Objective: Numerous reports advocate that training of the proprioceptive sense is a viable behavioral therapy for improving impaired motor function. However, there is little agreement of what constitutes proprioceptive training and how effective it is. We therefore conducted a comprehensive, systematic review of the available literature in order to provide clarity to the notion of training the proprioceptive system.Methods: Four major scientific databases were searched. The following criteria were subsequently applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function. From a total of 1284 articles, 51 studies fulfilled all criteria and were selected for further review.Results: Overall, proprioceptive training resulted in an average improvement of 52% across all outcome measures. Applying muscle vibration above 30 Hz for longer durations (i.e., min vs. s) induced outcome improvements of up to 60%. Joint position and target reaching training consistently enhanced joint position sense (up to 109%) showing an average improvement of 48%. Cortical stroke was the most studied disease entity but no clear evidence indicated that proprioceptive training is differentially beneficial across the reported diseases.Conclusions: There is converging evidence that proprioceptive training can yield meaningful improvements in somatosensory and sensorimotor function. However, there is a clear need for further work. Those forms of training utilizing both passive and active movements with and without visual feedback tended to be most beneficial. There is also initial evidence suggesting that proprioceptive training induces cortical reorganization, reinforcing the notion that proprioceptive training is a viable method for improving sensorimotor function.
Administering dCIT + TR produced additional benefits by improving grasping control and reversing the compensatory trunk movement at the early phase of a reach-to-grasp movement. The use of experimental tasks beyond and within arm's length might improve our understanding of optimal upper extremity rehabilitation.
This study mapped the development of proprioception in healthy, typically developing children by objectively measuring forearm position sense acuity. We assessed position sense acuity in a cross-sectional sample of 308 children (5–17 years old; M/F = 127/181) and a reference group of 26 healthy adults (18–25 years old; M/F = 12/14) using a body-scalable bimanual manipulandum that allowed forearm flexion/extension in the horizontal plane. The non-dominant forearm was passively displaced to one of three target positions. Then participants actively matched the target limb position with their dominant forearm. Each of three positions was matched five times. Position error (PE), calculated as the mean difference between the angular positions of the matching and reference arms, measured position sense bias or systematic error. The respective standard deviation of the differences between the match and reference arm angular positions (SDPdiff) indicated position sense precision or random error. The main results are as follows: First, systematic error, measured by PE, did not change significantly from early childhood to late adolescence (Median PE at 90° target: −2.85° in early childhood; −2.28° in adolescence; and 1.30° in adults). Second, response variability as measured by SDPdiff significantly decreased with age (Median SDPdiff at 90° target: 9.66° in early childhood; 5.30° in late adolescence; and 3.97° in adults). The data of this large cross-sectional sample of children document that proprioceptive development in typically developing children is characterized as an age-related improvement in precision, not as a development or change in bias. In other words, it is the reliability of the perceptual response that improves between early childhood and adulthood. This study provides normative data against which position sense acuity in pediatric patient populations can be compared. The underlying neurophysiological processes that could explain the observed proprioceptive development include changes in the tuning of muscle spindles at the spinal level, the maturation of supraspinal somatosensory pathways and the development of interhemispheric callosal connections responsible for the transfer of somatosensory information.
Background Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. Methods Twelve adults with chronic stroke completed a 2-day training (age range: 42–74 years; median time-after-stroke: 12 months; median Fugl–Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). Results Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = − 0.86, − 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. Conclusions This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407.
Objective: Spasmodic dysphonia (SD) is a debilitating voice/speech disorder without an effective cure. To obtain a better understanding of the underlying cortical neural mechanism of the disease we analyzed electroencephalographic (EEG) signals of people with SD during voice production.Method: Ten SD individuals and 10 healthy volunteers produced 50 vowel vocalization epochs of 2500ms duration. Two EEG features were derived: (1) event-related change in spectral power during vocalization relative to rest, (2) inter-regional spectral coherence.Results: During early vocalization (500-1000ms) the SD group showed significantly larger alpha band spectral power over the left motor cortex. During late vocalization (1000-2500ms) SD patients showed a significantly larger gamma band coherence between left somatosensory and premotor cortical areas. Conclusions:Two atypical patterns of cortical activity characterize the pathophysiology of spasmodic dysphonia during voice production: (1) a reduced movement-related desynchronization of motor cortical networks, (2) an excessively large synchronization between left somatosensory and premotor cortical areas. Significance:The pathophysiology of SD is characterized by an abnormally high synchronous activity within and across cortical neural networks involved in voice production that is mainly lateralized in the left hemisphere.
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