What is your doctor's current protocol to recover proprioception? Incompetently doesn't have one, right? No protocol, YOUR DOCTOR HAS BEEN INCOMPETENT FOR OVER A DECADE!
If your doctor writes E.T. prescriptions (Evaluate and Treat) to the OT, PT and OT like mine did, it means they KNOW NOTHING ABOUT STROKE RECOVERY! Why haven't they been fired yet? I could train a chimp to do that. If he knew anything about stroke recovery it didn't show.
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you don't have proprioception protocols.
Why isn't your 'professional' solving stroke?
Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!
proprioception (74 posts to March 2011)
- Proprioceptive based training
(2 posts to August 2015)
- proprioceptive body vibration rehabilitation
(1 post to December 2023)
- proprioceptive exercise
(1 post to July 2022)
- Proprioceptive Neuromuscular Facilitation
(3 posts to January 2014)
A pilot study for self-guided, active robotic training of proprioception of the upper limb in chronic stroke
Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 130 (2025)
Abstract
Background
Proprioceptive impairments of the upper limb are common after stroke. These impairments are not typically addressed during assessment or rehabilitation. Currently, most robotic paradigms for training of the upper limb have focused solely on improving motor function or have targeted proprioception in individuals with combined use of visual feedback. Our goal was to design a training paradigm that directly targets proprioception of the upper limb, while minimizing reliance on other sensory information to improve sensorimotor function after stroke.
Methods
In this pilot study, 5 individuals with stroke and 5 age-matched controls were tested on a single-day proprioceptive training paradigm. Here, participants used a joystick with their less-affected arm to send commands to a KINARM exoskeleton that would passively move their more-affected arm. To complete the passive reaching task, participants relied only on proprioceptive feedback from the more-affected arm and were only given knowledge of results information after each trial. Sensorimotor function of the upper limb was measured pre- and post-training via robotic measures of motor function [Visually Guided Reaching (VGR)] and position sense [Arm Position Matching (APM)]. Sensorimotor function was quantified as a Task Score, which incorporated multiple task-relevant parameters for both VGR and APM. Changes in sensorimotor performance due to training were calculated as the pre- to post-training difference for VGR and APM within the control and stroke groups.
Results
We found significant improvements from pre-training to post-training for VGR in individuals with stroke (p < 0.001, CLES = 100) that were not observed in control participants (p = 0.87, CLES = 80). We observed significant changes from pre- to post-training in both VGR (Posture Speed, Reaction Time, Initial Direction Angle, Min–Max Speed Difference, and Movement Time) and APM (Contraction/Expansion Ratiox and Shifty) parameters.
Conclusions
Our novel proprioceptive training paradigm is one of the first to implement a self-guided sensory training protocol. We observed improvements in motor function and proprioception for individuals with stroke. This pilot study demonstrates the feasibility of self-guided proprioceptive training to improve motor and sensory function in individuals with stroke. Future studies aim to examine multi-day training to examine longer-term impacts on upper limb sensorimotor function.
Background
Proprioception refers to our sense of static position (position sense) and movement (kinesthesia) in space [1]. Proprioception is critical for movement execution of the upper limb [2,3,4,5] and when proprioception is largely eliminated, as in individuals with sensory deafferentation, movement quality is significantly compromised [6, 7]. Neurological impairments, such as stroke, have also been shown to impair proprioception, with many individuals (~ 50 to 60%) after stroke exhibiting some type of proprioceptive impairment [8,9,10,11,12].
Historically, motor impairments following stroke have been studied extensively and remain a primary area for targeted improvement in neurorehabilitation [13,14,15,16,17,18]. In contrast, proprioceptive impairments are an often underexplored area of rehabilitation, as clinicians report that 1–25% of completed evaluations contain proprioceptive assessments [19]. Further, they report that use of evidence-based somatosensory training occurs in 18% or less of clinical interventions [20]. However, recent work has utilized robotic paradigms for the upper limb to examine whether proprioception can be improved [21,22,23,24,25,26]. Previous work in adults who are neurologically intact has shown efficacy for training proprioception using forced choice paradigms. Here, the participant’s arm is passively moved to the right or left of the midline. They report the perceived direction of movement and then receive feedback on response accuracy [21, 24, 26]. Other paradigms have required participants to make unseen reaches in 3D space to remembered targets [22] and actively retrace a pattern after being passively moved through the pattern [23]. A recent study implemented a forced choice paradigm in individuals with stroke and found improvements in both motor and proprioceptive behavior, providing promising evidence for targeted improvement of proprioception after stroke [25]. It is unsurprising that proprioceptive training improved reaching behavior as proprioception is critical for smooth and coordinated reaching movements [2, 4, 6, 27, 28]. Additionally, two of these studies have promoted active subject participation [22, 23] and yielded more robust improvements in proprioception compared to those studies with more passive designs [21, 24,25,26].
The goal of the current study was to design a proprioceptive training paradigm to improve proprioception in individuals with chronic stroke that would build on the insight gathered from a set of recent successful proprioceptive training studies [21, 23,24,25,26]. Here, we target the following task objectives: (1) promotion of active subject participation during task execution, (2) require and encourage participants to use real-time proprioception of the more-affected limb for task success, (3) cooperative interplay between the less-affected limb to actively guide passive movement of the more-affected limb. For evaluation of the developed paradigm, a sample of individuals post-stroke and control participants were recruited to participate in a single-session proprioceptive training protocol. We hypothesized that robotic proprioceptive training would result in a reduction of proprioceptive deficits associated with chronic stroke. Therefore, we predicted that (1) individuals with stroke would improve both their motor and proprioceptive performance after training, and (2) individuals with stroke would show more spatial and temporal errors and slower learning during proprioceptive training compared to age-matched controls [29].
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