Role of Spasticity Severity on the Balance of Post-stroke Patients

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

Assessment of Ankle Joint Proprioception in Cricket Players

Background and Aims: Superior balance ability is necessary to achieve the highest competitive level and avoid lower limb injuries. Balance control improvement is one of the most important goals in sports and exercise. Better the balance, better is the performance. Proprioception plays an important role in balance control and ankle proprioception is arguably the most important. Cricket is an evolving sport and it the ankle-foot complex in the only part that comes in contact with the ground which further leads to ankle injuries. Ankle proprioception is altered by sport related injuries or fatigue all of which subsequently leads to altered balance mobility. Ankle injuries often leads to disruption of muscles and tendons with associated damage to inherent mechanoreceptors which detrimentally alters the quality of proprioceptive information required for balance control. This study consists of an assessment of ankle joint proprioception in cricket players using an active to active reproduction test. Methodology: An observational study was conducted among 40 cricket players. Ankle proprioception was assessed using an active to active reproduction test. The mean difference between both the positions were then calculated. Results: The result of this study showed a clinically significant difference in both ankle plantarflexion and ankle dorsiflexion. The results also showed that right sided movements were affected in subjects who are right sided dominant and the same was there for left sided dominant subjects. The mean errors in Right PF and Left PF was 4.15º and 1.75º respectively which signifies that Right PF is affected in cricket players. The mean errors in Right DF and Left DF was 2.825º and 2.025º respectively which signifies that Right DF is more affected than that of Left DF. Conclusion: The ankle proprioception was affected in majority of the individuals. A clinically significant increase is noted in Right PF, Right DF and Left DF. Right plantarflexion was affected more than that of left plantarflexion and right dorsiflexion was affected more than that of left dorsiflexion. Hence, right sided dominant people showed affection in right sided movements and those who were left sided dominant showed affection in left sided movements. These results thus signify that the players are at mild risk of having ankle injuries because ankle proprioception is associated with ankle injuries which then indirectly affects the performance of the player. Key words: Ankle proprioception, Cricket Players, Balance, Active to Active reproduction test.

Ankle Proprioception in Patients with Type 2 Diabetes Mellitus

Background Ankle position sense may be reduced before the appearance of the clinical manifestation of diabetic peripheral neuropathy. This is known to impair gait and cause falls and foot ulcers. Early detection of impaired ankle proprioception is important because it allows physicians to prescribe an exercise program to patients to prevent foot complications. Methods Forty-six patients diagnosed as having type 2 diabetes mellitus and 22 control patients were included in the study. Presence of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Level of foot care awareness was determined using the Nottingham Assessment of Functional Footcare (NAFF). Joint position sense was measured using a dynamometer. Results Mean absolute angular error (MAAE) values were significantly higher in the neuropathy group compared with the control group (P < .05). Right plantarflexion MAAE values were significantly lower in the group without neuropathy compared with the group with neuropathy (P < .05). No correlation was found between MAAE values (indicating joint position sense) and age, educational level, disease duration, glycemic control, NAFF score, and MNSI history and examination scores in the groups with and without neuropathy (P > .05). Educational level and disease duration were found to be correlated with NAFF scores. Conclusions Increased MNSI history scores and increased deficits in ankle proprioception demonstrate that diabetic foot complications associated with reduced joint position sense may be seen at an increased rate in symptomatic patients.

Effects of Passive Bi-axial Ankle Movement Training with Electrical Stimulation on Ankle Sensorimotor Functions in Stroke Patients: A Randomized Controlled Pilot Study

Background: This study was conducted to investigate the effect of passive biaxial ankle movement training synchronized with electrical stimulation therapy (AMT-EST) on ankle proprioception, ankle strength, balance, and gait in chronic stroke patients. We observed the changes in ankle sensorimotor function after stroke.Methods: Thirty-five stroke patients were randomized to an experimental or control group, and 30 patients completed the trials. The experimental group received AMT-EST on the affected ankle for 30 minutes a day, 5 times a week for 4 weeks, for a total of 20 sessions. The control group received electrical stimulation therapy on the affected ankle. The primary outcome measures were ankle proprioception, passive range of motion, and strength. The secondary outcome measures were balance and gait-related functional abilities.Results: Compared with those in the control group, the participants in the experimental group who received AMT-EST showed significant post-training improvement in ankle proprioception of eversion (P<0.05). The ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion, plantarflexion, inversion, and eversion), and functional abilities (Fugl–Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Fall Efficacy Scale, and walking speed) significantly improved in the experimental group (P<0.05). Significant group×time interactions were observed in ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion), and Fugl–Meyer Assessment (P<0.05). All ankle proprioception moderately correlated with ankle passive range of motion (eversion), ankle strength (dorsiflexion and eversion), the Berg Balance Scale, and Fugl–Meyer Assessment (P<0.05).Conclusions: Biaxial AMT-EST effectively increased ankle proprioception, range of motion, strength, and functional abilities in chronic stroke patients. These findings suggest that AMT-EST can be proposed as a novel ankle rehabilitation program for chronic stroke patients with ankle sensorimotor impairment.Trial registration: This study was approved by the Institutional Review Board at a rehabilitation hospital (NRC-2017-04-035, National Rehabilitation Center, Seoul, South Korea) and retrospectively registered at a clinical trial registry on January 31, 2020 (CRIS, KCT0004688, https://cris.nih.go.kr/).

The Relationship Between Ankle Proprioception and Functional Mobility in People With Parkinson's Disease: A Cross-Sectional Study

Previous research has found ankle proprioception to be impaired in people with Parkinson's disease (PD). However, the relationship between ankle proprioception and functional mobility in people with PD has not been fully investigated. The purpose of this study was to examine whether ankle proprioception is related to the functional mobility of people with PD. Forty-two participants with mild to moderate PD volunteered. Ankle proprioceptive acuity was measured in standing, by using active movement extent discrimination assessment (AMEDA). Functional mobility measures included the timed-up-and-go test (TUG), 30 s sit-to-stand test (30s-STS) and 10-meter walking test (10MWT). Step length and step cadence were recorded during the 10MWT. No significant correlation was found between ankle proprioceptive discrimination scores and any mobility performance measure in people with PD (−0.20&lt;r&lt;0.04, all p &gt; 0.05). However, ankle proprioception scores were significantly correlated with step length (r = 0.38, p &lt; 0.05) and step cadence (r = −0.30, p &lt; 0.05), and were significantly and negatively correlated with the stage of modified Hoehn and Yahr (rho = −0.53, p &lt; 0.01). The lack of relationship between ankle proprioceptive acuity and functional mobility in PD suggests that people with PD may be more limited by reduced sensorimotor integration or may rely more on other sensory input, rather than ankle proprioception, to achieve functional mobility, a finding consistent with sensory reweighting theory. In addition, poorer ankle proprioceptive acuity was associated with decreased step length and increased step cadence, suggesting that the shuffling gait observed in PD may be related to impaired ankle proprioception, which has important clinical implications for gait retraining in people with PD. Given that ankle proprioception was significantly and negatively correlated with the stage of modified Hoehn and Yahr, it may warrant being used as an objective biomarker to monitor the progression of PD.