Auswahl der wissenschaftlichen Literatur zum Thema „Proprioceptive joint care“

Introduction: Proprioception is the body’s ability to perceive its position and movement in space, crucial for maintaining balance and coordination, especially in older adults. As individuals age, both peripheral and central mechanisms of proprioception decline. Peripheral contributions include sensory mechanisms in muscle spindles and cutaneous mechanoreceptors, vital for joint position sense. This decline can lead to balance disturbances and increased fall risk. Central contributions involve neuroanatomical changes, neurochemical alterations, and cognitive factors such as decreased memory, obstructing effective proprioceptive integration. Methods: The search utilised key databases such as PubMed, PubMed Central (PMC) BioMed Central (BMC) along with various grey literature sources, to gather a comprehensive range of information. Clinical implications: Impaired proprioception can decrease postural control and balance, increasing fall risk and associated chronic pain conditions. Interventions: Evidence highlights the effectiveness of technological advancements, personalised physical activity programmes, and proprioceptive training strategies. Collaborative efforts among healthcare professionals are vital for creating comprehensive care plans. Conclusion: Age-related proprioceptive decline significantly impacts balance and functional independence in older adults. Effective interventions to preserve proprioceptive function and reduce fall risk are crucial. A multifaceted approach that includes targeted training and interdisciplinary collaboration can enhance outcomes and support a more active life for older individuals. Future research should address literature gaps through longitudinal studies and randomised controlled trials to evaluate intervention effectiveness and advancements in technologies like virtual reality. A holistic approach involving interdisciplinary collaboration among healthcare professionals is essential. Keywords: Proprioception, ageing, balance, risk of falls, proprioception interventions

Background/AimAnkle sprains are frequent musculoskeletal injuries that can lead to sensorimotor deficits provoking long-term instability at the ankle joint. A broad variety of clinical tests currently exist to assess sensorimotor processing, and are commonly clinically referred to as proprioceptive tests. However, there is a discrepancy in the use of the term proprioception when looking at the main outcome of these tests. As identifying specific deficits is important for motor recovery, it is critical for clinicians to select the most appropriate tests.MethodsA systematic review of four databases was performed to provide an up-to-date review of the psychometric properties of available tests referred to as proprioceptive tests. Seventy-nine articles on eight ankle proprioceptive tests were included and critically appraised. Data on validity, reliability and responsiveness were extracted from the included articles and synthesised. The tests reviewed were then divided into two categories based on their main outcome: motor control or somatosensation.ResultsStrong evidence showed that the Star Excursion Balance Test, a motor control test, is capable of differentiating between stable and unstable ankles. Moderate evidence suggests that somatosensation tests, such as Joint Position Sense, are also valid and reliable, but their responsiveness has yet to be evaluated.ConclusionsTogether, these findings indicate that the Star Excursion Balance Test can be used in the clinic to assess motor control based on its excellent psychometric properties. However, as ankle stability control involves complex sensorimotor interactions, care has to be taken regarding the use of this test as a specific tool for proprioception assessment.

Background Diabetic polyneuropathy (DPN) is a notable microvascular complication of DM, affecting 16%-66% globally. DPN often leads to proprioceptive deficits in the lower limbs (LL), leading to impaired functional performance. However, evidence supporting proprioceptive rehabilitation programs (PRP) for DPN remains scarce. Aims This pilot study aims to evaluate the effectiveness of a novel 12-week PRP on LL static and dynamic proprioception and shed light on the potential benefits of PRP for DPN population. Methods Randomized Controlled Trail was conducted among 30 DPN patients (age 53.25±7.72 years, BMI 24.01±1.41 and DM duration 9.48±6.45 years), randomly allocated to intervention (n = 15) or control (n = 15) groups. The intervention group received PRP 3 times/week for 12 weeks. The control group received no exercise. Both groups received regular diabetic care. Static and dynamic proprioception of both LL were assessed at baseline, 6 weeks and 12 weeks. Position-reposition test was used to assess ankle joint position sense by obtaining difference between target and reproduced angles. Error in detecting knee angle and speed were obtained by performing Lower Limb Matching and Sense of Movement tests respectively to assess dynamic proprioception. Results Two-way ANOVA and paired comparisons revealed, no significant improvement in proprioceptive deficits at 6 weeks (p>0.05), but significant improvement was achieved at 12-weeks (p<0.05) in the intervention group. Mean errors in Pposition re-position(R:p<0.001, L;p<0.001) and Lower limb matching (R:p<0.001, L;p<0.001) tests reduced by 5° and 10° respectively, indicating a70% improvement in the intervention group. Error of detecting speed reduced only on right side by 0.041ms-1 accounting for a 42% improvement. No improvements were observed in the control group. Conclusions Novel 12-week PRP may yield a significant reduction in LL proprioceptive deficits among DPN patients. Future RCTs with larger samples should compare the effectiveness of this PRP compared with conventional rehabilitation programs.

Introduction. Adolescent idiopathic scoliosis (AIS), described as a complex three-dimensional spinal deformity, is thought to affect neurophysiological processes that result in a loss of proprioceptive input. The main purpose of this case study is to investigate the effect of Proprioceptive Neuromuscular Facilitation (PNF) on spine joint reposition (JR) sense in a 20-year-old with AIS. Methods/ Case Description. The subject was a 20-year-old college student with moderate dextrothoracic and levolumbar scoliosis. She has structural scoliosis-related impaired posture, as evidenced by findings of impaired JR sensation in all directions, postural deviations, and patient-reported deformity perception using the Walter Reed Visual Assessment Scale. She was seen 4 times a week for 3 weeks. Results: The most recent radiographs analyzed by a radiologist revealed that the curvature of the thoracic spine had decreased from 38° to 32° and the curvature of the lumbar spine had decreased from 26° to 24°. There were also improvements noted in JR sensation, postural deviation, and deformity perception. Discussion: Incorporation of PNF in the patient’s plan of care may have positively contributed to improvement in JR sense of the spine, postural symmetry, and deformity perception. Future studies should examine the other components of proprioception, the effect of PNF in subjects with greater or more severe curvature, and information on joint position perception in healthy subjects.

Parkinson's disease (PD) is a progressive neurological disease characterized by muscle stiffness, tremor, slowness of movement, and difficulties with posture and walking. Muscle and joint pain are frequent non-motor symptoms of PD. Pain associated with PD is mainly caused by a combination of truncal dystonia, stooped posture, and muscle rigidity. However, PD deformities were rarely discussed in the literature. A 68-year-old Asian female with PD treated with Levodopa for six years complained of progressive neck pain, contractures, and subluxation of both hands in the last two years. A positron emission tomography (PET) scan revealed decreased rostrocaudal gradient uptake in both posterior putamen. After 9 months of multimodal chiropractic rehabilitation, the patient had significant improvement in symptoms, including pain resolution as per the numeric rating scale and physical and mental improvement as per the PD questionnaire. Radiographic measurement showed significantly improved postural alignment and stability. Measurement of joint motion and angles showed an improvement in hand deformity. Although PD is a neurodegenerative disease that is not curable, multimodal rehabilitation may improve neurological and musculoskeletal functions by inducing proprioceptive balance, motor strength, and joint movement. The current study may illustrate multimodal rehabilitation addressing orthopedic deformity associated with symptoms in a PD patient.

Introduction. In psoriasis, plaque psoriasis is the most common kind. Patients may experience mild to severe symptoms, and while the sickness is not lethal, it is difficult to cure. Aim. The purpose of this study is to evaluate the efficacy of bee venom phonophoresis in treating mild to moderate plaque psoriasis of the knee. Materials and methods. Group A received bee venom phonophoresis in conjunction with conservative care, group B received bee venom topical application in conjunction with conservative care, and group C served as a control in a double-blind randomized controlled experiment including 96 patients with plaque psoriasis. Over the course of three months, every patient underwent a thorough evaluation that included blood tests to measure systemic inflammation (Neutrophil to lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate), as well as PASI (Psoriasis Area and Severity Index) and Isokinetic knee proprioceptive. Results and disscusion. No statistically significant difference was found between the three groups at baseline measurement; however, a treatment effect was observed after 12 weeks of treatment (p = 0.001 and f-value = 50.718). In addition, both groups (A and B) showed a statistically significant interaction between pre- and post-treatment treatment and time; however, this interaction was much more pronounced and noticeable in group A. Conclusion. Phonophoresis with bee venom improves proprioception in the knee joint and decreases N/L ratio, CRP, ESR, and PASI. Registration: Clinicaltrials.gov identifier No. NCT06106230; registered 20.10.2023.

IntroductionPatients with generalised joint hypermobility, including knee hypermobility (GJHk), often experience knee pain and are typically managed with low-intensity strength training and/or proprioceptive training as part of standard care. However, not all patients experience satisfactory outcomes. High-load strength training may offer additional benefits, such as increased muscle cross-sectional area, neural drive and tendon stiffness, which may reduce pain and improve active knee joint stability during movement tasks and daily activities. So far, no randomised controlled trials (RCTs) have compared high-load strength training with traditional treatment strategies (standard care) for this patient group.Methods and analysisIn this RCT, we aim to recruit patients with GJHk and knee pain from primary care physiotherapy clinics in the Region of Southern Denmark and via social media. Patients with competing injuries or experience with high-load strength training will be excluded. Patients will be randomised (1:1 ratio) to either 2 weekly sessions of high-load strength training or standard care for 12 weeks. The primary outcome is self-reported knee pain during an activity nominated by the patient as the most aggravating for their present knee pain measured using the Visual Analogue Scale for Nominated Activity (VASNA, 0–100; 0=no pain and 100=worst imaginable pain). This will be collected at baseline, 6 weeks, 12 weeks and 12 months. Secondary outcomes include self-reported knee function and adverse events (collected at baseline, 12 weeks and 12 months), objective measurements including a 5-repetition maximum single-leg press, proprioception and single-leg-hop for distance (collected at baseline and 12 weeks), and a range of other outcome measures such as fear of movement, tendon stiffness and global perceived effect. We aim to recruit 90 patients in total to detect a 10 mm group difference in the primary outcome with 80% power.Ethics and disseminationThis study was funded by Independent Research Fund Denmark (grant number 2034-00088B) on 14 June 2022; the Regional Committees on Health Research Ethics for Southern Denmark approved it (S-20230050) on 30 August 2023. The first recruitment site opened on 15 February 2024, and the final results will be submitted to a peer-reviewed journal to inform rehabilitation strategies for symptomatic GJHk.Protocol version 1, dated 4 July 2024.Trial registration numberNCT06277401.

Background Sensorimotor and specifically proprioception sense has been used in rehabilitation to treat neurological and joint injuries. These feedback loops are not well understood or implemented in wrist treatment. We observed a temporary sensorimotor loss, following distal radius fractures (DRF) that should be addressed postsurgery. Purpose The purpose of this prospective therapeutic study was to compare the outcomes of patients following surgery for DRF treated using a sensorimotor treatment protocol with those patients treated according to the postoperative standard of care. Patients and Methods Patients following surgery for DRF sent for hand therapy were eligible for the study. Both the evaluation and treatment protocols included a comprehensive sensorimotor panel. Patients were randomized into standard and standard plus sensorimotor postoperative therapy and were evaluated a few days following surgery, at 6 weeks, and 3 months postsurgery. Results Sixty patients following surgery were randomized into the two treatment regimens. The initial evaluation was similar for both groups and both demonstrated significant sensorimotor deficits, following surgery for DRF. There was documented sensorimotor and functional improvement in both groups with treatment. The clinical results were better in the group treated with the sensorimotor-proprioception protocol mostly in the wrist; however, not all of the differences were significant. Conclusion Patients after surgery for DRF demonstrate significant sensorimotor deficits which may improve faster when utilizing a comprehensive sensorimotor treatment protocol. However, we did not demonstrate efficacy of the protocol in treating proprioceptive deficits. Further study should include refinement of functional outcome evaluation, studying of the treatment protocol, and establishment of sensorimotor therapeutic guidelines for other conditions. Level of Evidence This is a level II, therapeutic study.

Abstract Thumb carpometacarpal joint osteoarthritis (CMC OA) is a common condition characterized by chronic progressive degeneration of the joint cartilage. Patients present with complaints of pain at the base of the thumb, morning stiffness, and muscle weakness, all of which impair hand function and thus interfere with activities and social participation. Grip and lateral pinch movements are most affected and have a direct impact on independence, self-care, and leisure activities. This review’s objective is to find physical therapy techniques for patients with thumb CMC OA’ and their effect on pain, function, grip strength, and quality of life. Databases searched were Google Scholar, PubMed, and ScienceDirect with keywords CMC arthritis, OA, function, and physiotherapy. Articles published in the last 5 years, in the English language, randomized controlled trials, controlled trials, prospective studies, or systemic reviews were included. Duplicate and nonrelevant articles, case reports, and noncontrolled trials were excluded. Thirteen articles were found of which five articles were included. Prefabricated CMC-metacarpophalangeal immobilization splint, proprioceptive exercises, and ischemic compression over myofascial trigger points in the first dorsal interossei, first dorsal interossei strengthening, and a self-management program called OA thumb-based therapy trial has shown an effect on pain, pinch strength, grip strength, and quality of life. Additional treatments can be used along with conservative treatment for better results in reducing pain, improving grip strength, function, and quality of life in patients with CMC joint arthritis. Utilizing these methods can enhance clinical practice interventions in the management of thumb CMC joint arthritis.

The brain damage caused by a stroke can lead to severe and long-lasting physical and mental health problems, which can have a significant impact on human quality of life. Although restoring gait parameters in stroke patients is one of the most important rehabilitation goals, currently around 80% of stroke survivors have some degree of upper limb motor impairment. Several authors have shown that restoration of upper limb function is often more difficult to achieve and requires a longer rehabilitation period. Proprioceptive neuromuscular facilitation (PNF) is thought to be one of the most common neurophysiological techniques used by physiotherapists in post-stroke rehabilitation. The aim is to evaluate the effectiveness of proprioceptive neuromuscular facilitation (PNF) in improving upper limb function in patients after stroke through a systematic literature review. The research inquiry was performed by searching through various online databases until February 2023. Following the PRISMA 2020 guidelines, studies were selected using the PICO model and its elements, and based on the inclusion and exclusion criteria. The quality of the selected studies was assessed using the PEDro scale. The review examined five studies on PNF effects in 210 stroke patients, all scoring six or more on the high-quality PEDro scale. Patients were, on average, 52 to 63 years old. Four of the five studies, using the Arm Motor Ability Test and Fugl-Meyer assessment, showed statistically significant improvements in upper limb motor ability and function post-PNF intervention. One study assessing self-care functional ability revealed significant improvements in the Barthel index for both experimental and control groups. Spasticity assessment with the Ashford scale in one study indicated a statistically significant reduction in upper limb spasticity in both groups. Yeole et al. found significant improvements in active range of motion using a manual goniometer in shoulder and elbow joints and wrist joint flexion, extension, and radial deviation for PNF-applied participants.

Les avancées en médecine néonatale ont permis d’accroître le nombre de bébés survivant à une naissance prématurée à des âges gestationnels de plus en plus précoces. Toutefois, la prématurité n’est pas sans conséquences pour le bébé et sa famille. Une prévalence plus élevée d’anxiété, de dépression post-natale et de stress post-traumatique est retrouvée chez les mères de bébés prématurés. Il a également été mis en évidence des représentations maternelles erronées concernant le bébé, la relation avec lui et leurs propres compétences parentales. Les recherches sur les pères ont émergé plus récemment et les données sont encore rares. Cette thèse a pour objectif d’étudier les niveaux de stress, d’anxiété, de dépression post-natale et de stress post-traumatique maternels et paternels en contexte de prématurité et d’évaluer l’effet d’un soin conjoint par stimulations proprioceptives, pratiqué par les parents sur leur bébé grand prématuré pendant l’hospitalisation en médecine néonatale, sur cette symptomatologie anxiodépressive parentale et sur les représentations maternelles. Nos résultats révèlent des niveaux anxiodépressifs significativement plus élevés chez les parents – mères et pères – d'enfants grands prématurés que chez les parents d'enfants modérément prématurés ou nés à terme, alors qu'aucune différence significative n'a été constatée entre ces deux derniers groupes. En revanche, les parents de bébés grands prématurés ayant pratiqué le soin conjoint proprioceptif durant l’hospitalisation en médecine néonatale présentaient des niveaux significativement plus faibles de symptomatologie anxiodépressive que ceux ayant pratiqué uniquement le soin peau à peau, avec des scores comparables à ceux des parents d’enfants modérément prématurés ou nés à terme. De plus, l’analyse thématique des discours des mères ayant participé au soin conjoint a révélé une bonne acceptabilité de ce soin ainsi qu’un effet bénéfique sur l’élaboration des représentations maternelles – que cela soit sur l’enfant, sur la relation dyadique ou sur leur propre rôle parental. Nos résultats suggèrent ainsi que le soin conjoint proprioceptif constitue une intervention préventive de la symptomatologie anxiodépressive parentale et offre un soutien à l’élaboration des représentations maternelles dans le contexte d’une naissance très prématurée
Advances in neonatal medicine have increased the number of babies surviving preterm birth at increasingly earlier gestational ages. However, prematurity is not without consequences for the baby and its family. A higher prevalence of anxiety, postnatal depression and post-traumatic stress is found in mothers of premature babies. Erroneous maternal representations concerning the baby, the relationship with him and their own parenting skills have also been highlighted. Research on fathers is more recent and data are still scarce. This thesis aims to study the levels of maternal and paternal stress, anxiety, postnatal depression and post-traumatic stress in the context of prematurity and to evaluate the effect of joint care through proprioceptive stimulation, practiced by parents on their very premature baby during hospitalization in the neonatal unit, on this parental anxiety-depressive symptomatology and on maternal representations. Our findings reveal significantly higher levels of anxiety-depressive symptoms in parents – mothers and fathers – of very premature infants than in parents of moderate preterm or term infants, while no significant difference was found between parents of moderate preterm and term infants. However, parents of very premature infants practicing proprioceptive stimulation on their extremely preterm babies had significantly lower levels of anxiety-depressive symptoms than those in the skin-to-skin group alone, and their scores were comparable to those of parents of moderately preterm and term infants. In addition, thematic analysis of the discourses of mothers who participated in joint care revealed good acceptability of this care as well as a beneficial effect on the maternal representations – whether on the child, on the dyadic relationship or on their own parental role. Our findings suggest that proprioceptive joint care constitutes a preventive intervention for parental anxiety-depressive symptomatology and offers support for the development of maternal representations in the context of a very premature birth

Proprioception considered as the obtaining of information about one’s own action does not necessarily depend on proprioceptors. At the knee joint, perceptual systems are active sets of organs designed to reach equilibrium through synergies. Many surgical procedures, such as ACL reconstruction in personalized medicine, are often based on native anatomy, which may not accurately reflect the proprioception between native musculoskeletal tissues and biomechanical artifacts. Taking an affordance-based approach to this type of “design” brings valuable new insights to bear in advancing the area of “evidence-based medicine (EBM).” EBM has become incorporated into many health care disciplines, including occupational therapy, physiotherapy, nursing, dentistry, and complementary medicine, among many others. The design process can be viewed in terms of action possibilities provided by the (biological) environment. In anterior crucial ligament (ACL) reconstruction, the design goal is to avoid ligament impingement while optimizing the placement of the tibial tunnel. Although in the current rationale for tibial tunnel placement, roof impingement is minimized to avoid a negative affordance, we show that tibial tunnel placement can rather aim to constrain the target bounds with respect to a positive affordance. We describe the steps for identifying the measurable invariants in the knee proprioception system and provide a mathematical framework for the outcome measure within the knee.

A 33-year-old woman with systemic lupus erythematosus, diagnosed 2 years prior and treated with hydroxychloroquine, sought care for a 4-week history of pain and paresthesias in her low back and lower extremities. She described a bandlike sensation of numbness starting in her midback which descended to both legs. Her symptoms progressed to constipation and inability to urinate adequately. She reported difficulty with ambulation. Over the course of 1 week of hospitalization, urinary and fecal incontinence developed. On examination, she was alert and appropriately oriented. She had a malar rash and swelling of the metacarpophalangeal joints consistent with bilateral hand synovitis. Neurologic examination indicated hyperreflexia with brisk patellar and Achilles tendon reflexes bilaterally. She had trace motor weakness of the hip flexors, quadriceps, and hamstrings. She had loss of pinprick and temperature sensation in the lower extremities, extending beyond the saddle area to the T12 dermatome. Vibration perception and proprioception were preserved. She had a positive Babinski sign in the left foot. Her cerebellar examination showed slowing of rapid alternating movements in the left hand. Magnetic resonance imaging of the lumbosacral spine indicated subtle T2 signal change of the intramedullary conus and enhancement of the cauda equina nerve roots. Cerebrospinal fluid analysis showed an increased protein concentration. Two white blood cells/µL were found in the cerebrospinal fluid. The serum antinuclear antibody was strongly positive, and the anti–double-stranded DNA antibody level was greater than 1,000 IU/mL. The serum complement levels were low. Lupus anticoagulant, beta-2 glycoprotein antibodies, and antiphospholipid antibodies were increased, at greater than twice the upper limits of normal. Electromyography indicated multiple sacral radiculopathies. The patient was diagnosed with autoimmune myeloradiculitis as a neuropsychiatric manifestation of systemic lupus erythematosus (neuropsychiatric systemic lupus erythematosus). The patient received methylprednisolone followed by prednisone, with a gradual taper. Her hospital course was complicated by the development of deep venous thromboses in the bilateral lower extremities. She was started on heparin and transitioned to warfarin therapy. She started mycophenolate mofetil. Hydroxychloroquine was continued. At a 24-month follow-up visit, the patient remained in neurologic remission. Neuropsychiatric systemic lupus erythematosus events consist of a heterogeneous array of neurologic and psychiatric disorders including intractable headaches, cognitive dysfunction, psychosis, seizure disorders, transverse myelitis, aseptic meningitis, cranial neuropathies, and acute inflammatory demyelinating polyneuropathy.

The ankle joint is a fundamental element in the biomechanical system of locomotion. When its functions are impaired, due to neurological insult such as brain trauma or a stroke, severe disability and loss of personal independence may ensue. For this reason, great care is given to the physical rehabilitation of the lower limb. On the other hand, it is often the case that only a limited amount of time can be specifically devoted to the ankle joint manipulation during routine rehabilitation sessions. Furthermore, early initiation of active workout may be impossible for patients showing paresis; even passive exercise is often delivered to a minimal degree while the general conditions of the patients impose that they are kept bedridden. The delay in commencing rehabilitation may have negative consequences in terms of detrimental changes in tissue properties, deafferentation through lack of proprioceptive stimulation, learned non-use, and, ultimately, spastic paresis [1].

Abstract Human’s motion and its mechanisms had become interesting in the last years, where the medecine’s field search for rehabilitation methods for handicapped persons. Other fields, like sport sciences, professional or military world, search to distinguish profiles and ways to train them with specific purposes. Besides, recent findings in neuroscience try to describe these mechanisms from an organic point of view. Until now, different researchs had given a model about control motor that describes how the union between the senses’s information allows adaptable movements. One of this sense is the proprioception, the sense which has a quite big factor in the orientation and position of the body, its members and joints. For this reason, research for new strategies to explore proprioception and improve the theories of human motion could be done by three different vias. At first, the sense is analysed in a case-study where three groups of persons are compared in a controlled enviroment with three experimental tasks. The subjects belong to each group by the kind of sport they do: sedentary, normal sportsmen (e.g. athletics, swimming) and martial sportmen (e.g. karate, judo). They are compared thinking about the following hypothesis: “Martial Sportmen have a better proprioception than of the other groups’s subjects: It could be due to the type of exercises they do in their sports as empirically, a contact sportsman shows significantly superior motor skills to the members of the other two groups. The second via are records from encephalogram (EEG) while the experimental tasks are doing. These records are analised a posteriori with a set of processing algorithms to extract characteristics about brain’s activity of the proprioception and motion control. 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