Proprioception

Question 1

Proprioception

joint position sense, kinesthetic awareness

Answer 1

Awareness of body in space

Both static and dynamic (Requires coordination)

Question 2

Usual Examination findings associated with Awareness Deficits - Subjective

Answer 2

• History of disruption of somatosensory or neuromuscular system
• Medical diagnosis affecting motor control or processing
• Poor coordination
• Current pain or history of chronic pain
• Fear avoidance

Question 3

Usual Examination findings associated with Awareness Deficits - Objective

Answer 3

Functional movement screen
– (CASSS: Control, Amount, Symmetry, Speed, Symptom reproduction)
– Aberrant motion, poor dissociation
Compensations driven by fear
– Multiple movement strategies (inconsistency)
– Poor coordination
* Inability to replicate movement
* Inability to decipher what their limb is doing when passively moved (joint position sense testing)
* Movement pattern changes without visual input (Ex: Pronator Drift)
* Movement pattern may change with increased cognitive demand

Question 4

Interventions that may help facilitate proprioception

Answer 4

• Increase input to joint receptors
  – Approximating the joint (resistance, weight bearing, CKC)
  – Vibration
  – Perturbation training
  – PNF Isometric Stabilization Concepts (Rythmic stabilization)
• Biofeedback to increase awareness of joint position
  – Tactile
  — Touch, compression (compression short), taping (ankle), bracing (ACL)
  – Visual
  — Laser pointers, mirrors, technology feedback systems (Bertec)
  – Auditory
  — Verbal cueing, alarm systems

Question 5

PNF ISOMETRIC STABILIZATION CONCEPTS

Answer 5

• Used to initiate co-contraction of muscles around a joint or the spine to improve proprioceptove feedback
• For both techniques:
  – Vary speed, hold time, resistance, body position
• Alternating Isometrics: Manual resistance is applied in a single plane on one side of body segment and then the other. MORE ANTICIPATORY
• Rhythmic Stabilization: Alternate isometrics in multiple directions to affect all muscles which cross a body segment. MORE REACTIVE
• Clinical applications?
  – Basis for balance training

Question 6

Variables important in motor control with proprioception

Answer 6

• ROM
• Planes of Mtoion
• Joints to Control
• Amount of resistance exercise
• Mode of Resistance
• Stability
• Speed of Contraction
• Concentration
• Motor Contol (Assist va patient controlled)

Question 7

Dosage for HEP

Answer 7

• Quality first…then increase quantity
• Establishing new movement patterns and awareness
  – Frequency (multiple times a day)
  – Sets (As many as they can do
  – Reps (Quality)