Browsing by Subject "proprioception"
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Item Assessment of Upper Limb Proprioception in Children with Developmental Coordination Disorder(2017-08) Tseng, Yu-TingIt has long been suspected that proprioceptive abnormalities underlie the motor problems in children with developmental coordination disorder (DCD). However, current empirical evidence of proprioceptive dysfunction in children with DCD is still inconsistent. To address this issue, this study pursued the following three aims: 1) To obtain objective measures of position sense acuity to verify that children with DCD have proprioceptive deficits. 2) To examine whether the proprioceptive abnormality in children with DCD is joint-specific or a generalized somatosensory deficit that affects distal as well as proximal joints. 3) To investigate the relationship between motor function and position sense acuity in children with and without DCD. Methods: Twenty children with DCD [(Mean age: 10 years 4 months (SD: 3 months); 9 ♂, 11♀) and thirty typically developing (TD) children [M age: 10 years 5 months (SD: 3 months); 14 ♂, 16♀] were recruited and screened using Movement Assessment Battery for Children (MABC-2). The DCD group had total MABC-2 score below 5th percentile, and TD group was above 25th percentile. Using a body-scalable wrist and elbow bimanual manipulandum, proprioceptive status was assessed using 1) a wrist and elbow joint position matching task requiring active movement to reproduce a target position with either the same or the opposite hand/forearm, and 2) a psychophysical two-alternate forced choice test for the wrist that relied on passive motion. It required children to discriminate between two joint positions. We measured both aspects of position sense acuity: bias and precision. Bias indicates the proximity of a sensed limb position corresponds to the true physical position of the limb. Precision represents the random error or the agreement between independent repeated responses and is thus a measure of response consistency. Results: First, in comparison to TD controls children with DCD exhibited a significantly lower position sense precision on both elbow (p < 0.05) and wrist (p < 0.001). Position sense bias during active joint position matching at either joint was not significantly higher in children with DCD. Second, the mean wrist position sense discrimination threshold for passive displacement was highly elevated in DCD group (+171%; p < 0.001). Third, position sense discrimination threshold correlated significantly with upper limb motor (r = -0.40) and balance scores (r= -0.50). Conclusion: This study documents that DCD is associated with a dysfunction of position sense. Furthermore, the proprioceptive dysfunction affected both proximal and distal upper limb joints in children with DCD, which is consistent with a view that proprioceptive dysfunction in DCD is generalized in nature. Given the substantial evidence that proprioceptive deficits degrade motor control, these sensory deficits may partly explain fine motor control impairment in DCD.Item Characterizing proprioceptive and haptic function in typically developing children and individuals with chemotherapy-related somatosensory impairment(2018-08) Holst-Wolf, JessicaDespite the importance of somatosensation during motor development, a comprehensive characterization of the typical development of somatosensory function in children does not exist. This is largely due to a lack of objective measures with appropriate resolution. Mapping trajectories of typical development of proprioceptive and haptic function is necessary in order to identify sensory deficits in pediatric patient populations with known or suspected proprioceptive and/or haptic deficits. One such population is children treated with chemotherapy for pediatric cancers. Chemotherapeutic agents used to treat cancer generate unwanted side effects including peripheral nerve damage called chemotherapy-induced peripheral neuropathy (CIPN). To date, the magnitude and timeline of somatosensory impairments due to CIPN are not well understood. We have updated a methodology of measuring proprioceptive acuity and developed a novel measure of haptic acuity and sensitivity that are appropriate for use in both adult and pediatric populations. The aims of this study were to apply these two assessment tools to characterize 1) proprioceptive and 2) haptic function during typical development, 3) measure somatosensory-related impairment in individuals treated with chemotherapy for pediatric cancer, and 4) identify relationships between chemotherapy-related somatosensory impairment and therapeutic markers such as cumulative dosage of chemotherapeutic agents. Methods: To map the development of proprioceptive acuity, 308 typically developing (TD) children (ages 5-17 years) and 26 adults (ages 18-25 years) performed a forearm position matching task with a bimanual manipulandum. Haptic acuity (discrimination) or sensitivity (detection) was measured using curvature perception assessments in 59 and 56 children respectively (ages 9-12 years). Healthy adults completed both haptic assessments (n = 27, ages 19-25 years). These proprioceptive and haptic assessments were utilized to characterize somatosensory impairment in 15 individuals treated with chemotherapy for pediatric cancers (ages 6-25 years). Results: First, proprioceptive development is characterized by a reduction in random limb position matching error, not a change in systematic limb position error. Second, haptic acuity and sensitivity does not change significantly after the age of 9 years. Third, these somatosensory assessments were able to characterize proprioceptive and haptic impairment in individuals treated with chemotherapy for pediatric cancer. 7 of 15 cancer survivors exhibited proprioceptive precision measures above the 75th percentile and 11 of 15 exhibited at least one haptic function measure above the 75th percentile of their age-matched cohort. Fourth, a multiple linear regression model of cumulative dosage of chemotherapeutic agent types predicted 80% of the variability in the haptic discrimination thresholds (adjusted R2 = 0.80). Conclusion: This work generated a complete characterization of the development of proprioceptive acuity in TD children and established haptic function is adult-like by the age of 9 years. This study also demonstrated proof-of-concept for identifying somatosensory deficits in individuals treated with chemotherapy for pediatric cancers. These objective, clinically appropriate, somatosensory assessments and the necessary normative development data established here can identify or monitor somatosensory deficits in pediatric populations with known or suspected deficits.Item Proprioception in aging: Effects of a healthy active lifestyle and Parkinson’s disease on ankle position sense(2024-05) Sertic, JacquelynIntroduction: Proprioceptive afferents are processed at multiple levels of the central nervous system and give rise to the conscious perception of body and limb position (i.e. the proprioceptive sense) and unconscious regulation of muscle tone. Proprioceptive function declines in typical aging. This cumulative dissertation concerns the proprioceptive sense in two neurologically polar aging populations: healthy active adults (Project 1) and people with Parkinson’s disease (PD, Project 2). Project 1: Emerging evidence indicates that physical activity may spare older adults from age-related proprioceptive decline. However, the role of physical activity in preserving position sense at the ankle was unknown, in part because objective and precise measures of ankle proprioception have not been available. Aim 1: Determine the influence of a physically active lifestyle on ankle position sense acuity in healthy aging adults. Methods: This study applied sensory psychophysics to obtain a just-noticeable-difference (JND) threshold and Uncertainty Area (UA) as measures of ankle position sense acuity in young, middle-aged, and older adults. Participants were tested at two reference positions, 15° and 25°. Results: At the 15° reference, younger adults had smaller JND thresholds than both older groups (χ2(2) = 7.953, p = 0.019, η2 = 0.048). The effect size was small as 74% and 71% of middle-aged and older adults, respectively, had thresholds within the range of controls. No differences between groups were found for JND threshold at the 25° reference position nor for UA at either reference position. Only a subset of participants adhered to Weber’s law (young adults: 81%, middle-aged: 67%, older adults: 52%), which is a principle in psychophysics stating that the JND threshold is proportional to the magnitude of the stimulus. Project 2: Parkinson’s disease alters the processing of proprioceptive information resulting in impaired limb proprioception and increased muscle rigidity. Research has not firmly established that ankle proprioception is systematically impaired in people with PD, nor has the relationship been delineated between ankle proprioception and muscle rigidity. Aim 2a: Determine the extent to which ankle position sense is impaired in people with mild-to-moderate PD. Aim 2b: Examine the relationship between ankle position sense acuity and lower extremity rigidity in mild-to-moderate PD. Methods: Using the same methods established in Project 1, JND threshold and UA were obtained as measures of ankle position sense acuity in people with mild-to-moderate PD and age-matched controls. The MDS-UPDRS was used to obtain a clinical impression of rigidity. The more affected leg was assessed for both ankle position sense acuity and rigidity in people with PD. Results: Median ankle position sense JND threshold and UA were significantly larger in the Parkinsonian group than controls (JND threshold: z = 66, p = 0.020, r = 0.413; UA: z = 68.5, p = 0.044, r = 0.366). Yet, 62.5% and 80% of participants with PD had JND thresholds and UA values, respectively, within the range of the controls. JND threshold correlated with lower extremity rigidity (ρ = 0.50, p = 0.047). Disease duration was moderately correlated with JND threshold (r = 0.52, p = 0.039) and the clinical assessment of rigidity (ρ = 0.57, p = 0.020). JND threshold also correlated moderately with levodopa equivalent dosage (r = 0.54, p = 0.03). Discussion and conclusion: This dissertation challenges prevailing assumptions about ankle proprioceptive decline in aging, demonstrating that a habitually active lifestyle can preserve ankle proprioceptive function. In contrast, people with PD showed evidence of impaired position sense. Importantly, proprioceptive decline was associated with Parkinsonian muscle rigidity, establishing for the first time, a link between abnormal proprioceptive perception and abnormal control of muscle tone.Item Proprioceptive Acuity As Measured By Traditional Matching Task Vs. Novel Psychophysical Task(2016-12) Elangovan, NaveenProprioceptive impairment causes movement inaccuracies and lack of inter-limb coordination in several movement disorders, which necessitates an accurate joint position sense evaluation as part of neurological evaluation. Currently, position sense acuity (i.e., the sharpness of the sense) is evaluated by means of joint position matching methods which involve matching a target position on one limb with the same limb or the other. These position sense evaluations can only identify severe impairments of position sense. They fail to isolate proprioception from other sensory inputs and are confounded by factors such as inter-hemispheric transfer and working memory. Alternatively, psychophysical evaluation methods are available. They are often used in research to evaluate joint position sense and are considered as ‘gold standard’ for assessing the sensitivity and acuity of the perceptual system. The purpose of this study was to compare and contrast the arm position sense acuity obtained by a contralateral matching task using a bimanual manipulandum with a psychophysical threshold measure using a passive motion apparatus. Results suggest that psychophysical testing provides a more precise measure of arm position sense acuity than measurements obtained in a contralateral matching task. Although, being two different evaluation methods for the common variable – arm position sense acuity, they show a poor correlation to each other. These findings suggest that psychophysical evaluation can help identify joint position sense impairment more accurately in patients with neurological disorders.Item Robot-Aided Assessment of Ankle Motion Sense and Associated Lesion-Symptom Mapping Analysis in Chronic Stroke(2023-06) Huang, QiyinBackground: Compromised ankle proprioception is a strong predictor of balance dysfunction in chronic stroke. However, objective, accurate methods for testing ankle proprioceptive function in clinical settings are not established. Only sparse data on ankle position sense and no systematic data on ankle motion sense dysfunction in stroke are available. Moreover, the lesion sites underlying impaired ankle proprioception have not been comprehensively delineated.Objectives: To address these knowledge gaps, this study aimed: 1) To examine the feasibility and test-retest reliability of a newly developed robotic technology that uses an adaptive psychophysical forced-choice method to obtain quantitative data on ankle position and motion sense acuity in healthy young adults. 2) To determine the extent and magnitude of ankle motion sense impairment observed in adults with chronic stroke and how such impairment coincides with position sense dysfunction using the robotic system. 3) To identify the brain lesions associated with ankle position and motion sense dysfunction. Methods: To verify aim 1, experiments 1 and 2 were conducted successively. Forty healthy adults (20 in each experiment, mean ± SD age 24 ± 3.9 years, F: 17) were recruited. The feasibility and test-retest reliability of the system were determined in Experiment 1. Experiment 2 was conducted to improve the motion sense test paradigm that controlled for confounding factors (time and position) that a person might use as motion cues to make a perceptual judgment of ankle joint motion. To verify aim 2 and 3, twelve stroke survivors (mean ± SD age, 54 ± 10.9 years, on average 6 years post-stroke, 10 ischemic, 2 hemorrhagic lesions), and 13 neurotypical adults participated. During the testing, the robot passively plantarflexed a participant’s ankle to two distinct positions or at two distinct velocities. Participants subsequently indicated which of the two movements was further/faster. Based on the stimulus-response data, a psychometric function was obtained, and just-noticeable-difference (JND) thresholds, as a measure of bias, and intervals of uncertainty (IU), as a measure of precision were derived. For adults with stroke (n = 11), lesion-symptom analyses identified the brain lesions associated with observed proprioceptive deficits in adults with stroke. Results: For aim 1, objective data on position sense acuity (JND threshold: 0.80° ± 0.10°, IU: 0.84° ± 0.41°) and motion sense acuity (JND threshold: 0.73°/s ± 0.11°/s, IU: 0.60°/s ± 0.29°/s) were obtained in experiment 1. Additionally, moderate-to-excellent test-retest reliability of the system has been established based on the JND threshold for position sense (average intraclass correlation coefficient (ICC) = 0.86 [0.50 - 0.98], standard error of measurement (SEM) = 0.0173°) and motion sense (average ICC = 0.88, SEM = 0.0197°/s). In experiment 2, the results showed that the mean JND motion sense threshold increased almost linearly from 0.53°/s at the 10°/s reference to 1.6°/s at 20°/s (p < 0.0001). Perceptual uncertainty increased similarly (median IU = 0.33°/s at 10°/s and 0.97°/s at 20°/s; p < 0.0001). Both measures were strongly correlated (rs = 0.70). For aim 2, 83% of adults with stroke exhibited abnormalities in either position or motion sense, or both. JND and IU measures were significantly elevated compared to the control group (JNDPosition: +77%, p = 0.03; JNDMotion: +153%, IUPosition: +148%, and IUMotion: +78%, all p < 0.01). The JND and IU values of both senses were strongly positively correlated (rs = 0.56-0.62). For aim 3, lesions in the primary somatosensory, posterior parietal, motor cortices, insula, and temporoparietal regions (supramarginal, superior temporal, Heschl's gyri) were associated with deficits in both senses. Meanwhile, lesions in the medial/lateral occipital cortex were linked to impaired position sense, and temporal pole lesions were associated with impaired motion sense. Moreover, temporal pole lesions were significantly related to motion sense deficit (z-score = 3.26). Conclusion: This research demonstrated that the proposed robot-aided test produces quantitative data on human ankle position and motion sense acuity. It yields two distinct measures of proprioceptive acuity (i.e., bias and precision) as part of a comprehensive analysis of proprioceptive function. Using the robot-aided assessment, this study documented the initial data on the magnitude and prevalence of ankle position and motion sense impairment in adults with chronic stroke. Proprioceptive dysfunction was characterized by elevated JND thresholds and increased uncertainty in perceiving ankle position/motion. Associated cortical lesions for both proprioceptive senses were largely overlapping, but temporal pole lesions were independently linked to motion sense dysfunction.