Telling us of a problem with no suggested
solution doesn't help stroke survivors one bit! What will your
competent? doctor do to prevent this problem from happening? What is your doctor's EXACT PROTOCOL TO BRING BACK PROPRIOCEPTION? Doesn't have one? You don't have a functioning stroke doctor!
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with name and my response in my blog. Or are you afraid to engage with my stroke-addled mind?
Impaired proprioception and magnified scaling of proprioceptive error responses in chronic stroke
Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 51 (2024)
Abstract
Background
Previous work has shown that ~ 50–60% of individuals have impaired proprioception after stroke. Typically, these studies have identified proprioceptive impairments using a narrow range of reference movements. While this has been important for identifying the prevalence of proprioceptive impairments, it is unknown whether these error responses are consistent for a broad range of reference movements. The objective of this study was to characterize proprioceptive accuracy as function of movement speed and distance in stroke.
Methods
Stroke (N = 25) and controls (N = 21) completed a robotic proprioception test that varied movement speed and distance. Participants mirror-matched various reference movement speeds (0.1–0.4 m/s) and distances (7.5–17.5 cm). Spatial and temporal parameters known to quantify proprioception were used to determine group differences in proprioceptive accuracy, and whether patterns of proprioceptive error were consistent across testing conditions within and across groups.
Results
Overall, we found that stroke participants had impaired proprioception compared to controls. Proprioceptive errors related to tested reference movement scaled similarly to controls, but some errors showed amplified scaling (e.g., significantly overshooting or undershooting reference speed). Further, interaction effects were present for speed and distance reference combinations at the extremes of the testing distribution.
Conclusions
We found that stroke participants have impaired proprioception and that some proprioceptive errors were dependent on characteristics of the movement (e.g., speed) and that reference movements at the extremes of the testing distribution resulted in significantly larger proprioceptive errors for the stroke group. Understanding how sensory information is utilized across a broad spectrum of movements after stroke may aid design of rehabilitation programs.
Background
Proprioception, the sense of our body’s location and motion in space [1], is necessary for coordinated movement. Our group and others have detailed that proprioception is impaired in ~ 30–60% of individuals after stroke [2,3,4,5,6,7,8,9]. Loss or impairment of proprioception can result in poor coordination [10], decreased stability and interlimb coordination [11, 12], reduced motor learning [13], and overall poorer function and independence [14]. While the functional implications for stroke survivors with proprioceptive impairments are broad, our understanding of the scope and impact of these impairments to movement is limited.
To date, a variety of techniques have been employed to identify deficits in position sense and kinesthesia of the wrist [2, 15] or the limb [4, 6, 16,17,18,19,20,21,22,23]. Here, the experimenter or device passively moves the participant’s hand or limb to a pre-determined location. The participant then indicates using a protractor or other representational map of space (i.e., opposite limb), where they feel that their wrist or limb is located. While these techniques have been successful in identifying proprioceptive impairments, these paradigms have been limited in that they only observed a single type of movement or minimal variations (e.g., different angles) on a single type of movement [4, 6, 16, 18, 22, 24, 25]. Therefore, these paradigms fail to broadly survey movements similarly to how they are produced in everyday functional activities.
The contributions of proprioception to movement execution are complex and include several factors that can contribute to changes in proprioceptive error detection and accuracy outside of the impact of stroke, including limitations of the sensitivity and detection thresholds of muscle spindles [26,27,28], sensory attenuation [29,30,31], and perceptual differences in peripersonal vs. extrapersonal space [32,33,34]. It is likely that stroke further magnifies these systemic differences and limitations; however, we have only just begun to identify and understand the proprioceptive contributions to movement execution in stroke. While current research has demonstrated proprioceptive impairment in stroke, these paradigms have limited insights across a broad range of movements, especially when we consider the broad ranging neural damage that can impact proprioception [35, 36]. Therefore, the main goal of the current study was to examine how stroke affects proprioceptive error to reference movements drawn from broad speed and distance distributions within the upper limbs. Reference movements are defined as passive movements of the more affected limb that were matched. We predicted that individuals with chronic stroke will have greater proprioceptive impairments compared to age-matched controls and that these impairments would be most salient for reference movements drawn from both tails of the distributions (e.g., slower or longer movements) [37]. By identifying proprioceptive error to a broad range of reference movement characteristics, we can better understand how upper limb proprioceptive accuracy contributes to impairments in sensorimotor function and subsequently inform rehabilitation practices.
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