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Amrita Patro and Wanda van Niekerk Page Owner - Amanda Ager as part of the One Page Project Introduction[edit | edit source]Proprioception (sense of proprioception) is an important bodily neuromuscular sense. It falls under our "sixth sense", more commonly known as somatosensation. The term somatosensation (or somatosensory senses) is an all encompassing term which includes the sub-categories of mechanoreception (vibration, pressure, discriminatory touch), thermoreception (temperature), nociception (pain), equilibrioception (balance) and proprioception (sense of positioning and movement).[1] The feedback from all these different sensory components arise from our peripheral nervous system (PNS), and feed information to our central nervous system (CNS), both at the level of the spinal cord (reflexive) and sent to the cerebral cortex for higher processing.[2] Proprioception itself can be understood as including various sub-modalities: Proprioception (Joint Position Sense): Proprioception is our sense of joint / limb positioning. It is often measured through joint position sense - active joint position sense (AJPS) and passive joint position sense (PJPS). Joint position sense determines the ability of a person to perceive a presented joint angle and then, after the limb has been moved, to actively or passively reproduces the same joint angle[3] (Clinically measured as a joint matching task). Kinaesthesia: Kinaesthesia (kinaesthesis) is the awareness of motion of the human body (motion sense).[4] Sense of movement refers to the ability to appreciate joint movement, including the duration, direction, amplitude, speed, acceleration and timing of movements.[3] Sense of Force: Sense of Force (SoF) is also known as sense of effort / heaviness / tension or the force matching sense. It is the ability to reproduce (or match) a desired level of force one or more times. Sense of force is thought to stem from the afferent feedback of the Golgi Tendon Organs (GTOs) embedded within our tendons, the muscle spindles within our muscles and proprioceptions within our skin.[5] Sense of Change in Velocity (SoV): SoV is our ability to detect vibration, derived from oscillating objects placed against the skin.[6] It is believed to travel through the same type of large afferent nerve fibers (Aαβ) as proprioception.[7] Somatosensation. Retrieved from: Ager, A.L., Borms, D., Deschepper, L., Dhooghe, R., Dijkhuis, J., Roy, J.S., & Cools, A.Proprioception and shoulder pain: A Systematic Review. J Hand Ther. 2019 Aug 31. pii: S0894-1130(19)30094-8. doi: 10.1016/j.jht.2019.06.002. Globally, all sub-modalities of proprioception arise from the sum of neural inputs from the joint capsules, ligaments, muscles, tendons, and skin, in a multifaceted system, which influences behavior regulation and motor control of the body.[8] Proprioception is critical for meaningful interactions with our surrounding environment. Proprioception helps with the planing of movements, sport performance, playing a musical instrument and ultimately helping us avoid an injury. The neurological basis of proprioception comes primarily from sensory receptors (mechanoreceptors and proprioceptors) located in your skin, joints, and muscles (muscle spindles with a smaller component from tendon organ afferents, cutaneous receptors and minimal input from joint receptors). These muscle afferents receptors allow for the identification of limb position and movement via neural signalling of a change in muscle, skin or joint stretch[9]. Hence, proprioception is basically a continuous loop of feedforward and feedback inputs between sensory receptors throughout your body and your nervous system. A mechanoreceptor is a sensory receptor in your body that responds to mechanical changes of tissues. Different types of mechanoreceptors include
There are also mechanoreceptors within the hair and skin. There are four types of mechanoreceptors found within ligamentous tissues. As all the types of mechanoreceptors are myelinated and rapidly transmit sensory information to the CNS.[10]
Type II and Type III mechanoreceptors in particular are believed to be linked to one's sense of proprioception.[10] The short video below gives a good insight into the complexities of proprioception. [11] Causes of Proprioception Impairment[edit | edit source]Poor proprioception at a joint may result in the increased likelihood of an injury.[12] The reason for proprioception impairments are not clear at this time. A decreased sense of proprioception can be caused by localized tissue damage, the presence of edema (swelling) or competitive nociceptive inputs (presence off pain). Proprioception can be affected by the following factors:
Proprioception impairments have been noted among the following neurological conditions:
Assessing Proprioception[edit | edit source]The measurement of proprioception is presently not well developed. Proprioception can only be confidently measured in a laboratory setting, using complex computer-interfaced equipment. There is presently a lack of valid, reliable and responsive tools and outcome measures to quantify proprioception deficits, in a clinical setting.[13] If you suspect a proprioception deficit, focus on the following clinical aspects. Subjective assessment should include questions regarding the following:
Objective assessment should include observation of the above and the points below:
There are a few clinical tests Physiotherapists can use to assess proprioception, depending on the body part being assessed. The include:
Learning New Skills[edit | edit source]An intact sense of proprioception is crucial to learning a new skill. During the learning of any new skill, (sport performance or an artistic activity, for example) it is usually necessary to become familiar with some proprioceptive tasks specific to that activity. Without the appropriate integration of proprioceptive input, an artist would not be able to brush paint onto a canvas without looking at the hand as it moved the brush over the canvas; it would be impossible to drive an automobile because a motorist would not be able to steer or use the foot pedals while looking at the road ahead. A person could not touch-type (typing without looking at the keys) or perform a ballet dance. The bottom line remains that our sense of proprioception is important to train and develop, as it allows us to interact with our environments without the dependence on visual feedback (for example, reaching for a cup on the top shelve, without looking at the cup). Physiotherapy - Training Proprioception[edit | edit source]No matter the underlying cause of a proprioceptive deficit, clinicians can rehabilitate patients with tasks and activities to improve motor skills, strength,balance and coordination. They can also help patients learn how to manage daily tasks (ADLs) while living with a proprioception dysfunction. There is converging evidence that proprioceptive training can yield meaningful improvements in somatosensory and sensorimotor function.[14] Retraining of a somatosensory function includes any interventions that addresses the remediation of the somatosensory modalities. Intervention methods include:
A 2019 review on sensory retraining of the leg following a stroke, concluded that interventions used for retraining leg somatosensory impairment significantly improved somatosensory function and balance, but not gait suggesting a specificity of training effect.[15] A 2005 systematic review of the effect of proprioceptive and balance exercises on people with an injured or reconstructed anterior cruciate ligaments, reported that proprioceptive and balance exercise improves outcomes in individuals with ACL-deficient knees.[16] Similarly a 2015 review on ankle sprains amongst a sporting population, concluded that proprioceptive training programmes are effective at reducing the rate of re-injury, particularly amongst those with a history of ankle sprain.[17] The effectiveness of physiotherapy treatment on balance dysfunction and postural instability in persons with Parkinson’s disease: a systematic review and meta-analysis in 2016 reported that physiotherapy interventions like balance training combined with muscle strengthening, range of movement and walking training exercise is effective in improving balance in patients with Parkinson’s disease. As proprioception can also be improved with balance training, this could possibly advocate for proprioceptive retraining as well, amongst this population.[18] Proprioception rehabilitation often include:[edit | edit source]
3. somatosensory stimulation training, such as vibration therapy, different textures (cotton ball vs. velcro); 4. Joint repositioning training (joint matching tasks). For complimentary topics, please read the following pages: Neuromuscular Exercise Program Coordination Exercises Developmental Coordination Disorder and Physical Activity Sensorimotor Impairment in Neck Pain References[edit | edit source]
What sense allows you to know where your limbs are?Proprioception, or kinesthesia, is the sense that lets us perceive the location, movement, and action of parts of the body. It encompasses a complex of sensations, including perception of joint position and movement, muscle force, and effort.
What is the sense of your body in space?This sense is called proprioception (pronounced “pro-pree-o-ception”); it's an awareness of where our limbs are and how our bodies are positioned in space. And like the other senses — vision, hearing, and so on — it helps our brains navigate the world. Scientists sometimes refer to it as our “sixth sense.”
What is the sense of body position called?Proprioception is the group of sensations generated by the body's own actions. It includes the senses of limb position and movement, the senses of force and heaviness, the sense of effort and the sense of balance.
What is the proprioception sense?Proprioception is the body awareness sense. It tells us where our body parts are without having to look for them. This helps to know where body parts are relative to each other, which strengthens our coordination skills. It also tells us how much force to use when we're holding, pushing, pulling, or lifting objects.
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