The effectiveness of proprioceptive training for improving motor function: a systematic review

Your doctor should already know how to get your proprioception restored but if not have them look at this. Mine is still not very good. Something like this should be in the public domain as a stroke protocol or at least available via our great stroke association if we had one.
http://journal.frontiersin.org/article/10.3389/fnhum.2014.01075/full?utm_source=newsletter&

Joshua E. Aman^1,2, Naveen Elangovan¹, I-Ling Yeh¹ and Jürgen Konczak^1,2*

• ¹Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
• ²Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA

Objective: Numerous reports advocate that training of the proprioceptive sense is a viable behavioral therapy for improving impaired motor function. However, there is little agreement of what constitutes proprioceptive training and how effective it is. We therefore conducted a comprehensive, systematic review of the available literature in order to provide clarity to the notion of training the proprioceptive system.

Methods: Four major scientific databases were searched. The following criteria were subsequently applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function. From a total of 1284 articles, 51 studies fulfilled all criteria and were selected for further review.

Results: Overall, proprioceptive training resulted in an average improvement of 52% across all outcome measures. Applying muscle vibration above 30 Hz for longer durations (i.e., min vs. s) induced outcome improvements of up to 60%. Joint position and target reaching training consistently enhanced joint position sense (up to 109%) showing an average improvement of 48%. Cortical stroke was the most studied disease entity but no clear evidence indicated that proprioceptive training is differentially beneficial across the reported diseases.

Conclusions: There is converging evidence that proprioceptive training can yield meaningful improvements in somatosensory and sensorimotor function. (Where is the stroke protocol that accomplishes that?)However, there is a clear need for further work. Those forms of training utilizing both passive and active movements with and without visual feedback tended to be most beneficial. There is also initial evidence suggesting that proprioceptive training induces cortical reorganization, reinforcing the notion that proprioceptive training is a viable method for improving sensorimotor function.

Introduction

Proprioceptive signals from mechanoreceptors of the joints, muscles, tendons, and skin are essential for the intact neural control of movement. The loss of proprioceptive afferents may affect the control of muscle tone, disrupts postural reflexes (Allum et al., 1998; Dietz, 2002; Rossignol et al., 2006) and severely impairs spatial (Gordon et al., 1995) as well as temporal aspects (Gentilucci et al., 1994) of volitional movement. Numerous neurological and orthopedic conditions are associated with proprioceptive and kinesthetic impairment such as stroke (Kenzie et al., 2014; Meyer et al., 2014), Parkinson's disease (PD) (Rickards and Cody, 1997; Khudados et al., 1999; Mongeon et al., 2009; Konczak et al., 2012), focal dystonia (Rosenkranz et al., 2000; Putzki et al., 2006), peripheral sensory neuropathies (Rothwell et al., 1982; Ghez et al., 1990), or injuries to ligaments, joint capsules, and muscles (Barrack et al., 1989; Lephart et al., 1994; Fridén et al., 1997).

Given the importance of proprioception for motor control, it has been argued that therapies aiming to restore motor function after injury should focus on training the proprioceptive sense. Numerous interventions claim to constitute a form of proprioceptive training that improves proprioception and aids motor recovery. Unfortunately, there is little agreement of what actually constitutes proprioceptive training, which may be partially owed to the fact that there are various definitions for the term proprioception. Broadly defined, proprioception refers to the conscious awareness of body and limbs and has several distinct properties: passive motion sense, active motion sense, limb position sense, and the sense of heaviness (Goldscheider, 1898). However, it has long been established that proprioception has an unconscious component in which proprioceptive signals are used for the reflexive control of muscle tone and the control of posture that has long been recognized (Sherrington, 1907). In order to distinguish between the conscious and unconscious processing of proprioceptive afferents it has been suggested to refer to kinesthesia as the conscious perception of limb and body position and motion and to reserve the term proprioception for referring to the unconscious processing of proprioceptive information (Konczak et al., 2009). However, this distinction is not without problems, because the term kinesthesia has also been used to indicate motion sense in distinction to position sense.

Recognizing that the processing of proprioceptive signals has conscious and unconscious components implies that the available methods for assessing proprioceptive function may only address one of the two aspects of proprioception. For assessing the perceptual aspect of proprioception, psychophysical thresholds represent the gold standard (Gescheider, 1985; Elangovan et al., 2014). In addition, determining a joint position error when matching the position of two homologous limbs (e.g., two arms), is the most easily acquired measure of proprioceptive function (Goble, 2010) and common in clinical practice. For determining the contribution of proprioceptive signals for balance control, many biomechanical measures have been employed such as latencies and amplitudes of electromyographic signals, joint kinematics or kinetics, or variables indicative of the postural sway of the body's center of mass. With respect to proprioceptive training this means that an intervention focusing on training the proprioceptive sense may train one or both aspects of proprioception, that is, the conscious perceptual or the unconscious or implicit sensorimotor aspect.

Further, it needs to be considered that proprioception is closely linked to movement. Unlike senses such as audition, where, for example, pitch perception can be trained in the absence of limb or body movement, proprioception requires movement. Thus, when evaluating the effectiveness of an intervention to improve proprioception, it may be difficult to isolate the sensory from a motor aspect of training. In fact, one can argue that any form of motor learning is associated with proprioceptive processing and thus may train proprioception. If one subscribes to such wide interpretation of proprioceptive training, the acquisition of motor skills, even those that are typically viewed to be visuomotor tasks such as reaching for objects or throwing darts, constitute a form of proprioceptive training. We would argue that such a wide definition of proprioceptive training is not helpful when addressing motor deficits that are known to be associated with proprioceptive dysfunction. Knowing that motor learning is inherently multisensory, it becomes impossible to discern if improvements in the acuity or sensitivity of one or more modality such as proprioception or vision contributed to improvements in motor performance, or whether changes in multisensory or sensorimotor integration are responsible. Consequently, in order to gain an understanding of the effectiveness of proprioceptive training, there ought to be a common understanding of what constitutes proprioceptive training. We therefore propose the following operational definition: Proprioceptive training is an intervention that targets the improvement of proprioceptive function. It focuses on the use of somatosensory signals such as proprioceptive or tactile afferents in the absence of information from other modalities such as vision. Its ultimate goal is to improve or restore sensorimotor function.

Because the term proprioceptive training has been widely used and claims of improved proprioception through specific interventions are commonly found in the literature, we applied the above definition to conduct a systematic review on the effectiveness of proprioceptive training. Specifically, we aimed to (a) document the array of outcome measures that have been used to assess proprioceptive training, (b) provide quantifiable data on the effectiveness of proprioceptive training intervention methods to improve somatosensory or sensorimotor performance, and (c) examine to what disease entities proprioceptive training has been applied. Finally, we critically discuss the main findings of this comprehensive review and provide recommendations for future research in this emerging field of study.

More at link.