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>
	<li>Dukelow, S. 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. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proprioceptive+acuity+assessment+via+joint+position+matching:+from+basic+science+to+general+practice.">Proprioceptive acuity assessment via joint position matching: from basic science to general practice.</a> Physical therapy. 90, 1176-1184 (2010).</li><li>Meyer, S., Karttunen, A. H., Thijs, V., Feys, H., Verheyden, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+do+somatosensory+deficits+in+the+arm+and+hand+relate+to+upper+limb+impairment,+activity,+and+participation+problems+after+stroke?+A+systematic+Review.">How do somatosensory deficits in the arm and hand relate to upper limb impairment, activity, and participation problems after stroke? A systematic Review.</a> Physical Therapy. 94, (2014).</li><li>Elangovan, N., Herrmann, A., Konczak, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+proprioceptive+function:+evaluating+joint+position+matching+methods+against+psychophysical+thresholds.">Assessing proprioceptive function: evaluating joint position matching methods against psychophysical thresholds.</a> Physical therapy. 94, 553 (2014).</li><li>Aman, J. E., Elangovan, N., Yeh, I. L., Konczak, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effectiveness+of+proprioceptive+training+for+improving+motor+function:+a+systematic+review.">The effectiveness of proprioceptive training for improving motor function: a systematic review.</a> Frontiers in human neuroscience. 8, (2014).</li><li>Thiemann, U., 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=Cortical+post-movement+and+sensory+processing+disentangled+by+temporary+deafferentation.">Cortical post-movement and sensory processing disentangled by temporary deafferentation.</a> Neuroimage. 59, 1582-1593 (2012).</li><li>Furmanek, M. P., S&#322;omka, K., Juras, 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+effects+of+cryotherapy+on+proprioception+system.">The effects of cryotherapy on proprioception system.</a> BioMed research international. 2014, (2014).</li><li>Costello, J. T., Donnelly, A. 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. C., Boisseau, &. #. 2. 0. 1. ;., Descarreaux, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensorimotor+control+during+peripheral+muscle+vibration:+An+experimental+study.">Sensorimotor control during peripheral muscle vibration: An experimental study.</a> Journal of manipulative and physiological therapeutics. 38, 35-43 (2015).</li><li>Rolke, R., 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+sensory+testing:+a+comprehensive+protocol+for+clinical+trials.">Quantitative sensory testing: a comprehensive protocol for clinical trials.</a> European Journal of Pain. 10, 77-77 (2006).</li><li>Ayres, 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=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. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Raynaud's+phenomenon.">Raynaud's phenomenon.</a> New England Journal of Medicine. 347, 1001-1008 (2002).</li><li>Oldfield, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+assessment+and+analysis+of+handedness:+the+Edinburgh+inventory.">The assessment and analysis of handedness: the Edinburgh inventory.</a> Neuropsychologia. 9, 97-113 (1971).</li><li>Kito, T., Hashimoto, T., Yoneda, T., Katamoto, S., Naito, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensory+processing+during+kinesthetic+aftereffect+following+illusory+hand+movement+elicited+by+tendon+vibration.">Sensory processing during kinesthetic aftereffect following illusory hand movement elicited by tendon vibration.</a> Brain research. 1114, 75-84 (2006).</li><li>Carey, L. M., Oke, L. E., Matyas, T. 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. -. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relations+between+the+directions+of+vibration-induced+kinesthetic+illusions+and+the+pattern+of+activation+of+antagonist+muscles.">Relations between the directions of vibration-induced kinesthetic illusions and the pattern of activation of antagonist muscles.</a> Brain research. 881, 128-138 (2000).</li><li>Fallon, J. B., Macefield, V. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vibration+sensitivity+of+human+muscle+spindles+and+Golgi+tendon+organs.">Vibration sensitivity of human muscle spindles and Golgi tendon organs.</a> Muscle &amp; nerve. 36, 21-29 (2007).</li><li>Seizova-Cajic, T., Smith, J. L., Taylor, J. L., Gandevia, S. 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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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Research

JoVE Journal

Behavior

Simultaneous Scalp Electroencephalography (EEG), Electromyography (EMG), and Whole-body Segmental Inertial Recording for Multi-modal Neural Decoding

Recent studies support the involvement of supraspinal networks in control of bipedal human walking. Part of this evidence encompasses studies, including our previous work, demonstrating that gait kinematics and limb coordination during treadmill walking can be inferred from the scalp electroencephalogram (EEG) with reasonably high decoding accuracies. These results provide impetus for development of non-invasive brain-machine-interface (BMI) systems for use in restoration and/or augmentation of gait- a primary goal of rehabilitation research. To date, studies examining EEG decoding of activity during gait have been limited to treadmill walking in a controlled environment. However, to be practically viable a BMI system must be applicable for use in everyday locomotor tasks such as over ground walking and turning. Here, we present a novel protocol for non-invasive collection of brain activity (EEG), muscle activity (electromyography (EMG)), and whole-body kinematic data (head, torso, and limb trajectories) during both treadmill and over ground walking tasks. By collecting these data in the uncontrolled environment insight can be gained regarding the feasibility of decoding unconstrained gait and surface EMG from scalp EEG.

Simultaneous Scalp Electroencephalography EEG, Electromyography EMG, and Whole-body Segmental Inertial Recording for Multi-modal Neural Decoding

Development of an effective brain-machine-interface (BMI) system for restoration and rehabilitation of bipedal locomotion requires accurate decoding of user's intent. Here we present a novel experimental protocol and data collection technique for simultaneous non-invasive acquisition of neural activity, muscle activity, and whole-body kinematics during various locomotion tasks and conditions.

Recent  studies support the involvement of supraspinal networks in control of bipedal  human walking. Part of this evidence  encompasses studies, ...

Simple and Computer-assisted Olfactory Testing for Mice

Olfaction is highly conserved among species and is required for reproduction and survival.
In humans, olfaction is also one of the senses that is affected with aging and is a strong predictor of neurodegenerative diseases. Thus, olfaction testing is used as a non-invasive diagnostic method to detect neurological deficits early on. In order to understand the mechanisms underlying olfactory network susceptibility, olfactory research in rodents has gained momentum in the past decade.
Here, we present a very simple, time efficient and reproducible olfactory testing method of innate odor perception and sensitivity in mice without the need of any prior food or water restriction. The tests are performed in a familiar environment to the mice, require only the scents and a 2 min session of odorant exposure. The analysis is performed, post-hoc, using computer-assisted commands on ImageJ and can be, therefore, carried out from start to end by one researcher.
This protocol does not require any special hardware or setup and is indicated for any laboratory interested in testing olfactory perception and sensitivity.

We present a simple and unbiased olfactory test in mice. With this protocol olfactory discrimination, preference, avoidance and sensitivity to a novel odor as compared to water can be assessed in single behavioral sessions. This method is indicated for a single experimenter and analysis is based on computer-assisted video processing.

Olfaction is highly conserved among species and is required for reproduction and survival.
In humans, olfaction is also one of the senses that is affected ...

Non-Invasive Electrical Brain Stimulation Montages for Modulation of Human Motor Function

Non-invasive electrical brain stimulation (NEBS) is used to modulate brain function and behavior, both for research and clinical purposes. In particular, NEBS can be applied transcranially either as direct current stimulation (tDCS) or alternating current stimulation (tACS). These stimulation types exert time-, dose- and in the case of tDCS polarity-specific effects on motor function and skill learning in healthy subjects. Lately, tDCS has been used to augment the therapy of motor disabilities in patients with stroke or movement disorders. This article provides a step-by-step protocol for targeting the primary motor cortex with tDCS and transcranial random noise stimulation (tRNS), a specific form of tACS using an electrical current applied randomly within a pre-defined frequency range. The setup of two different stimulation montages is explained. In both montages the emitting electrode (the anode for tDCS) is placed on the primary motor cortex of interest. For unilateral motor cortex stimulation the receiving electrode is placed on the contralateral forehead while for bilateral motor cortex stimulation the receiving electrode is placed on the opposite primary motor cortex. The advantages and disadvantages of each montage for the modulation of cortical excitability and motor function including learning are discussed, as well as safety, tolerability and blinding aspects.

Non-invasive electrical brain stimulation can modulate cortical function and behavior, both for research and clinical purposes. This protocol describes different brain stimulation approaches for modulation of the human motor system.

Non-invasive electrical brain stimulation (NEBS) is used to modulate brain function and behavior, both for research and clinical purposes. In particular, ...

Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children.

Several children with unilateral Cerebral Palsy seem to disregard the preserved capacity of their affected upper limb. This Developmental Disregard is extensively described in the literature but the involved cognitive processes have not been studied. To study underlying cognitive factors of upper limb control, an event-related potential protocol was developed.

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral ...

Combined Invasive Subcortical and Non-invasive Surface Neurophysiological Recordings for the Assessment of Cognitive and Emotional Functions in Humans

In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging (fMRI) for extracting crucial information about the mechanism of the human brain, such methods remain insufficient to provide information about physiological processes reflecting cognitive and emotional functions at the subcortical level. In this respect, modern invasive clinical approaches in humans, such as deep brain stimulation (DBS), offer a tremendous possibility to record subcortical brain activity, namely local field potentials (LFPs) representing coherent activity of neural assemblies from localized basal ganglia or thalamic regions. Notwithstanding the fact that invasive approaches in humans are applied only after medical indication and thus recorded data correspond to altered brain circuits, valuable insight can be gained regarding the presence of intact brain functions in relation to brain oscillatory activity and the pathophysiology of disorders in response to experimental cognitive paradigms. In this direction, a growing number of DBS studies in patients with Parkinson&#39;s disease (PD) target not only motor functions but also higher level processes such as emotions, decision-making, attention, memory and sensory perception. Recent clinical trials also emphasize the role of DBS as an alternative treatment in neuropsychiatric disorders ranging from obsessive compulsive disorder (OCD) to chronic disorders of consciousness (DOC). Consequently, we focus on the use of combined invasive (LFP) and non-invasive (EEG) human brain recordings in assessing the role of cortical-subcortical structures in cognitive and emotional processing trough experimental paradigms (e.g. speech stimuli with emotional connotation or paradigms of cognitive control such as the Flanker task), for patients undergoing DBS treatment.

The present protocol aims at assessing cognitive-emotional functions in the basal ganglia by simultaneous neurophysiological recording of local field potentials and non-invasive brain cortical activity (EEG). The procedure is exemplified by the use of paradigms involving speech stimuli with emotional connotation or the Flanker task involving cognitive control.

In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging ...

The Treadmill Fatigue Test: A Simple, High-throughput Assay of Fatigue-like Behavior for the Mouse

Fatigue is a prominent symptom in many diseases and disorders and reduces quality of life for many people. The lack of clear pathogenesis and failure of current interventions to adequately treat fatigue in all patients leaves a need for new treatment options. Despite the therapeutic need and importance of preclinical research in helping identify promising novel treatments, few preclinical assays of fatigue are available. Moreover, the most common preclinical assay used to assess fatigue-like behavior, voluntary wheel running, is not suitable for use with some strains of mice, may not be sensitive to drugs that reduce fatigue, and has relatively low throughput. The current protocol describes a novel, non-voluntary preclinical assay of fatigue-like behavior, the treadmill fatigue test, and provides evidence of its efficacy in detecting fatigue-like behavior in mice treated with a chemotherapy drug known to cause fatigue in humans and fatigue-like behavior in animals. This assay may be a beneficial alternative to wheel running, as fatigue-like behavior and potential interventions can be assessed in a greater number of mice over a shorter time frame, thus permitting faster discovery of new therapeutic options.

Fatigue is a common, undertreated and frequently poorly-understood symptom in many diseases and disorders. New preclinical assays of fatigue may help to improve current understanding and future treatment of fatigue. To that end, the current protocol provides a novel means of measuring fatigue-like behavior in the mouse.

Fatigue is a prominent symptom in many diseases and disorders and reduces quality of life for many people. The lack of clear pathogenesis and failure of ...

Sit-to-stand-and-walk from 120% Knee Height: A Novel Approach to Assess Dynamic Postural Control Independent of Lead-limb

Individuals with sensorimotor pathology e.g., stroke have difficulty executing the common task of rising from sitting and initiating gait (sit-to-walk: STW). Thus, in clinical rehabilitation separation of sit-to-stand and gait initiation - termed sit-to-stand-and-walk (STSW) - is usual. However, a standardized STSW protocol with a clearly defined analytical approach suitable for pathological assessment has yet to be defined.
Hence, a goal-orientated protocol is defined that is suitable for healthy and compromised individuals by requiring the rising phase to be initiated from 120% knee height with a wide base of support independent of lead limb. Optical capture of three-dimensional (3D) segmental movement trajectories, and force platforms to yield two-dimensional (2D) center-of-pressure (COP) trajectories permit tracking of the horizontal distance between COP and whole-body-center-of-mass (BCOM), the decrease of which increases positional stability but is proposed to represent poor dynamic postural control.
BCOM-COP distance is expressed with and without normalization to subjects&#39; leg length. Whilst COP-BCOM distances vary through STSW, normalized data at the key movement events of seat-off and initial toe-off (TO1) during steps 1 and 2 have low intra and inter subject variability in 5 repeated trials performed by 10 young healthy individuals. Thus, comparing COP-BCOM distance at key events during performance of an STSW paradigm between patients with upper motor neuron injury, or other compromised patient groups, and normative data in young healthy individuals is a novel methodology for evaluation of dynamic postural stability.

Here, we present a novel protocol to measure positional stability at key events during the sit-to-stand-to-walk using the center-of-pressure to the whole-body-center-of-mass distance. This was derived from the force platform and three-dimensional motion-capture technology. The paradigm is reliable and can be utilized for the assessment of neurologically compromised individuals.

Individuals with sensorimotor pathology e.g., stroke have difficulty executing the common task of rising from sitting and initiating gait (sit-to-walk: ...

A Method to Test the Effect of Environmental Cues on Mating Behavior in Drosophila melanogaster

An individual's sexual drive is influenced by genotype, experience and environmental conditions. How these factors interact to modulate sexual behaviors remains poorly understood. In Drosophila melanogaster, environmental cues, such as food availability, affect mating activity offering a tractable system to investigate the mechanisms modulating sexual behavior. In D. melanogaster, environmental cues are often sensed via the chemosensory gustatory and olfactory systems. Here, we present a method to test the effect of environmental chemical cues on mating behavior. The assay consists of a small mating arena containing food medium and a mating couple. The mating frequency for each couple is continuously monitored for 24 h. Here we present the applicability of this assay to test environmental compounds from an external source through a pressurized air system as well as manipulation of the environmental components directly in the mating arena. The use of a pressurized air system is especially useful to test the effect of very volatile compounds, while manipulating components directly in the mating arena can be of value to ascertain a compound's presence. This assay can be adapted to answer questions about the influence of genetic and environmental cues on mating behavior and fecundity as well as other male and female reproductive behaviors.

A Method to Test the Effect of Environmental Cues on Mating Behavior in Drosophila melanogaster

We demonstrate an assay to analyze the environmental and genetic cues that influence mating behavior in the fruit fly Drosophila melanogaster.

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. Game-based therapy can promote patients&#39; engagement in rehabilitation therapy as a more interesting and a motivating tool. Mobile devices such as smartphones and tablet PCs can provide personalized home-based therapy with interactive communication between patients and clinicians. In this study, a mobile VR upper extremity rehabilitation program using game applications was developed. The findings from the study show that the mobile game-based VR program effectively promotes upper extremity recovery in patients with stroke. In addition, patients completed two weeks of treatment using the program without adverse effects and were generally satisfied with the program. This mobile game-based VR upper extremity rehabilitation program can substitute for some parts of the conventional therapy that are delivered one-on-one by an occupational therapist. This time-efficient, easy to implement, and clinically effective program would be a good candidate tool for tele-rehabilitation for upper extremity recovery in patients with stroke. Patients and therapists can collaborate remotely through these e-health rehabilitation programs while reducing economic and social costs.

Here, we present a protocol to develop and apply a mobile game-based virtual reality program for the recovery of upper limb dysfunction in patients with stroke. The present study shows that the mobile program is feasible and effectively promotes upper limb recovery in stroke patients.

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 in mouse models is a non-invasive and reproducible activity assay that is directly analogous to measures of patient ambulation such as the 6-minute walk test and related mobility scores. Many common methods for testing mouse ambulation speed and distance are based on the open field test, where an animal&#39;s free movement within an arena is measured over time. One major downside to this approach is that commercial software and equipment for high-resolution motion tracking is expensive and may require transferring mice to specialized facilities for testing. Here, we describe a low-cost, video-based system for measuring mouse ambulation that utilizes free and open-source software. Using this protocol, we demonstrate that voluntary ambulation in the dystrophin-null mdx mouse model for Duchenne muscular dystrophy (DMD) is decreased relative to wild-type mouse activity. In mdx mice expressing the utrophin transgene, these activity deficits are not observed and the total distance traveled is indistinguishable from wild-type mice. This method is effective for measuring changes in voluntary ambulation associated with dystrophic pathology, and provides a versatile platform that can be readily adapted to diverse research settings.

This protocol describes a flexible, low-cost system for measuring mouse ambulation in an open field activity assay. We show that a 6-minute ambulation assay based on this system detects a decrease in voluntary movement in mdx mice, and accurately distinguishes improvement in a muscle-specific rescue of these animals.

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