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 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.