Name: a simple non-invasive method for temporary knockdown of upper limb proprioception
Uploaded: 2018-03-03T14:00:00
Description: Watch this Scientific Journal Video about A Simple Non-invasive Method for Temporary Knockdown of Upper Limb Proprioception at JoVE.com

The authors would like to acknowledge Jon Nelson PhD, PT, for conducting the analysis to confirm the vibration frequency of the vibrator used in this protocol.

The Institutional Review Board at the College of St. Scholastica has approved the study under which this protocol was developed and tested.
NOTE: The manufacturer&#39;s specifications of the vibrator used in this protocol indicated that the frequency on &#39;high&#39; was 11,00 rpm (183.3 Hz). This frequency was confirmed using a sample of vibration data collected through one input of a differential amplifier sampled at 2 kHz. The mean period of the signal was 5.56 x 10-3 s, which i...

<ol>
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P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+assessment+of+limb+position+sense+following+stroke.">Quantitative assessment of limb position sense following stroke.</a> Neurorehabilitation and neural repair. 24, 178 (2010).</li><li>Cappello, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-aided+assessment+of+wrist+proprioception.">Robot-aided assessment of wrist proprioception.</a> Frontiers in human neuroscience. 9, (2015).</li><li>Han, J., Waddington, G., Adams, R., Anson, J., Liu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+proprioception:+a+critical+review+of+methods.">Assessing proprioception: a critical review of methods.</a> Journal of Sport and Health Science. 5, 80-90 (2016).</li><li>Goble, D. 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E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryotherapy+and+joint+position+sense+in+healthy+participants:+a+systematic+review.">Cryotherapy and joint position sense in healthy participants: a systematic review.</a> Journal of athletic training. 45, 306-316 (2010).</li><li>Weerakkody, N., Mahns, D., Taylor, J., Gandevia, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impairment+of+human+proprioception+by+high-frequency+cutaneous+vibration.">Impairment of human proprioception by high-frequency cutaneous vibration.</a> The Journal of physiology. 581, 971-980 (2007).</li><li>Boucher, J. A., Normand, M. 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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensory+integration+and+praxis+test+(SIPT).">Sensory integration and praxis test (SIPT).</a> Los Angeles, Western Psychological Services. , (1989).</li><li>Dunn, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Somatosensation+assessment+using+the+NIH+Toolbox.">Somatosensation assessment using the NIH Toolbox.</a> Neurology. 80, S41-S44 (2013).</li><li>Dunn, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+Change+in+Somatosensation+Across+the+Lifespan.">Measuring Change in Somatosensation Across the Lifespan.</a> American Journal of Occupational Therapy. 69, 6903290020p6903290021-6903290020p6903290029 (2015).</li><li>Witchalls, J., Blanch, P., Waddington, G., Adams, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intrinsic+functional+deficits+associated+with+increased+risk+of+ankle+injuries:+a+systematic+review+with+meta-analysis.">Intrinsic functional deficits associated with increased risk of ankle injuries: a systematic review with meta-analysis.</a> Br J Sports Med. 46, 515-523 (2012).</li><li>Borstad, A. L., Nichols-Larson, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+and+treating+Higher-level+Somatosensory+Impairments+Post+Stroke.">Assessing and treating Higher-level Somatosensory Impairments Post Stroke.</a> Topics in Stroke Rehabilitation. 21, 290-295 (2014).</li><li>Kandel, E. R., Schwartz, J. H., Jessell, T. M., Siegelbaum, S. A., Hudspeth, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Principles of neural science. 4, (2000).</li><li>Goodwin, G. M., Mccloskey, D. I., Matthews, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+contribution+of+muscle+afferents+to+keslesthesia+shown+by+vibration+induced+illusionsof+movement+and+by+the+effects+of+paralysing+joint+afferents.">The contribution of muscle afferents to keslesthesia shown by vibration induced illusionsof movement and by the effects of paralysing joint afferents.</a> Brain. 95, 705-748 (1972).</li><li>Burke, D., Hagbarth, K. E., L&#246;fstedt, L., Wallin, B. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+responses+of+human+muscle+spindle+endings+to+vibration+of+non-contracting+muscles.">The responses of human muscle spindle endings to vibration of non-contracting muscles.</a> The Journal of physiology. 261, 673-693 (1976).</li><li>Roll, J., Vedel, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Kinaesthetic+role+of+muscle+afferents+in+man,+studied+by+tendon+vibration+and+microneurography.">Kinaesthetic role of muscle afferents in man, studied by tendon vibration and microneurography.</a> Experimental Brain Research. 47, 177-190 (1982).</li><li>Wigley, F. 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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impaired+limb+position+sense+after+stroke:+a+quantitative+test+for+clinical+use.">Impaired limb position sense after stroke: a quantitative test for clinical use.</a> Arch.Phys.Med.Rehabil. 77, 1271-1278 (1996).</li><li>Roll, J., Vedel, J., Ribot, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alteration+of+proprioceptive+messages+induced+by+tendon+vibration+in+man:+a+microneurographic+study.">Alteration of proprioceptive messages induced by tendon vibration in man: a microneurographic study.</a> Experimental brain research. 76, 213-222 (1989).</li><li>Calvin-Figui&#232;re, S., Romaigu&#232;re, P., Roll, J. -. 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This protocol provides a method to knock down human proprioception in the upper limb. Across 20 healthy participants the effect of proprioceptive knockdown was large as measured by VDT a psychophysical measure of sensitivity thought to reflect A&#945; afferent axon transmission. The VDT was measured as quickly as possible after removal of vibration, when A&#945; afferent discharge is reduced.25 The effect of this protocol on error in reaching to a target with visual occlusion (tBKT) was moderate. ...

Of all contributors to the neural control of movement, proprioception may be the least well measured. Research measures of proprioception using specialized equipment have recently achieved reliability, validity, and precision;1,2,3 in contrast, clinical measures of proprioception, the most common being limb position sense testing,4 have low resolution, are contaminated by other sensory modalities,4 and have poor or no published psychometric properties.5 New precise, reliable measures of proprioception are needed to elucidate peripheral and central mechanisms of proprioceptive control,3 for clinical diagnosis of impairment, and to measure outcomes of proprioceptive training.2,5,6,7 Toward this end, a simple, non-invasive method to temporarily impair or &#39;knockdown&#39; proprioception is needed.
Proprioceptive knockdown in healthy humans allows researchers to infer the role of proprioceptive function in a sensorimotor task, which is useful to inform the development and validation of standardized measures. Knockdown models have two main advantages over studying humans with impaired proprioception. The first is participant availability; individuals with proprioception impairment are not easily accessible to many researchers. Second, unlike in vivo proprioception impairment, knockdown models may allow the ability to control the extent of impairment across participants.
Current published methods of temporary proprioception knockdown of the upper limb are invasive, impractical, or uncomfortable for the participant. Anesthetic injections, while relatively safe, require technical expertise and may be considered invasive by some research participants. Ischemic nerve blocks cause discomfort and a blood test to screen for clotting disorders prior to their application is practiced.8 Cryotherapy also causes discomfort. The average time of application for cryotherapy to impact proprioception is 20.3 &#177; 5.3 min.9 Once cryotherapy is removed, a brief window in which to measure proprioception prior to rewarming remains, which may contribute to the inconsistent effect of cryotherapy on joint position sense.10 High frequency (300 Hz) vibration was used successfully to reduce proprioceptive acuity in a finger movement detection task; the mechanism was reported to be pacinian corpuscle-induced inhibition of input from other vibration sensitive cutaneous receptors.11 Recently, soleus muscle vibration (80 Hz) was found to decrease isometric force production accuracy by distorting proprioceptive information.12 However, a simple non-invasive method for temporary knockdown of upper limb proprioception has not been published.
The purpose of this method is to use high frequency vibration to temporarily knockdown upper limb proprioception in healthy adults. Knockdown was confirmed using two measures, the Vibration Detection Threshold (VDT) and the tablet version of the Brief Kinesthesia Test (tBKT). The VDT is a psychophysical measure of sensitivity thought to reflect A&#945; afferent axon transmission.13 Proprioceptive performance was quantified using the tBKT that is under development in our lab. The Brief Kinesthesia Test (BKT), based on the work of Ayres,14 is an experimental instrument that was tested for but not included in the National Institutes of Health (NIH) Toolbox core batteries.15,16 The BKT includes three reaching trials for each upper limb. The tBKT includes 20 reaching trials per upper limb and is being developed with the goal of improving the psychometric properties over the original test. The tBKT involves a sensory input (examiner guidance of upper limb to target), central processing (remember the spatial location of the target) and a motor output (attempting to locate the target after guidance is removed), thought to be necessary in a measure of overall proprioceptive performance.17 The VDT and the tBKT measurements, represent low and higher levels, respectively, in the somatosensory hierarchy,18 and thus should provide a more comprehensive quantification of proprioception than either measure used alone.
Two neural mechanisms relate most closely to the reduced proprioceptive acuity caused by high frequency vibration. First, Pacinian corpuscles are the cutaneous mechanoreceptor most commonly associated with vibration detection. The continuous vibration used in this protocol likely raises the receptor tuning threshold of vibration detection based on the neural mechanism of short-term habituation in the A&#945; and &#946; fiber group associated with Pacinian corpuscles.19 The physiologic result is that a vibration of the same intensity and frequency, such as 128 Hz used in the VDT test, is felt for a shorter duration. Second, it is thought that muscle spindles, via A&#945; afferent fibers, code muscle length inaccurately following high frequency vibration resulting in distorted proprioceptive information as evidenced by reduced accuracy during force reproduction,12 illusion of movement,20,21 and reduced kinesthesia.22

<table border="0" cellpadding="0" cellspacing="0" width="1075">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:329px;">Pure Enrichment-Massage Mini with Built in USB Rechargeable Battery</td>
			<td style="width:123px;">ebay</td>
			<td style="width:171px;">None</td>
			<td style="width:455px;">183 Hz cordless vibrator, 7 inches total length including handle</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Chattanooga 2.5 inch velcro strap&#160;</td>
			<td>ebay</td>
			<td>None</td>
			<td>used to secure vibrator to arm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Tuning Fork C128 ENT Surgical Medical Instruments Exam Diagnostic Tools</td>
			<td>ebay</td>
			<td>None</td>
			<td>Used in VDT</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Handheld Digital stop watch</td>
			<td>ebay</td>
			<td>None</td>
			<td>Used to time VDT</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Universal Rubber Bands Size 33, 3 1/2 x 1/8 inch</td>
			<td>ebay</td>
			<td>Universal - UNV00433</td>
			<td>used to secure vibrator head to arm</td>
		</tr>
		<tr height="40">
			<td colspan="4" height="40" style="height:40px;">Instructions to build Visual Screen were published here: https://www.jove.com/video/53178/design-fabrication-administration-hand-active-sensation-test&#160;</td>
		</tr>
	</tbody>
</table>

a simple non-invasive method for temporary knockdown of upper limb proprioception

Proprioception may be the least well measured of all contributors to the neural control of movement. New precise, reliable measures of proprioception are needed for clinical diagnosis of impairment, and to measure outcomes of proprioceptive training. The purpose of this simple, non-invasive method is to temporarily knockdown upper limb proprioception in healthy adults, to an extent that would be useful in the development and testing of upper limb proprioception measures. Knockdown models have two main advantages over studying humans with impaired proprioception: participant availability and the ability to control the extent of impairment across participants. Current published methods of temporary proprioception knockdown of the upper limb, such as ischemic nerve blocks and cryotherapy, are invasive, impractical, or uncomfortable for the participant. Here, vibration over the ulnar groove was used to reduce upper limb proprioception. High frequency vibration may reduce proprioceptive acuity by inhibiting pacinian corpuscle-induced input. The effect of vibration used in this protocol was confirmed using two quantitative measures. This method was simple to administer, comfortable for participants, and practical.

Using the protocol presented here, we tested 20 healthy adults, 8 were male (mean age (SD)= 32.5 (12.5) years; 19 right-, and 1 left- handed). The participants had no known pathology involving the upper extremities. Handedness was assessed using the Edinburgh Handedness Inventory.24 Study participants reported no adverse events.
Both upper limbs of each participant were tested using the VDT and the tBKT a...

Watch this Scientific Journal Video about A Simple Non-invasive Method for Temporary Knockdown of Upper Limb Proprioception at JoVE.com

A Simple Non-invasive Method for Temporary Knockdown of Upper Limb Proprioception

The goal of this protocol is to demonstrate a practical method to temporarily interfere with proprioception in the upper limb of healthy humans.

Proprioception may be the least well measured of all contributors to the neural control of movement. New precise, reliable measures of proprioception are ...

The overall objective of this protocol is to demonstrate a practical method to temporarily interfere with proprioception in the upper limb of healthy humans. This video describes the materials needed, the procedure for the protocol as well as representative results from carrying out this protocol. The materials used in this protocol include:a two and a half inch wide strap, a rubber band, a permanent marker, and a cordless 183 hertz vibrator.This protocol is intended to reduce proprioceptive acuity in the upper limb of healthy humans. For this protocol the head of the vibrator is placed in the ulnar groove just superior to the line between the olecranon process of the humerus and the medial epicondyle of the ulna. To locate the placement for the head of the vibrator palpate the ulnar nerve in the ulnar groove between the olecranon process and the medial epicondyle.Place an x just superior to them. Place the head of the vibrator onto the marked location with the handle of the vibrator superior to the head. Apply a strap around the handle of the vibrator and the participant's arm.Apply a rubber band around the head of the vibrator to ensure its connection with the surface of the skin. Have the participant bend and straighten their elbow. If they report interference adjust the straps and rubber band so that freedom of movement is ensured.Turn the vibrator on and wait for two minutes prior beginning your measurement of upper limb kinesthetic sense. In this experiment, with the vibrator still on, proprioceptive performance was quantified using the tablet version of the Brief Kinesthesia Test which is under development in our lab. The tablet version of the Brief Kinesthesia Test includes 20 routine trials with visual occlusion per upper limb.Absolute error in the distance for the target is quantified and is thought to reflect kinesthetic sense. The tablet version of the Brief Kinesthesia Test involves a sensory input, which is the examiner's guidance of the upper limb to the target. Central processing, in which the participant tries to remember the spatial location of the target, and a motor output, which is the participant's attempt to locate the target after guidance has been removed.These three elements are thought to be necessary in a measure of overall proprioceptive performance. The materials needed to determine the vibration detection threshold include:a 128 hertz tuning fork, a stopwatch, a textbook, a standard-height table and chair, and a pen. Using a permanent marker color the bottom one millimeter around the stem of the tuning fork.This mark is used to standardize the depth and therefore the pressure of the tuning fork application during the test. Mark a dot on the skin over the distal biceps tendon one centimeter superior to the crease in the elbow. Place a textbook at the edge of the table close to the participant, the textbook provides a firm but compliant surface on which to strike the tuning fork.Good.Read the instructions to the participant. This is test of your ability to detect vibration. Now I will put this tuning fork ion your biceps tendon.Please tell me if you feel any vibration, then say now immediately when the sensation of vibration disappears. This procedure will be repeated three times. For this protocol the vibration detection test was conducted immediately after removal of the vibration which had been on the arm for five minutes.To administer the vibration detection test the examiner holds the stem of the tuning fork loosely between the thumb and index finger and strikes it on the book inside of the square target with enough force to produce resonance. Immediately after striking the tuning fork, it's placed on the test location using enough pressure to depress the skin and conceal the one millimeter band on the tuning fork from vision. Using the stopwatch you quantify the time from the placement of the tuning fork on the participant's skin, until the participant no longer feels the vibration and says now.This procedure is repeated two more times on that arm. Here we present representative results. Using the protocol presented here we tested 20 healthy adults who had no known pathology of the upper limbs.Each participant was tested using the two measures at two separate sessions which were one week apart. At session two participants completed the same measures under the condition of temporary proprioception knockdown. A repeated measures design evaluated the vibration detection threshold test, retest, reliability.The Pearson correlations were 0.64 and 0.61 for the right and left upper limbs respectively The intraclass correlation coefficients were 0.77 and 0.76. To test the directional hypothesis that proprioception knockdown using vibration would result in proprioception impairment, one-tailed paired t-tests were used to compare mean error between week one, week two, and the proprioception knockdown conditions for the VDT and the BKT. The proprioception knockdown protocol resulted in statistically poorer scores on the VDT and the BKT for both upper limbs, while the control conditions were not statistically different.The extent of proprioception knockdown that resulted from the protocol was quantified by calculating effect size. The effect size on the vibration detection threshold was large, while the effect size for the Brief Kinesthesia Test was moderate. In summary high frequency vibration is successful in reducing upper limb proprioceptive acuity.This could be used in the development and testing of limb proprioceptive measures, it is simple to administer, comfortable for participants, and practical.

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An individual's sexual drive is influenced by genotype, experience and environmental conditions. How these factors interact to modulate sexual behaviors ...

Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation

Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. Virtual reality (VR) has the potential to satisfy these requirements. ...

A Simple and Low-cost Assay for Measuring Ambulation in Mouse Models of Muscular Dystrophy

Measuring functional outcomes in the treatment of muscular dystrophy is an essential aspect of preclinical testing. The assessment of voluntary ambulation ...