterial, 20 venous, median age 12 years, 42% female) were compared to 106 healthy controls. Stroke cases displayed significantly impaired kinesthesia that remained when vision was restored. Kinesthesia was more impaired in arterial versus venous lesions and correlated with clinical measures.ConclusionsRobotic assessment of kinesthesia is feasible in children with perinatal stroke. Kinesthetic impairment is common and associated with stroke type. Failure to correct with vision suggests sensory network dysfunction.

Localization of Impaired Kinesthetic Processing Post-stroke.

Kinesthesia is our sense of limb motion, and allows us to gauge the speed, direction, and amplitude of our movements. Over half of stroke survivors have significant impairments in kinesthesia, which leads to greatly reduced recovery and function in everyday activities. Despite the high reported incidence of kinesthetic deficits after stroke, very little is known about how damage beyond just primary somatosensory areas affects kinesthesia. Stroke provides an ideal model to examine structure-function relationships specific to kinesthetic processing, by comparing lesion location with behavioral impairment. To examine this relationship, we performed voxel-based lesion-symptom mapping and statistical region of interest analyses on a large sample of sub-acute stroke subjects (N = 142) and compared kinesthetic performance with stroke lesion location. Subjects with first unilateral, ischemic stroke underwent neuroimaging and a comprehensive robotic kinesthetic assessment (~9 days post-stroke). The robotic exoskeleton measured subjects' ability to perform a kinesthetic mirror-matching task of the upper limbs without vision. The robot moved the stroke-affected arm and subjects' mirror-matched the movement with the unaffected arm. We found that lesions both within and outside primary somatosensory cortex were associated with significant kinesthetic impairments. Further, sub-components of kinesthesia were associated with different lesion locations. Impairments in speed perception were primarily associated with lesions to the right post-central and supramarginal gyri whereas impairments in amplitude of movement perception were primarily associated with lesions in the right pre-central gyrus, anterior insula, and superior temporal gyrus. Impairments in perception of movement direction were associated with lesions to bilateral post-central and supramarginal gyri, right superior temporal gyrus and parietal operculum. All measures of impairment shared a common association with damage to the right supramarginal gyrus. These results suggest that processing of kinesthetic information occurs beyond traditional sensorimotor areas. Additionally, this dissociation between kinesthetic sub-components may indicate specialized processing in these brain areas that form a larger distributed network.

Dynamic High-Cadence Cycling Improves Motor Symptoms in Parkinson's Disease.

Individuals with Parkinson's disease (PD) often have deficits in kinesthesia. There is a need for rehabilitation interventions that improve these kinesthetic deficits. Forced (tandem) cycling at a high cadence improves motor function. However, tandem cycling is difficult to implement in a rehabilitation setting. To construct an instrumented, motored cycle and to examine if high cadence dynamic cycling promotes improvements in motor function. This motored cycle had two different modes: dynamic and static cycling. In dynamic mode, the motor maintained 75-85 rpm. In static mode, the rider determined the pedaling cadence. UPDRS Motor III and Timed Up and Go (TUG) were used to assess changes in motor function after three cycling sessions. Individuals in the static group showed a lower cadence but a higher power, torque and heart rate than the dynamic group. UPDRS score showed a significant 13.9% improvement in the dynamic group and only a 0.9% improvement in the static group. There was also a 16.5% improvement in TUG time in the dynamic group but only an 8% improvement in the static group. These findings show that dynamic cycling can improve PD motor function and that activation of proprioceptors with a high cadence but variable pattern may be important for motor improvements in PD.

Kinesthetic deficit in children with developmental coordination disorder.

The aim of this study was to measure and compare kinesthetic sensitivity in children with developmental coordination disorder (DCD) and typically developing (TD) children between 6 and 11 years old. 30 children with DCD aged 6 to 11 years (5 in each age group) and 30 TD children participated in the study. Participants placed their forearms on a passive motion apparatus which extended the elbow joint at constant velocities between 0.15 and 1.35°s(-1). Participants were required to concentrate on detection of passive arm motion and press a trigger held in their left hand once they sensed it. The detection time was measured for each trial. The DCD group was significantly less sensitive in detection of passive motion than TD children. Further analysis of individual age groups revealed that kinesthetic sensitivity was worse in DCD than TD children for age groups beyond six years of age. Our findings suggested that individual with DCD lag behind their TD counterparts in kinesthetic sensitivity. Between the ages of 7 and 11 years the difference between groups is quantifiable and significant with 11 year old children with DCD performing similar to 7 year old TD children.

Relationship Between Visuospatial Neglect and Kinesthetic Deficits After Stroke

Background. After stroke, visuospatial and kinesthetic (sense of limb motion) deficits are common, occurring in approximately 30% and 60% of individuals, respectively. Although both types of deficits affect aspects of spatial processing necessary for daily function, few studies have investigated the relationship between these 2 deficits after stroke. Objective. We aimed to characterize the relationship between visuospatial and kinesthetic deficits after stroke using the Behavioral Inattention Test (BIT) and a robotic measure of kinesthetic function. Methods. Visuospatial attention (using the BIT) and kinesthesia (using robotics) were measured in 158 individuals an average of 18 days after stroke. In the kinesthetic matching task, the robot moved the participant’s stroke-affected arm at a preset direction, speed, and magnitude. Participants mirror-matched the robotic movement with the less/unaffected arm as soon as they felt movement in their stroke affected arm. Results. We found that participants with visuospatial inattention (neglect) had impaired kinesthesia 100% of the time, whereas only 59% of participants without neglect were impaired. For those without neglect, we observed that a higher percentage of participants with lower but passing BIT scores displayed impaired kinesthetic behavior (78%) compared with those participants who scored perfect or nearly perfect on the BIT (49%). Conclusions. The presence of visuospatial neglect after stroke is highly predictive of the presence of kinesthetic deficits. However, the presence of kinesthetic deficits does not necessarily always indicate the presence of visuospatial neglect. Our findings highlight the importance of assessment and treatment of kinesthetic deficits after stroke, especially in patients with visuospatial neglect.

Robotic Identification of Kinesthetic Deficits After Stroke

Kinesthesia, the sense of body motion, is essential to proper control and execution of movement. Despite its importance for activities of daily living, no current clinical measures can objectively measure kinesthetic deficits. The goal of this study was to use robotic technology to quantify prevalence and severity of kinesthetic deficits of the upper limb poststroke. Seventy-four neurologically intact subjects and 113 subjects with stroke (62 left-affected, 51 right-affected) performed a robot-based kinesthetic matching task with vision occluded. The robot moved the most affected arm at a preset speed, direction, and magnitude. Subjects were instructed to mirror-match the movement with their opposite arm (active arm). A large number of subjects with stroke were significantly impaired on measures of kinesthesia. We observed impairments in ability to match movement direction (69% and 49% impaired for left- and right-affected subjects, respectively) and movement magnitude (42% and 31%). We observed impairments to match movement speed (32% and 27%) and increased response latencies (48% and 20%). Movement direction errors and response latencies were related to clinical measures of function, motor recovery, and dexterity. Using a robotic approach, we found that 61% of acute stroke survivors (n=69) had kinesthetic deficits. Additionally, these deficits were highly related to existing clinical measures, suggesting the importance of kinesthesia in day-to-day function. Our methods allow for more sensitive, accurate, and objective identification of kinesthetic deficits after stroke. With this information, we can better inform clinical treatment strategies to improve poststroke rehabilitative care and outcomes.

Study of proprioceptive function in professional volleyball athletes with atrophy of the infraspinatus

BackgroundThe isolated atrophy of the infraspinatus muscle is an uncommon clinical alteration, generally secondary to the selective lesion of the suprascapular nerve related to sport activities, especially in professional volleyball...

Kinesthetic Ability in Children with Spastic Hemiplegia

The purpose was to examine the differences in kinesthetic ability, at the elbow joint, between children with (n = 15) and without (n= 15) spastic hemiplegia. The Kin Com 125 AP isokinetic dynamometer Configuration Chattanooga was used. Results revealed significant (p < .05) interaction between participant groups and side which was a repeated measures factor (nonaffected side for CP group and dominant side for nonCP group vs. affected side for CP and nondominant side for nonCP group) with respect to the passive reproduction of movement (PRM) and detection of passive movement (DPM). The interaction was attributed to the kinesthetic deficits of the hemiplegic participants compared to the control group. A significant relationship was found between the level of spasticity and PRM scores.

Shoulder proprioception in baseball pitchers

We examined proprioceptive differences between the dominant and nondominant shoulders of 21 collegiate baseball pitchers without a history of shoulder instability or surgery. A proprioceptive testing device was used to measure kinesthesia and joint position sense. Joint position sense was significantly (P =.05) more accurate in the nondominant shoulder than in the dominant shoulder when starting at 75% of maximal external rotation and moving into internal rotation. There were no significant differences for proprioception in the other measured positions or with kinesthesia testing. Six pitchers with recent shoulder pain had a significant (P =.04) kinesthetic deficit in the symptomatic dominant shoulder compared with the asymptomatic shoulder, as measured in neutral rotation moving into internal rotation. The net effect of training, exercise-induced laxity, and increased external rotation in baseball pitchers does not affect proprioception, although shoulder pain, possibly due to rotator cuff inflammation or tendinitis, is associated with reduced kinesthetic sensation. (J Shoulder Elbow Surg 2001;10:438-44.)

Lumbar spine kinesthesia in patients with low back pain.

Single-group, posttest only, using a sample of convenience. To measure the repositioning error of subjects with low back pain for lumbar sagittal movement using a simple kinesthetic test previously described. Patients with low back pain are commonly observed to have difficulty in adopting a mid or neutral position of the lumbar spine. Twenty subjects with low back pain were required to reproduce an upright neutral posture of the lumbar spine following movement into flexion in a sitting position. Trunk positioning accuracy was measured with an electromagnetic tracking device. The mean absolute value of the repositioning error in the sagittal plane was 2.25 degrees +/-0.88 degrees on day 1 and 2.32 degrees +/-1.62 degrees on day 2. The performance of patients with low back pain was similar to that of asymptomatic patients in a previous study, although subjects with low back pain overshot the neutral position more frequently (79%) than did nonimpaired subjects (50%). Subjects with low back pain may have attempted to use extra mechanoreceptive cues to compensate for some kinesthetic deficit. Nevertheless, the kinesthetic test used was not sensitive enough to detect any repositioning deficits, and reasons for this are explored.

Toward a clinical test of lumbar spine kinesthesia.

Poor lumbar spine kinesthetic awareness is often observed in low back pain patients and is usually evaluated qualitatively in the clinical situation. The purpose of this study was to investigate a simple, kinesthetic test for the lumbar spine. The experimental protocol utilized a 3Space Fastrak to determine the error, within and between days, of 10 healthy subjects in reproducing a neutral lumbopelvic (T10-S2) position following movement into flexion. The mean value of the repositioning error for the sagittal plane movement (flexion/extension) over the three repetitions within day 1 was 2.6 +/- 1.2 degrees and for day 2 was 2.6 +/- 1.7 degrees. No statistically significant difference existed between days. These repositioning errors were well within the ranges described by other authors for various asymptomatic joint complexes. These results provide a basis for further evaluation of this test on patients with low back pain to investigate its ability to detect any kinesthetic deficit.

Shoulder Kinesthesia in Healthy Unilateral Athletes Participating in Upper Extremity Sports

Shoulder kinesthesia has not been extensively studied in upper extremity athletes. The purpose of this study was to determine if there were differences in threshold to detection of passive motion between dominant and nondominant shoulders of healthy overhead athletes in two positions, 0 degrees and 75 degrees of external rotation. In addition, the study attempted to determine if there was a relationship between the range of external rotation (ER) and internal rotation (IR) and the threshold to detection of passive motion values. Shoulder kinesthesia was assessed in the dominant and nondominant shoulders of 20 collegiate athletes participating in unilateral upper extremity sports. A proprioceptive testing device passively moved the shoulder into internal and external rotation. The dominant shoulder had a significantly greater difficulty detecting motion compared with the nondominant arm at both 0 degrees and 75 degrees of external rotation. Both shoulders exhibited enhanced kinesthesia (lower threshold to detection of passive motion scores) at 75 degrees of external rotation compared with 0 degrees, where the glenohumeral joint capsule is relatively taut. The results of this study suggest that healthy upper extremity athletes may have kinesthetic deficits in their throwing shoulder compared with their nondominant shoulder.

Rose Excellence in Research Award, Orthopaedic Section, 1990: Shoulder Kinesthesia After Anterior Glenohumeral Joint Dislocation

The purpose of this study was to examine kinesthesia in normal (uninjured) shoulders and in shoulders with a history of glenohumeral joint dislocations. Both shoulders of 10 healthy subjects and 8 subjects with a history of unilateral anterior dislocation were tested for accuracy of angular reproduction, threshold to sensation of movement, and end-range reproduction using a motor-driven shoulder-wheel apparatus. An analysis of variance revealed significant differences (p < 0.001) between the injured and uninjured shoulders for all three tests. Post hoc analysis showed significant differences (p < 0.02) between the involved shoulders and all uninvolved shoulders. No significant difference was found among the uninvolved shoulders. The results of this study indicate that kinesthetic deficits occur after glenohumeral dislocation and may result in abnormal neuromuscular coordination and subsequent reinjury of the shoulder. Clinicians should consider rehabilitation of shoulder kinesthesia using therapeutic activation of the shoulder joint and muscle receptors when treating patients with previous dislocations. [Smith RL, Brunolli J: Shoulder kinesthesia after anterior glenohumeral joint dislocation. Phys Ther 69: 106–112, 1989.]

Shoulder kinesthesia after anterior glenohumeral joint dislocation.

The purpose of this study was to examine kinesthesia in normal (uninjured) shoulders and in shoulders with a history of glenohumeral joint dislocations. Both shoulders of 10 healthy subjects and 8 subjects with a history of unilateral anterior dislocation were tested for accuracy of angular reproduction, threshold to sensation of movement, and end-range reproduction using a motor-driven shoulder-wheel apparatus. An analysis of variance revealed significant differences (p less than .001) between the injured and uninjured shoulders for all three tests. Post hoc analysis showed significant differences (p less than .02) between the involved shoulders and all uninvolved shoulders. No significant difference was found among the uninvolved shoulders. The results of this study indicate that kinesthetic deficits occur after glenohumeral dislocation and may result in abnormal neuromuscular coordination and subsequent reinjury of the shoulder. Clinicians should consider rehabilitation of shoulder kinesthesia using therapeutic activation of the shoulder joint and muscle receptors when treating patients with previous dislocations.

Kinesthetic awareness in subjects with multiple ankle sprains.

The purposes of this study were 1) to determine whether decreased kinesthetic awareness occurs in individuals with recurrent ankle sprains and 2) to determine whether the one-legged standing balance test can be used to differentiate between ankle instability in injured and uninjured ankles. Thirty athletes between 18 and 24 years of age with multiple sprains of one ankle and no reported sprains of the other ankle were tested to compare their ability to detect passive plantar flexion and standing balance in each ankle. Luce's choice theory was used to analyze subjects' responses. Subjects had significantly greater difficulty detecting passive motion in the ankle with sprains as compared with the uninjured ankle. Subjects also performed a one-legged standing balance test on both the injured and uninjured legs. In 20 subjects, either the subject or observer reported balance deficits on the injured side as compared with the uninjured side. The results of this study demonstrate the need for clinicians to evaluate kinesthetic deficits and to design exercise programs to improve kinesthetic awareness and decrease ankle instability in individuals with multiple ankle sprains.

A kinesthetic deficit after partial transection of a pyramidal tract in monkeys

Summary Monkeys were trained to perform a thermal and a kinesthetic discrimination in immediate succession; the response was a sequence of movements involving the turning of a handle with the right hand. In the left medullary pyramid 25–45% of the fibers were transected. After motor function was fully recovered, as evaluated by general observation, the monkeys were retrained to stable performance. Comparison of 1000 trials before with 1000 trials after the lesions showed a deficit in kinesthetic discrimination; temperature discrimination was unaffected. Simple response latency, choice latency and the time required to reach for the manipulandum were increased even after the smallest pyramidal lesion. The time required to perform the turning response was also increased, but this was, in part, due to retraining. The effect of continued training was determined in 2 monkeys by comparing 2 postoperative observation periods 6 months apart. Both sensory and motor performances were unaffected in a monkey with a control lesion in the right dorsal column. In interspersed trials a visual cue present during the inter-trial period facilitated temperature discrimination. This did not improve the subsequent kinesthetic discrimination, and thus no evidence was obtained for involvement of the pyramidal tract in a mechanism for rapid modality switching. The pyramidal tract must have a sensory function because many of its fibers terminate in the dorsal horn; that it may be related to kinesthesis is consistent with the recent finding that afferent transmission is modulated only during movement.

RELATION OF DISCHARGE FREQUENCY TO CONDUCTION VELOCITY IN PYRAMIDAL TRACT NEURONS.

RELATION OF DISCHARGE FREQUENCY TO CONDUCTION VELOCITY IN PYRAMIDAL TRACT NEURONS.