Assessing Proprioception: A Systematic Review of Possibilities

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Abstract

Proprioception is a vital aspect of motor control and when degraded or lost can have a profound impact on function in diverse clinical populations. This systematic review aimed to identify clinically related tools to measure proprioceptive acuity, to classify the construct(s) underpinning the tools, and to report on the clinimetric properties of the tools. We searched key databases with the pertinent search terms, and from an initial list of 935 articles, we identified 57 of relevance. These articles described 32 different tools or methods to quantify proprioception. There was wide variation in methods, the joints able to be tested, and the populations sampled. The predominant construct was active or passive joint position detection, followed by passive motion detection and motion direction discrimination. The clinimetric properties were mostly poorly evaluated or reported. The Rivermead Assessment of Somatosensory Perception was generally considered to be a valid and reliable tool but with low precision; other tools with higher precision are potentially not clinically feasible. Clinicians and clinical researchers can use the summary tables to make more informed decisions about which tool to use to match their predominant requirements. Further discussion and research is needed to produce measures of proprioception that have improved validity and utility.

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Most cited references 69

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Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people.

S. R. Lord, S M Murray, K. Chapman … (2002)

Sit-to-stand (STS) performance is often used as a measure of lower-limb strength in older people and those with significant weakness. However, the findings of recent studies suggest that performance in this test is also influenced by factors associated with balance and mobility. We conducted a study to determine whether sensorimotor, balance, and psychological factors in addition to lower-limb strength predict sit-to-stand performance in older people. Six hundred and sixty nine community-dwelling men and women aged 75-93 years (mean age 78.9, SD = 4.1) underwent quantitative tests of strength, vision, peripheral sensation, reaction time, balance, health status, and sit-to-stand performance. Many physiological and psychological factors were significantly associated with sit-to-stand times in univariate analyses. Multiple regression analysis revealed that visual contrast sensitivity, lower limb proprioception, peripheral tactile sensitivity, reaction time involving a foot-press response, sway with eyes open on a foam rubber mat, body weight, and scores on the Short-Form 12 Health Status Questionnaire pain, anxiety, and vitality scales in addition to knee extension, knee flexion, and ankle dorsiflexion strength were significant and independent predictors of STS performance. Of these measures, quadriceps strength had the highest beta weight, indicating it was the most important variable in explaining the variance in STS times. However, the remaining measures accounted for more than half the explained variance in STS times. The final regression model explained 34.9% of the variance in STS times (multiple R =.59). The findings indicate that, in community-dwelling older people, STS performance is influenced by multiple physiological and psychological processes and represents a particular transfer skill, rather than a proxy measure of lower limb strength.

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Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study.

Bohdanna Zazulak, Timothy Hewett, N Peter Reeves … (2007)

Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports. Decreased trunk (core) neuromuscular control may compromise dynamic knee stability. (1) Increased trunk displacement after sudden force release would be associated with increased knee injury risk; (2) coronal (lateral), not sagittal, plane displacement would be the strongest predictor of knee ligament injury; (3) logistic regression of factors related to core stability would accurately predict knee, ligament, and ACL injury risk; and (4) the predictive value of these models would differ between genders. Cohort study (prognosis); Level of evidence, 2. In this study, 277 collegiate athletes (140 female and 137 male) were prospectively tested for trunk displacement after a sudden force release. Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury. Twenty-five athletes (11 female and 14 male) sustained knee injuries over a 3-year period. Trunk displacement was greater in athletes with knee, ligament, and ACL injuries than in uninjured athletes (P < .05). Lateral displacement was the strongest predictor of ligament injury (P = .009). A logistic regression model, consisting of trunk displacements, proprioception, and history of low back pain, predicted knee ligament injury with 91% sensitivity and 68% specificity (P = .001). This model predicted knee, ligament, and ACL injury risk in female athletes with 84%, 89%, and 91% accuracy, but only history of low back pain was a significant predictor of knee ligament injury risk in male athletes. Factors related to core stability predicted risk of athletic knee, ligament, and ACL injuries with high sensitivity and moderate specificity in female, but not male, athletes.

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Postural stability and associated physiological factors in a population of aged persons.

Scott R D Clark, Richard Webster, I W Webster (1991)

A battery of 13 visual, vestibular, sensorimotor, and balance tests was administered to 95 elderly persons (mean age 82.7 years) to examine the relationships between specific sensorimotor functions and measures of postural stability. When subjects stood on a firm surface, increased body sway was associated with poor tactile sensitivity and poor joint position sense. When subjects stood on a compliant surface (which reduced peripheral sensation) with their eyes open, increased body sway was associated with poor visual acuity and contrast sensitivity, reduced vibration sense, and decreased ankle dorsiflexion strength as well as reduced joint position sense. Increased body sway with eyes closed on the compliant surface was associated with poor tactile sensation, reduced quadriceps and ankle dorsiflexion strength, and increased reaction time. Poor performance in two clinical measures of postural stability was associated with reduced sensation in the lower limbs as measured by joint position sense, tactile sensitivity and vibration sense, reduced quadriceps and ankle dorsiflexion strength, and slow reaction times. The prevalence of vestibular impairments was high in this group, but vestibular function was not significantly associated with sway under any of the test conditions. The results suggest that reduced sensation, muscle weakness in the legs, and increased reaction time are all important factors associated with postural instability. An analysis of the percentage increases in sway under conditions where visual and peripheral sensation systems are removed or diminished, compared with sway under optimal conditions, indicated that peripheral sensation is the most important sensory system in the maintenance of static postural stability.

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Author and article information

Journal

Title: Neurorehabilitation and Neural Repair

Abbreviated Title: Neurorehabil Neural Repair

Publisher: SAGE Publications

ISSN (Print): 1545-9683

ISSN (Electronic): 1552-6844

Publication date Created: February 04 2015

Publication date Created: November 2015

Publication date (Electronic): February 23 2015

Publication date (Print): November 2015

Volume: 29

Issue: 10

Pages: 933-949

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[1 ]University of South Australia, Adelaide, South Australia, Australia

Article

DOI: 10.1177/1545968315573055

PubMed ID: 25712470

SO-VID: 3c043c79-1265-418d-a301-5a9138f5a1fa

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http://journals.sagepub.com/page/policies/text-and-data-mining-license

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Assessing Proprioception : A Systematic Review of Possibilities

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Most cited references 69

Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people.

Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study.

Postural stability and associated physiological factors in a population of aged persons.

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