Comparison of the validity and reliability of three different methods used for wrist proprioception measurement

Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report

BACKGROUND

Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements.

PURPOSE

This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS).

CASE DESCRIPTION

A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed.

OUTCOMES

The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability.

CONCLUSION

Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.

Investigation of sensory and motor functions of wrist in patients with rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) is a systemic and autoimmune disease that affects many tissues and organs in the body, especially the synovial joint and periarticular structures. One of the most affected joints is the hand joints, and there is also involvement in the wrist joint.

OBJECTIVES

The purpose of this study was to assess the sensory and motor functions of the wrist with a gold standard method and to determine the relationship between the motor and sensory functions of the wrist and wrist-related pain/disability level and hand grip strength in patients with RA.

METHOD

Flexor and extensor muscle strength and joint position sense of the wrist were evaluated using isokinetic dynamometer, hand grip strength was measured using dynamometer, and wrist related pain and disability was assessed by Patient Rated Wrist Evaluation (PRWE) questionnaire.

RESULTS

Thirty-one patients with RA and 31 healthy controls were included in the study. Control group had better results regarding wrist flexor and extensor muscle strength and wrist joint position sense than RA patients for both hands/wrists. A positive and strong correlation and a negative and weak correlation were found between muscle strength and joint position sense of the wrist and hand grip strength, respectively.

CONCLUSIONS

Compared to healthy subjects, RA patients showed wrist-related sensorimotor deficits. Therefore, evaluation of the wrist should not be ignored in the examination of patients with RA. In addition, when planning the treatment program of the patients, not only hand exercises but also exercises involving the wrist should be taken into consideration.