Comparison of the effect of weight-bearing and non-weight-bearing positions on knee position sense in patients with chronic stroke

Can We Target Close Therapeutic Goals in the Gait Re-Education Algorithm for Stroke Patients at the Beginning of the Rehabilitation Process?

(1) Background: The study aimed to determine the most important activities of the knee joints related to gait re-education in patients in the subacute period after a stroke. We focused on the tests that a physiotherapist could perform in daily clinical practice. (2) Methods: Twenty-nine stroke patients (SG) and 29 healthy volunteers (CG) were included in the study. The patients underwent the 5-meter walk test (5mWT) and the Timed Up and Go test (TUG). Tests such as step up, step down, squat, step forward, and joint position sense test (JPS) were also performed, and the subjects were assessed using wireless motion sensors. (3) Results: We observed significant differences in the time needed to complete the 5mWT and TUG tests between groups. The results obtained in the JPS show a significant difference between the paretic and the non-paretic limbs compared to the CG group. A significantly smaller range of knee joint flexion (ROM) was observed in the paretic limb compared to the non-paretic and control limbs in the step down test and between the paretic and non-paretic limbs in the step forward test. (4) Conclusions: The described functional tests are useful in assessing a stroke patient's motor skills and can be performed in daily clinical practice.

Reference value of knee position sense in weight-bearing and non-weight-bearing conditions

BACKGROUND

Our study aimed to identify age-related changes in knee proprioception to provide reference values for weight-bearing (WB) and non-weight-bearing (NWB) conditions and to identify factors (age, WB condition, dominance, and sex) that can affect knee proprioception.

METHODS

A total of 84 healthy adult men and women were recruited. Active knee joint position sense (JPS) was measured using a digital inclinometer for knee proprioception. The participants performed the required movements actively, with verbal feedback from the examiner, slowly moving to the target angles (30° and 50°) and maintaining them for 5 s before returning to the starting position. Afterward, without assistance from the examiner, the participants actively moved back to the same angle, and the examiner confirmed the angles. This procedure was repeated twice for each target angle, and the average values were used as the data. The participants were barefoot, wearing shorts, and closed their eyes while the measurements were obtained. The measurements were first obtained on the dominant side under the NWB conditions. When a change in posture was needed during the measurement, the participants sat in a resting position for 2 min.

RESULTS

Except for age, all other factors (WB condition, dominance, sex) were not statistically significant. Age showed a significant difference in knee JPS, except for the non-dominant side at 30° and the dominant side at 50° in the NWB condition.

CONCLUSION

This study indicates that the WB condition, dominant side, and sex need not be considered when measuring and assessing knee JPS. Age shows a negative correlation with knee joint position sense, and the reference values presented in this study can be used as objective target values during the rehabilitation process.

Hybrid robot-assisted gait training for motor function in subacute stroke: a single-blind randomized controlled trial

Background

Robot-assisted gait training (RAGT) is a practical treatment that can complement conventional rehabilitation by providing high-intensity repetitive training for patients with stroke. RAGT systems are usually either of the end-effector or exoskeleton types. We developed a novel hybrid RAGT system that leverages the advantages of both types.

Objective

This single-blind randomized controlled trial evaluated the beneficial effects of the novel RAGT system both immediately after the intervention and at the 3-month follow-up in nonambulatory patients with subacute stroke.

Methods

We recruited 40 patients with subacute stroke who were equally randomized to receive conventional rehabilitation either alone or with the addition of 15 RAGT sessions. We assessed lower-extremity motor function, balance, and gait performance by using the following tools: active range of motion (AROM), manual muscle test (MMT), the Fugl–Meyer Assessment (FMA) lower-extremity subscale (FMA-LE) and total (FMA-total), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), Tinetti Performance-Oriented Mobility Assessment (POMA) balance and gait subscores, and the 3-m and 6-m walking speed and Timed Up and Go (TUG) tests. These measurements were performed before and after the intervention and at the 3-month follow-up.

Results

Both groups demonstrated significant within-group changes in the AROM, MMT, FMA-LE, FMA-total, PASS, BBS, POMA, TUG, and 3-m and 6-m walking speed tests before and after intervention and at the 3-month follow-up (p < 0.05). The RAGT group significantly outperformed the control group only in the FMA-LE (p = 0.014) and total (p = 0.002) assessments.

Conclusion

Although the novel hybrid RAGT is effective, strong evidence supporting its clinical effectiveness relative to controls in those with substantial leg dysfunction after stroke remains elusive.

Trial registration The study was registered with an International Standard Randomized Controlled Trial Number, ISRCTN, ISRCTN15088682. Registered retrospectively on September 16, 2016, at https://www.isrctn.com/ISRCTN15088682

Role of active joint position sense on the upper extremity functional performance tests in college volleyball players

Background

It has been well established that proprioception plays a decisive role in shoulder stability and sport performance. Notwithstanding, there is a lack of clear association between active joint position sense (AJPS) and the performance of upper-extremity functional performance tests. The aim of this study was to determine whether the AJPS of the shoulder complex is associated with the performance of college volleyball players with the following functional tests: Y-Balance Test-Upper Quarter (YBT-UQ), Closed Kinetic Chain Upper-Extremity Stability Test (CKCUEST), and Seated Medicine Ball Throw (SMBT). The secondary aim was to investigate whether the magnitude of the proprioception error through the AJPS had the ability to act as a predictor for functional test scores.

Methods

Cross-sectional study with a convenience sampling. Healthy college volleyball players (≥12 h of training/week), 30 males and 22 females, between 18 and 26 years of age were included. AJPS of the shoulder (90° of flexion (90°Flex), 90° of internal rotation at 90° of abduction (90°IR/ABD), 90° of external rotation at 90° of abduction (90°ER/ABD)) and three upper-extremity functional performance tests (YBT-UQ, CKCUEST and SMBT) were assessed. A Pearson's test and a stepwise multiple linear regression analysis were used to determine possible associations and relationships between outcome measures, respectively.

Results

The analysis revealed that AJPS at 90°IR/ABD and 90°ER/ABD were the only proprioceptive variables with an association to the YBT-UQ and SMBT. Despite these relationships, only the AJPS at 90°IR/ABD was associated with the performance of the YBT-UQ in; superolateral direction (β = -0.7; 95% CI [-1.3 to 0.1]; p = 0.025); inferolateral direction (β = -1.5; 95% CI [-2.1 to -0.8]; p = 0.001); and composite score (β = -0.8; 95% CI [-1.3 to -0.3]; p = 0.002). From these, AJPS at 90°IR/ABD mainly explained the variability of YBT-UQ (inferolateral direction) performance (R² = 0.32; %R² = 0.32). Our findings allow for a possible expanded role for proprioception as a contributing factor in upper limb motor control during functional movements. Further research is required to explore and distinguish the associations between proprioception, motor control and sport performance involving the upper limbs.

Reliability of hip joint position sense tests using a clinically applicable measurement tool in elderly participants with unilateral hip osteoarthritis

Hip joint proprioception is vital in maintaining posture and stability in elderly individuals. Examining hip joint position sense (JPS) using reliable tools is important in contemporary clinical practice. The objective of this study is to evaluate the intra-rater and inter-rater reliability of hip JPS tests using a clinically applicable measurement tool in elderly individuals with unilateral hip osteoarthritis (OA). Sixty-two individuals (mean age = 67.5 years) diagnosed with unilateral hip OA participated in this study. The JPS tests were evaluated using a digital inclinometer in hip flexion and abduction directions. The absolute difference between target and reproduced angle (repositioning error) in degrees was taken to measure JPS accuracy. The intraclass correlation coefficient (ICC (2.k), was used to assess the reliability. The Intra rater-reliability for hip JPS tests showed very good agreement in the lying position (hip flexion-ICC = 0.88–0.92; standard error of measurement (SEM) = 0.06–0.07, hip abduction-ICC = 0.89–0.91; SEM = 0.06–0.07) and good agreement in the standing position (hip flexion-ICC = 0.69–0.72; SEM = 0.07, hip abduction-ICC = 0.66–0.69; SEM = 0.06–0.08). Likewise, inter-rater reliability for hip JPS tests demonstrated very good agreement in the lying position (hip flexion-ICC = 0.87–0.89; SEM = 0.06–0.07, hip abduction-ICC = 0.87–0.91; SEM = 0.07) and good agreement in the standing position (hip flexion-ICC = 0.64–0.66; SEM = 0.08, hip abduction-ICC = 0.60–0.72; SEM = 0.06–0.09). The results support the use of hip JPS tests in clinical practice and should be incorporated in assessing and managing elderly participants with hip OA.

Effect of Force Level and Gender on Pinch Force Perception in Healthy Adults

This study investigated the effects of both force level and gender on pinch force reproduction errors in normal participants during an ipsilateral force reproduction task. In total, 20 healthy participants were asked to generate a range of levels of reference forces ranging from 5% to 60% maximal voluntary isometric contraction (MVIC) in increments of 5% MVIC using the tip pinch and to reproduce these forces using the same hand. The results showed that the males more accurately and consistently reproduced the forces than did the females, and the most accurate estimation occurred at approximately 20% to 35% MVIC. This finding can help us better understand the reasons for the higher rate of musculoskeletal disorders in females than in males and to develop tools and preventive strategies to decrease the rate of hand injuries in both genders.

Test-retest reliability of tip, key, and palmar pinch force sense in healthy adults

Background

No previous studies have investigated the test–retest reliability of tip, key, and palmar pinch force sense in healthy adults. The present study explores the test-retest reliability of tip, key, and palmar pinch force sense for different force levels in healthy adults during an ipsilateral force reproduction task.

Methods

Fifty-six healthy subjects were instructed to produce varying levels of reference forces (10, 30, and 50% maximal voluntary isometric contraction (MVIC)) using three types of pinches (tip pinch, palmar pinch, and key pinch) and to reproduce these forces using the same hand. The subjects were tested twice by the same experienced testers, 1 week apart.

Results

Based on the high values of the intraclass correlation coefficient (ICC), the tip pinch (0.783–0.895) and palmar pinch (0.752–0.903) force sense tests demonstrated good reliability for all the variables. The ICCs for the key pinch (0.712–0.881) indicated fair to good relative test-retest reliability.

Conclusion

1) This study demonstrates that high test-retest reliability of tip, key, and palmar pinch force sense in healthy adults can be achieved using standardized positioning and the proposed approach. 2) According to the reliability measurements, 30 and 50% maximal voluntary isometric contraction (MVIC) are the most reliable pinch force sense levels.

Effects of Elastic Therapeutic Taping on Joint Position Sense of the Ankle in Stroke Survivors

Impairments in ankle joint position sense along with muscle weakness greatly affect the recovery of balance among stroke survivors. Elastic therapeutic taping has been studied in musculoskeletal conditions of the ankle to improve joint position sense and its effects in stroke are not known. The aims of the study were to investigate the differences in joint position sense between paretic and nonparetic ankles and to examine the effects of elastic therapeutic taping on joint position sense of the paretic ankle in stroke survivors. Sixteen chronic stroke survivors participated in a 2-day protocol of ankle elastic therapeutic taping on the paretic side. Active and passive joint position sense at the ankle was measured by Biodex Isokinetic III system on both the paretic and nonparetic sides before elastic therapeutic taping and only the paretic side after elastic therapeutic taping. The active and passive ankle joint position sense values were significantly (P < 0.001) lower on the paretic side than the nonparetic side before intervention. Joint position sense significantly (P < 0.001) improved for the paretic ankle after elastic therapeutic taping. Chronic stroke survivors were deficient in ankle joint position sense on the paretic side. Elastic therapeutic taping was effective in the short term to improve active and passive joint position sense.

Effect of body awareness training on balance and walking ability in chronic stroke patients: a randomized controlled trial

[Purpose] To investigate the effects of body awareness training on balance and walking ability in chronic stroke patients. [Subjects] The subjects were randomly assigned to a body awareness training group (n=6) and a control group (n=6). [Methods] Patients in the body awareness training group received body awareness training for 20 minutes, followed by walking training for 30 minutes a day, 5 days a week for 4 weeks. The control group received walking training for 30 minutes a day, 5 days a week for 4 weeks. [Results] After the intervention, both groups showed significant improvements in the Berg Balance Scale, Timed Up and Go Test, and 10 m walk test compared with baseline results. The body awareness training group showed more significant improvements in the Berg Balance Scale and Timed Up and Go Test than the control group. There was no significant difference in the 10 m walk test between the groups. [Conclusion] The results of this study suggest that body awareness training has a positive effect on balance in patients with chronic stroke.