ABCs of Proprioception

1
ABCs of Proprioception

• CHAPTER 8

2
Postural Control

• Human body is tall structure with small base and
  high center of gravity
• Balance dynamic process that involves alignment
  of joint segments to maintain COG within limits
  of stability
• Affected by muscular weakness, proprioceptive
  ROM deficits
• Postural control operates as feedback loop

• Proprioception
• Agility
• Balance
• Coordination
• Complex functioning dependent on
• Strength
• Flexibility
• Necessary for dexterity, consistency, and
  precision

3
Neurophysiology of proprioception

• Cutaneous receptors
• Fast-adapting afferents
• Slow-adapting type I and II afferents
• Not primary receptors for joint position sense
• take up the slack for injured joint
• Muscle and tendon receptors
• Muscle spindles
• Golgi tendon organs

• Joint receptors
• Group II afferents
• Ruffini endings
• Pacinian corpuscles
• Golgi-mazoni corpuscles (not VIP)
• Group III and IV afferents
• Nociceptors
• CNS receptors
• Spinal cord
• Brain stem
• Cerebral cortex

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Role of the CNS

• Sensory processes determine the timing,
  direction, and amplitude of corrections
• Vision orientation of eyes and head
• Provides feedback
• Visual fixation
• Vestibular gravitational, linear, and angular
  accelerations
• Vestibular ocular reflex
• Balance evaluation
• Tests and progressions??

• Muscle coordination processes determine temporal
  sequencing and distribution of activity of the
  legs and trunk
• Impairment of one component is usually
  compensated for by the others
• Irradiation (overflow) causes undesired motion

5
Learning proprioception

• Feedback
• CNS learning process
• Evaluate movement quality, make adjustments,
  repeat
• Repetition
• Consistency required for accuracy and
  coordination
• Create movement engram
• Inhibition
• Cannot be trained
• Facilitated by slow, controlled activity until
  engram is solid

• Applying to rehab
• Proper form key
• Use multiple forms of feedback (visual/verbal/tact
  ile)
• Distractions lead to imprecise movement
• Practice new movements slowly (build speed over
  time)
• Fatigue decreases coordination
• Perform coordination exercise early in rehab
  session

6
Balance

• Coordinated joint systems located between the
  base and COG maintain balance
• Ankle, hip, and stepping strategies
• Subjective assessment
• Romberg test
• BESS test
• Goal is to test semidynamic and dynamic balance
  by decreasing size of base

• Objective assessment
• Quantitatively measure static and dynamic balance
• Force platforms
• Steadiness
• Symmetry
• Dynamic stability

7
Balance Training

• Injury ? proprioception inappropriate joint
  loading and injury
• Also causes compensatory weight shifts and gait
  changes
• 5 Rules for balance training
• Safe and challenging
• Multiple planes of motion
• Begin static, bilateral, and stable ? dynamic,
  unilateral, unstable
• Progress to sport specific

• Do exercises in open area with assistive device
  nearby
• Progress in speed, force, and control
• Classification of exercises
• Phase 1 nonballistic static
• Phase 2 dynamic lose/gain balance
• Phase 3 sport-specific drills

8
Lower extremity proprioception
9
Upper extremity proprioception