Upper extremity proprioception in healthy aging and stroke populations, and the effects of therapist- and robot-based rehabilitation therapies on proprioceptive function

I've got 25 posts on proprioception but  none struck me as being useful for rehab. But then if we had a decent or even mediocre stroke association we could go to their website and see the protocols for each deficit and their efficacy. But we have jackshit, deal with it.
http://journal.frontiersin.org/article/10.3389/fnhum.2015.00120/full?
Charmayne Mary Lee Hughes¹*, Paolo Tommasino¹, Aamani Budhota^1,2 and Domenico Campolo¹

• ¹Robotics Research Centre, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
• ²Interdisciplinary Graduate School, Nanyang Technological University, Singapore

The world’s population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover, the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review, we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist- and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research.

Introduction

Proprioceptive information is important for balance and postural control, the control and regulation of coordinated movements, motor learning, and error correction during movements (Jeannerod, 1988; Schmidt and Lee, 1988) and is generally composed of the modalities joint position sense and the sensation of limb movement (Gandevia et al., 2002). Joint position sense is defined as the ability of an individual to identify the static location of a body part, and is served by muscle spindle afferents and cutaneous afferents (Proske, 2006; Proske and Gandevia, 2009). Kinesthesia, a term introduced by Bastian (1887), refers to the perception of active and passive motion. Passive motion sense is served by slowly adapting mechanoreceptors (mainly secondary spindle endings and tendon organs in muscle), and tendon organs and Ruffini spray endings in other deep tissues, whereas active motion sense stems from the more rapidly adapting proprioceptors; mainly the muscle spindle primary endings, and lamellated corpuscles in other deep tissues (Grigg, 1994; Hogervorst and Brand, 1998).

The importance of proprioception in performing coordinated movements has been demonstrated in studies investigating motor control in individuals with proprioceptive deficits resulting from sensory neuropathy conditions or surgery (Rothwell et al., 1982; Ghez et al., 1995; Gordon et al., 1995; Messier et al., 2003; Sarlegna et al., 2006) and by disrupting proprioception in physically and neurologically healthy participants using tendon vibration (Cody et al., 1990; Cordo et al., 1995). Deficits in upper extremity proprioceptive function have also been reported in normally aging older adults (Adamo et al., 2007; Riberio and Oliveria, 2007) and individuals with stroke (Twitchell, 1951; Carey et al., 1993; Yekutiel, 2000), and have been found to negatively impact the quality of daily life and independence of the affected individual (Carey et al., 1997).

In this review, we first provide an overview of the behavioral research on upper extremity proprioceptive deficits in normally aging older adults, and then present an up-to-date overview of the proprioceptive declines in stroke patients. We conclude this review by reporting the state of the art in conventional and robotic rehabilitation of upper extremity proprioceptive function, and discuss the existing problems in this field and what may be proposed to move this area of science forward.