Proprioception

Clinic

• Also referred to as Kinaesthesia / Kinesthesia
• It is the sense of self-movement, force, and body position.
• It is mediated by Proprioceptors/ Mechanosensory neurons located within Muscles /Tendons /Joints, which detect kinematic parameters, such as joint position, movement, and load.
• CNS receive Proprioceptive signals and integrate them with other information from other sensory systems such as Visual / Vestibular system to create an overall representation of body Position / Movement / Acceleration.

Reflexes

• Proprioceptors can form reflex circuits with motor neurons to provide rapid feedback about body and limb position.
• For example, consider the stretch reflex, in which stretch across a muscle is detected by a sensory receptor, which activates a motor neuron to induce muscle contraction and oppose the stretch.

Conscious and non-conscious

• Conscious proprioception is communicated by the dorsal column-medial lemniscus pathway to the cerebrum.
• Non-conscious proprioception is communicated primarily via the dorsal spinocerebellar tract and ventral spinocerebellar tract, to the cerebellum.
• A non-conscious reaction is seen in the human proprioceptive reflex, or righting reflex—in the event that the body tilts in any direction, the person will cock their head back to level the eyes against the horizon. This is seen even in infants as soon as they gain control of their neck muscles. This control comes from the cerebellum, the part of the brain affecting balance.

Function

• Stability: An important role for proprioception is to allow an animal to stabilize itself against perturbations. For instance, for a person to walk or stand upright, they must continuously monitor their posture and adjust muscle activity as needed to provide balance. Similarly, when walking on unfamiliar terrain or even tripping, the person must adjust the output of their muscles quickly based on estimated limb position and velocity. Proprioceptor reflex circuits are thought to play an important role to allow fast and unconscious execution of these behaviors, To make control of these behaviors efficient, proprioceptors are also thought to regulate reciprocal inhibition in muscles, leading to agonist-antagonist muscle pairs.
• Planning and refining movements: When planning complex movements such as reaching or grooming, animals must consider the current position and velocity of their limb and use it to adjust dynamics to target a final position. If the animal's estimate of their limb's initial position is wrong, this can lead to a deficiency in the movement. Furthermore, proprioception is crucial in refining the movement if it deviates from the trajectory.

Impairment

Chronic

Proprioception, a sense vital for rapid and proper body coordination, can be permanently lost or impaired as a result of genetic conditions, disease, viral infections, and injuries. For instance, patients with joint hypermobility or Ehlers-Danlos syndrome, a genetic condition that results in weak connective tissue throughout the body, have chronic impairments to proprioception. Moreover, proprioception may be chronically impaired in

• Physiological aging (presbypropria),
• Autism spectrum disorder,
• Parkinson's disease

In rare cases, viral infections result in a loss of proprioception. Ian Waterman and Charles Freed are two such people that lost their sense of proprioception from the neck down from supposed viral infections (i.e. gastric flu and a rare viral infection). After losing their sense of proprioception, Ian and Charles could move their lower body, but could not coordinate their movements. However, both individuals regained some control of their limbs and body by consciously planning their movements and relying solely on visual feedback. Interestingly, both individuals can still sense pain and temperature, indicating that they specifically lost proprioceptive feedback, but not tactile and nociceptive feedback. The impact of losing the sense of proprioception on daily life is perfectly illustrated when Ian Waterman stated, "What is an active brain without mobility".

Phantom limb syndrome

Proprioception is also permanently lost in people who lose a limb or body part through injury or amputation. After the removal of a limb, people may have a confused sense of that limb's existence on their body, known as phantom limb syndrome. Phantom sensations can occur as passive proprioceptive sensations of the limb's presence, or more active sensations such as perceived movement, pressure, pain, itching, or temperature. There are a variety of theories concerning the etiology of phantom limb sensations and experience. One is the concept of "proprioceptive memory", which argues that the brain retains a memory of specific limb positions and that after amputation there is a conflict between the visual system, which actually sees that the limb is missing, and the memory system which remembers the limb as a functioning part of the body. Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, such as after amputation of the breast, extraction of a tooth (phantom tooth pain), or removal of an eye (phantom eye syndrome).

VZV

Acute[edit]

Proprioception is occasionally impaired spontaneously, especially when one is tired. Similar effects can be felt during the hypnagogic state of consciousness, during the onset of sleep. One's body may feel too large or too small, or parts of the body may feel distorted in size. Similar effects can sometimes occur during epilepsy or migraine auras. These effects are presumed to arise from abnormal stimulation of the part of the parietal cortex of the brain involved with integrating information from different parts of the body. Proprioceptive illusions can also be induced, such as the Pinocchio illusion.

Temporary impairment of proprioception has also been known to occur from an overdose of vitamin B6 (pyridoxine and pyridoxamine)^{[citation needed]}. Most of the impaired function returns to normal shortly after the amount of the vitamin in the body returns to a level that is closer to that of the physiological norm. Impairment can also be caused by cytotoxic factors such as chemotherapy.

It has been proposed that even common tinnitus and the attendant hearing frequency-gaps masked by the perceived sounds may cause erroneous proprioceptive information to the balance and comprehension centers of the brain, precipitating mild confusion.

Temporary loss or impairment of proprioception may happen periodically during growth, mostly during adolescence. Growth that might also influence this would be large increases or drops in bodyweight/size due to fluctuations of fat (liposuction, rapid fat loss or gain) and/or muscle content (bodybuilding, anabolic steroids, catabolisis/starvation)^{[citation needed]}. It can also occur in those that gain new levels of flexibility, stretching, and contortion. A limb's being in a new range of motion never experienced (or at least, not for a long time since youth perhaps) can disrupt one's sense of location of that limb. Possible experiences include suddenly feeling that feet or legs are missing from one's mental self-image; needing to look down at one's limbs to be sure they are still there; and falling down while walking, especially when attention is focused upon something other than the act of walking.

Diagnosis[edit]

Impaired proprioception may be diagnosed through a series of tests, each focusing on a different functional aspect of proprioception.

The Romberg's test is often used to assess balance. The subject must stand with feet together and eyes closed without support for 30 seconds. If the subject loses balance and falls, it is an indicator for impaired proprioception.

For evaluating proprioception's contribution to motor control, a common protocol is joint position matching. The patient is blindfolded while a joint is moved to a specific angle for a given period of time and then returned to neutral. The subject is then asked to move the joint back to the specified angle. Recent investigations have shown that hand dominance, participant age, active versus passive matching, and presentation time of the angle can all affect performance on joint position matching tasks.^{[citation needed]}

For passive sensing of joint angles, recent studies have found that experiments to probe psychophysical thresholds produce more precise estimates of proprioceptive discrimination than the joint position matching task. In these experiments, the subject holds on to an object (such as an armrest) that moves and stops at different positions. The subject must discriminate whether one position is closer to the body than another. From the subject's choices, the tester may determine the subject's discrimination thresholds.

Proprioception is tested by American police officers using the field sobriety testing to check for alcohol intoxication. The subject is required to touch his or her nose with eyes closed; people with normal proprioception may make an error of no more than 20 mm (0.79 in)^{[citation needed]}, while people with impaired proprioception (a symptom of moderate to severe alcohol intoxication) fail this test due to difficulty locating their limbs in space relative to their noses.