Proprioception Deficit Disorders
A major component of proprioception is joint position sense, which is a measurement of the accuracy of joint-angle replication from what was initiated from the brain. This can be conducted actively or passively as well as in an open or closed chain environment. Proprioception is the sense of relative position of neighboring parts of the body and strength of effort being employed during movement. Proprioceptors in striated muscles (skeletal muscles), tendons, and joints provide proprioception in humans.
Originally described by Julius Caesar Scaliger (1484—1558) as a “sense of locomotion” and later described as a “muscle sense” by Charles Bell (1774—1842), proprioception was one of the first descriptions of physiologic feedback mechanisms. Charles Scott Sherrington (1857—1952) introduced the terms proprioception, interoception, and exteroception, which all provide information as to where information originates. Joint position sense tests involve the ability of an individual to perceive the position of a joint without the aid of vision. Experimental evidence shows there is no strong relationship between these two aspects.
Applications and Impairment
Many applications of proprioception are used in things including but not limited to field sobriety tests, diagnosis, learning new skills, training, and joint-position matching. Being asked to touch your finger to your nose with your eyes closed is a common field sobriety test. Those with no deficits can do this with little to no error. Those with deficits, or alcohol intoxication, will fail this test because they cannot locate their limbs in space in relation to their nose. A very similar test is also done to diagnose neurological disorders. Proprioception is what allows a person to learn how to walk in complete darkness without losing balance.
Proprioception can be impaired in individuals with diseases or injuries including but not limited to (1) just being tired, (2) seizures and epilepsy, (3) vitamin B6 overdose, (4) Ehlers-Danlos syndrome (an inherited disease that affects the connective tissues, particularly of the spine and craniovertebral junction), and (5) a spectrum of autism disorders like Asperger’s syndrome, to name just a few.
In 2013, Elke Heremans and colleagues wrote a review of current research about freezing of gait in Parkinson’s disease. They defined freezing of gait “as a brief, episodic absence or marked reduction of forward progression of feet despite the intention to walk.” Additionally, freezing of gait is one of the most debilitating motor symptoms that patients with Parkinson’s disease exhibit and is the leading cause of falls in these patients. Heremans and colleagues found that freezing of gait consists of both motor deficits and cognitive deficits, and that the main cause of freezing of gait is an abnormal gait pattern generation.
Another study by Toby Smith and colleagues (2013) addressed joint proprioception in people with benign joint hypermobility syndrome (BJHS). This research focused on determining whether people with BJHS exhibit reduced joint proprioception and if they do, if it is evident in all age groups. BJHS is one of the most common heritable connective tissue disorders and is associated with joint laxity, instability, and pain. It typically manifests with symptoms including but not limited to decreased stiffness and stability from tendons, ligaments, and join capsules. Their study mostly consisted of database searches in MEDLINE, Embase, CINAHL, AMED, PubMed, and PEDro using keywords including but not limited to position sense, proprioception, postural balance, and instability. They initially found 116 individuals from the search but only 18 were potentially eligible for the study. However, the number decreased to five individuals being eligible after full text review. Following the analysis of the data Smith and colleagues collected, they concluded that people with BJHS demonstrate poorer lower limb joint position sense and threshold detection to movement with statistically different results from those without joint hypermobility. Very few studies Smith et al. looked at addressed upper limbs, so results were not significant in their study as this sample size was too small to make any conclusions.
See also: Exteroception; Interoception; Proprioception
Heremans, Elke, Alice Nieuwboer, & Sarah Vercruysse. (2013). Freezing of gait in Parkinson’s disease: Where are we now? Current Neurology and Neuroscience Reports, 13(6), 350.
Scheper, Mark C., Janneke E. de Vries, Jeanine Verbunt, & Raoul H. Engelbert. (2015). Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): It is a challenge. Journal of Pain Research, 8, 591—601.
Smith, Toby O., Emma Jerman, Victoria Easton, Holly Bacon, Kate Armon, Fiona Poland, & Alex J. Macgregor. (2013). Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis. Rheumatology International, 33(11), 2709—2716. Retrieved from http://link.springer.com/article/10.1007/s00296-013-2790-4#/page-2