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The rehabilitation outcome of spinal meningioma induced proprioception deficit.

Chronic non-traumatic myelopathy developed in a woman who presented symptoms of gait ataxia, right leg motor weakness, dysesthesia and urinary difficulty. Clinical evaluation revealed right leg weakness and global anesthesia as well as temperature, vibratory and proprioception sensation loss below the T-9 level and deep tendon hyperreflexia over the lower extremities. Magnetic resonance imaging showed an extra-intramedullary meningioma at the T-9 level. Following microscopic subtotal excision of the tumor, the patient underwent satisfactory rehabilitation programs with outstanding outcomes presented using the neurological scoring system, functional balance grade, postural analysis of Baropodometry screen and single leg standing time.

Female↗

Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain.

BACKGROUND AND PURPOSE: Improving functional performance in patients with chronic low back pain is of primary importance. The purpose of this study was to examine the effects of 2 proprioceptive neuromuscular facilitation (PNF) programs on trunk muscle endurance, flexibility, and functional performance in subjects with chronic low back pain (CLBP). SUBJECTS: Eighty-six women (40.2+/-11.9 [mean+/-SD] years of age) who had complaints of CLBP were randomly assigned to 3 groups: rhythmic stabilization training, combination of isotonic exercises, and control. METHODS: Subjects trained with each program for 4 weeks with the aim of improving trunk stability and strength. Static and dynamic trunk muscle endurance and lumbar mobility were measured before, at the end of, and 4 and 8 weeks after training. Disability and back pain intensity also were measured with the Oswestry Index. RESULTS: Multivariate analysis of variance indicated that both training groups demonstrated significant improvements in lumbar mobility (8.6%-24.1%), static and dynamic muscle endurance (23.6%-81%), and Oswestry Index (29.3%-31.8%) measurements. DISCUSSION AND CONCLUSION: Static and dynamic PNF programs may be appropriate for improving short-term trunk muscle endurance and trunk mobility in people with CLBP.

Adult↗

[The Armatron technic: a solution to control proprioceptive sense in a unit implant. An alternative to a bridge].

The Armatron technique permits the easy construction of single-implants controlling the proprioceptive sensitivity with the use of a natural tooth. This is an elegant solution, rather mildly disabling, with simple concept and realization. Besides, it is a non aggressive and reasonable alternative to costly solutions such as bridges on intact teeth or implants. Although simple and safe, the Armatron technique was only made possible by the use of modern materials as well as surgical tools with high definition technology which guarantee the reliability of this method.

Adult↗

Modulation of cutaneous flexor responses induced in man by vibration-elicited proprioceptive or exteroceptive inputs.

The effects of muscle tendon or skin vibration on the early and late components of polyphasic cutaneous responses elicited in the flexor carpi radialis by electrical stimulation of the radial nerve at the wrist were studied in the human, with all muscles at rest. Both early and late flexor responses were enhanced by flexor vibration and depressed by extensor vibration; facilitation was accompanied by a reduction of latency. Furthermore, when an "antagonist vibration response" was present, inhibition of the flexor reflexes was replaced by a facilitation. Palm skin vibration depressed both components of the flexor reflex, while dorsal or "back-hand" skin vibration induced either a facilitation or an inhibition. In addition, back-hand vibration modified the location of the sensations evoked by electrical stimulation of the nerve. In all cases, vibratory stimulus attenuated the perceived intensity of the electrical stimulus. These observations indicate that proprioceptive or exteroceptive information can modulate the gain of the cutaneous reflex loops in a flexible way, under supraspinal control. These data also suggest a possible impairment of the protective withdrawal reflex under vibratory environmental conditions at rest and eventually in active muscles.

Adaptation, Physiological↗

Differential responses to proprioceptive neuromuscular facilitation (PNF) stretch techniques.

The purpose of this study was to investigate the effects of sustained stretch and two common proprioceptive neuromuscular facilitation (PNF) stretch techniques on hamstring muscle activation and knee extension range of motion (ROM) in different athletic populations. Three stretch techniques: stretch-relax (SR), contract-relax (CR), and agonist contract-relax (ACR) were applied to 10 endurance athletes (EN), 10 high intensity athletes (HI), and 10 control subjects (C). The results revealed that ACR produced 89-110% greater hamstring EMG activity (P less than 0.05) and 9-13% more knee joint ROM than CR and SR, respectively. This same pattern was evident for the individual subject groups. Comparisons of mean data among the three subject groups revealed that the EN athletes generated 58-113% more hamstring EMG activity (P less than 0.05) than the HI and C groups, respectively, across all stretch conditions, whereas the EN group attained significantly less ROM than the HI and C groups for CR and ACR conditions. It was postulated that high intensity-short term activity training necessitates less hamstring resistance to knee extension than long term endurance training. The findings suggest that decreases in muscle activity may not be strongly related to increases in joint range of motion and that factors other than muscle relaxation are important in achieving increased ROM. Also, the differential effects of various stretch techniques between dissimilar athletic populations should be considered if stretch-induced injury is to be avoided.

Adult↗

Neuromodulation of the crab pyloric central pattern generator by serotonergic/cholinergic proprioceptive afferents.

In the stomatogastric nervous system of the crab, Cancer borealis, a set of 4 serotonergic/cholinergic proprioceptive neurons, called gastropyloric receptor (GPR) cells, have effects on the pyloric motor pattern. In a semi-intact foregut preparation, the GPR cells are not activated by movements of the pyloric filter; instead they respond to the slower movements of the gastric mill (Katz et al., 1989). Thus, their activity is not synchronized to the pyloric motor pattern. However, when the GPR cells are stimulated in an in vitro preparation in a manner that resembles their normal firing pattern, they produce dramatic effects on the pyloric motor pattern. These effects include: (1) a prolonged increase in the pyloric cycle frequency, (2) a momentary pause in the motor pattern, (3) transient inhibition of some motor neurons, (4) strong excitation of other motor neurons, and (5) altered phase relationships of the different components of the motor pattern. These changes in the motor pattern are due to direct effects of the GPR cells on neurons in the pyloric central pattern generator (CPG). All of the cells in the pyloric circuit appear to receive GPR input. However, only 2 neurons receive detectable rapid nicotinic synaptic potentials. The other neurons receive only slower neuromodulatory input from GPR stimulation. The neuromodulatory effects include burst enhancement, plateau potential enhancement, excitation, and inhibition. These modulatory effects are largely mimicked by bath-applied serotonin (5-HT). Thus, primary sensory neurons can alter the production of motor patterns by a CPG through a phase-independent mechanism; these proprioceptors do not need to fire at a precise time in the cycle to be effective because their effects are mediated through the slower actions of the neuromodulator 5-HT.

Animals↗

The fine structure of human extraocular muscle spindles and their potential proprioceptive capacity.

Twenty seven muscle spindles from six extraocular muscles removed following ocular enucleation from patients aged 58, 76 and 74 years were examined throughout all or most of their length by means of light and electron microscopy using serial transverse sections. Five others were prepared in longitudinal section. Twelve spindles of the superior rectus muscle from three sheep orbits were studied in a similar manner to provide a comparison. The human spindles contained a total of 90 (42%) nuclear chain and 5 (2%) nuclear bag fibres with the usual complement of sensory endings, and 120 (56%) fibres were anomalous with continuous, unattenuated myofibrils throughout their length, a constant width and peripherally placed nuclei. Eight anomalous fibres received sensory terminals similar in form to those of chain and bag fibres. Most (26) spindles contained at least one chain and one anomalous fibre. The periaxial space was limited or absent and the inner capsule was often segmented and in contact with the outer capsule. Abrupt termination of some chain fibres including several with one pole missing, together with evidence of fibre fragmentation and other structural anomalies, were indicative of degeneration. Eight further encapsulated fibre groups were identified as false spindles containing only anomalous fibres; associated nerves failed to terminate in the encapsulations. Sheep spindle content was of regular form, all spindles containing several chain and at least one bag fibre enclosed by an inner capsule and surrounded by a substantial periaxial space equatorially. The human extraocular muscle spindles have lost, either by aging or phylogenetically, the privilege of contractile chambers isolated by a fluid periaxial space from extrafusal fibre activity and sensory terminals are subject to the direct mechanical influences of anomalous intrafusal fibres. These, and the other departures from normal structure described, must jeopardize monitoring of muscle activity in the manner normally attributed to spindles and their capacity to provide useful proprioceptive information is questionable.

Aged↗

Neuropsychiatric observations of proprioceptive sensitivity in motion sickness susceptibility.

The assessment of motion sickness susceptibility is still an unsolved problem, due in part to its unclear etiology. We studied 16 referred patients suffering from "idiopathic motion sickness" and 4 pilots suffering from motion airsickness. All clinical and neurological tests proved negative, including electroencephalograms, electronystagmograms, Doppler studies, and computerized tomography of the brain. Cervical spine X-rays and personality characteristics were assessed. Simultaneously, 35 asymptomatic pilots and pilot applicants were studied as controls. Both groups were exposed to cross-coupled accelerations on a Barany chair at 15 rpm along with 0.5 Hz head flexions. The pathological group showed a straightened cervical curvature as well as a significantly higher degree of malaise (scale of Graybiel and Lackner). Their personalities were highly alexithymic or obsessive compared to the control group (Kruskal-Wallis Test). Alexithymic and obsessive personalities may express their stress reactions and psychic conflicts through somatic signs, such as cervical muscle contractures; consequently, straightening the cervical spine with the subsequent alteration of proprioceptive inputs to the vestibular nuclei may increase motion sickness susceptibility.

Adult↗

Muscle activation during proprioceptive neuromuscular facilitation (PNF) stretching techniques.

Proprioceptive neuromuscular facilitation (PNF) techniques are often used to induce muscle relaxation and increase joint range of motion (ROM). However, the relationship between muscle activation and ROM with PNF is not well understood. The purpose of this study was to investigate the effect of three common PNF stretching techniques on hamstring muscle activation and knee extension. Three PNF techniques: stretch-relax (SR), contract-relax (CR) and agonist contract-relax (ACR) were applied to ten male and female subjects aged 23-36 years who were stabilized to isolate knee extension measurements. Knee joint position and EMG activity from quadriceps and hamstring muscles were computer processed throughout technique application. The results revealed mean hamstring EMG activity increased 8-43% within a given trial of ACR and CR respectively, and did not diminish across trials. SR produced a 11% decrease in mean hamstring EMG activity. ACR produced 3-6% greater knee extension values than CR and SR respectively, in spite of 71-155% greater hamstring EMG activity during ACR. The data suggest that CR and ACR do not evoke sufficient relaxation in muscles opposing knee extension to overcome tension facilitation generated by stretch. Thus, increases in ROM are achieved while the hamstrings are under considerable tension. Such tension increases muscle vulnerability to soreness and strain if stretching continues. The degree of knee extension produced via SR, although 3-6% less than CR and ACR, was achieved during simultaneous reduction in hamstring activity and may be the safer stretching technique.

Adult↗

[Proprioceptive sensitivity and orofacial functions].

Proprioceptive sensibility from stimulation of muscle, ligament articular and vestibular receptors plays a determining role in the regulation of tone, of the resting position of the mandible, of head posture and of the closure pathway of the mandible. Studies conducted on temporomandibular joints of fetuses and adult subjects failed to demonstrate the specialized corpuscles (a fact previously noted by Ramfjord) in the temporomaxillary joint capsule, described typically in other joints. In contrast, however, histology showed a particularly rich population of muscle receptors adjacent to this joint, this being only one of several particular characteristics.

Adult↗

[Importance of the general radiograph of the cervical spine in vertigo and pathologic proprioceptive cervical nystagmus].

The general roentgenogram of the cervical spine often shows manifold pathological alterations by patients without any clinical complaints. On the other hand, there are cervical vertigo and different symptoms caused by the cervical spine, its joints, muscles and ligaments without any X-ray manifestation. Nevertheless, some connections are assumed to exist between vertigo and alterations of the cervical spine an assumption supported especially by the frequently successful elimination of cervical troubles by chirotherapy. We compared the X-ray manifestations in patients complaining of vertigo with any and without any pathological proprioceptive cervical nystagmus provoked by examination according to Moser and revealed by electronystagmography. The extended posture of the cervical spine seems to point to a possible cause of vertigo. Likewise, some degenerative alterations seem to exercise a pathological effect, provoking cervical vertigo additionally if both effects are combined. Uncovertebral arthroses seem to have the same effect without occurring in combination with other effects. The general roentgenogram of the cervical spine in the sloping, lateral and anterior-posterior direction may consequently point to some possible causes of cervical vertigo.

Cervical Vertebrae↗

Proprioceptive influences on directional hearing: dependence on the movement type.

Proprioceptive effects (PE) on directional hearing, i.e., sound image shifts relatively to the sound source, produced by changes in head position, were studied in their dependence on head movement type in two groups of listeners. The first group included subjects in whom horizontal head deviation to the right or to the left, performed on instruction before the presentation of clicks, caused sound image displacement of 10-15 degrees. When the same sounds were made signals of movement direction, i.e., of pointing with the head at the sound source, PE became fully inhibited in all subjects. The second group included listeners in whom PE was either absent or only very small; substitution of passive head deviations for active turns resulted (in 63 percent of cases) in PEs which presumably had been previously inhibited. Thus identical muscle activities play different roles in auditory spatial perception depending on the type of movement and on the significance of the acoustic signal for the motor act.

Auditory Perception↗

Design and evaluation of a prosthesis control system based on the concept of extended physiological proprioception.

This paper describes the design and evaluation of an experimental prosthesis-control system based on the concept of extended physiological proprioception (EPP). It was originally hypothesized that EPP control effected by residual shoulder motion could be effectively applied in multifunctional prostheses for shoulder disarticulation amputees. The experimental system developed for this study utilized a force-driven control scheme and a shoulder motion transduction system in which direct cable linkages to the prosthesis components were used to implement EPP position-servo relationships between shoulder elevation-depression and prosthesis elbow flexion, and between shoulder protraction-retraction and prosthesis wrist rotation. The results of experiments performed with this prosthesis (and with an experimental velocity-controlled prosthesis implemented for comparison purposes) clearly demonstrated the superior performance provided by EPP control of prosthesis function.

Arm↗

An analysis of extended physiological proprioception as a prosthesis-control technique.

This research was devoted to an investigation of the practicality and potential effectiveness of applying the concept of extended physiological proprioception (EPP) to the control of upper-limb prostheses. The purpose of this study was to verify that EPP control, implemented by coupling prosthesis function to residual shoulder motion in a position-servo relationship, could be effectively applied in multifunctional prostheses for shoulder disarticulation amputees. Although Simpson has shown that the principle works, the authors wanted to quantify its effectiveness and analyze its limitations. Studies were performed analyzing the feasibility of using shoulder elevation-depression and protraction-retraction as prosthesis control inputs. The results of this study showed that a prosthesis mechanism with nonlimiting dynamic response characteristics and shoulder-activated EPP control of wrist rotation and elbow flexion/extension, exhibited functional characteristics comparable to those of the physiological elbow and wrist as defined by tracking capabilities. The results of this investigation also showed that shoulder-effected position control of prosthesis function has considerably more potential for providing effective control than similarly effected velocity control.

Arm↗

[Proprioceptive proximo-distal relationships between the quadriceps and soleus muscles in man].

Electrical stimulation of femoral nerve modulates voluntary tonic activity o of ipsilateral soleus muscle. Stimulus time-locked inhibitory and facilitatory phases can be distinguished. EMG temporal analysis suggests that early perturbations are correlated with spinal effects of centripetal electrical activity. The inhibitory effects which momentarily abolish voluntary soleus activity are thought to result from quadriceps Ib fibres recruitment. While no heteronymous activity is induced at rest, femoral nerve Ia fibres activation can produce soleus muscle reflex when soleus motor nucleus excitability is increased by voluntary command. Recurrent discharge resulting from soleus reflex response enhances inhibition initially due to quadriceps Ib volley. Secondary effects of isometric quadriceps contraction (and soleus contraction when the femoral stimulus elicits a reflex in this muscle) have their own effects later. These findings suggest that proprioceptive relationships of the two muscular groups are efficient during tonic isometric voluntary command.

Electric Stimulation↗

[Equilibrium disorders, vertigo and nystagmus induced by maximal deviation of gaze. Role of extra-ocular proprioception].

The behavior of 64 normal subjects was studied after they had been submitted to excentric lateral ocular fixation of gaze of more than 40 degrees for periods of one the three minutes. A significant proportion developed vertigo, slow segmental deviations and nystagmus. Nystagmus appearing during gaze fixation (physiological nystagmus of extreme lateral gaze) was distinguished from nystagmus in the opposite direction which appeared after cessation of fixation and was named "post-fixation nystagmus". The possible role of proprioceptive receptors in the extra-ocular muscles is discussed and a hypothesis proposed of an oculo-oculogyric reflex possibly through the vestibular nuclei and influencing the control mechanisms of posture and balance.

Adult↗

[Convergence of visual and neck proprioceptives on the vestibulo-ocular reflex arc and the "vestibulo-cerebellum" (author's transl)].

Linked to the vestibular reflex, ontologically the most primitive, nuchal and visual proprioceptive afferent impulses heighten perception of movement and the position of the head and body in space. The final goal of these reflexes appears to be maintenance of the visual axis and of posture. They are under cerebellar control which adapts responses according to sensory interactions, and probably increases reactions when a deficiency exists. Functional exploratory tests in patients with positional or postural vertigo should include the study of responses to separate or combined stimulation of these three types of receptor according to the three planes of the semicircular canals.

Animals↗

Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation?

The effects of stretching techniques on the flexibility of the shoulder, trunk, and hamstring muscles were compared in college men. Subjects were randomly assigned to one of 4 groups: control (n=10), ballistic (n=11), static (n=10), or proprioceptive neuromuscular facilitation (PNF) (n=12). Baseline measurements (Leighton flexometer) were obtained on 2 separate days prior to and following a 3-day per week, 6-week flexibility training program. A 4x3 (subject group x muscle group) unweighted mean factorial analysis of variance for the difference scores (post minue pre) revealed significant (p less than 0.05) main effects for the 4 subjects groups and the 3 muscle groups. Post hoc analysis showed that only the PNF group had flexibility increases (10.6 degrees) greater than the control (3.4 degrees), and that the hamstrings (9.4 degrees increase) improved more than the trunk (5.2 degree increase). Furthermore, reliability was generally higher for the post-training scores, and the variability between days was lower for the post-training scores of the shoulder and hamstrings (p less than 0.05). The significant (p less than 0.05) between-day changes in flexibility pre-training confirm the importance of establishing baseline data prior to any training study. The findings indicate that PNF may be the preferred technique for improving flexibility, and that flexibility training results in an increased consistency of flexibility scores.

Adult↗