Assessing Proprioception in an Older Population: Reliability of a Protocol Based on Active Movement Extent Discrimination

Proprioceptive ability – the sense of where body parts are located in space - is one of many factors thought to affect falls risk among the elderly. Active movement extent discrimination is an approach to measuring proprioception that is administered in an ecologically valid testing environment to better reflect the exercise of proprioceptive skills in daily life. The Active Movement Extent Discrimination Apparatus (AMEDA) was developed to objectively measure this proprioceptive discrimination. However, the current absolute identification testing protocol is cognitively demanding, and it yields results that are insufficiently reliable to assess performance at the individual level. The objectives of this pilot study were to test the reliability and feasibility of a proposed new AMEDA testing protocol and to explore how performance related to cognitive ability and any perceived dysfunction in the foot or ankle. We tested 42 participants (aged 19 – 94 years) three times on the ankle AMEDA using a newly developed protocol that asked participants to report whether a given angle of ankle inversion was shallower or deeper than the immediately preceding inversion. Participants also completed the Stroop test, as a measure of cognitive ability, and two validated questionnaires for identifying foot or ankle dysfunction (the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure). The proportion of correct responses for the AMEDA test showed the expected sigmoid shape of the psychometric function as signal strength increased. The intraclass correlation coefficient measured over the three tests was 0.65 (95% confidence interval: 0.49 - 0.78), suggesting moderate reliability. We found a positive and statistically significant correlation between AMEDA performance and Stroop results but no relationship between the AMEDA score and questionnaire-measured foot or ankle dysfunction. This study confirmed that the alternative testing protocol was simple to administer and easily understood by participants.

Using the Active Movement Extent Discrimination Apparatus to Test Individual Proprioception Acuity: Implications for Test Design

The Active Movement Extent Discrimination Apparatus (AMEDA) has been used for measuring proprioception at various joints in the body for more than two decades. The utility of this instrument for discriminating groups has been reported in terms of an area under the curve (AUC) derived from an absolute identification test. This metric has supported statistically significant group differences, but it is not clear whether the AMEDA’s testing protocol is suitable for measuring individual proprioception acuity changes. This study aimed to test the reliability, variance and absolute AUC scores obtained with the AMEDA with reference to other studies that have tested absolute identification acuity in other domains and the theoretical underpinnings of the testing protocol. We re-analyzed raw data from a 2013 study involving 65 people, most of whom were tested three times over two separate sessions on the ankle AMEDA by now assessing the accuracy of individual responses and calculating the sensitivity index, d’, in addition to the AUC. To assess reliability, we calculated the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for those who completed all three tests. Fewer than 50% of presented stimuli were accurately identified and relatively poor discrimination was achieved between adjacent stimuli (in only one case was the median d’ value greater than 1). The ICC of AUC scores across the three tests was poor (0.47). The SEM was 0.04, while 90% of participants’ AUC scores fell between 0.59 and 0.76. The variation in performance at the individual level was substantial, producing a large SEM relative to the population spread of scores. We considered potential theoretical factors that may be affecting these results and concluded that an alternative approach will be needed in order for the apparatus to be used to explore individual proprioceptive performance.

Mekanisme Pemberian Bantuan Hukum Bagi Masyarakat Miskin Di Pengadilan Negeri Samarinda

ABSTRACT The court is a space or a last fort for people to get justice but in this case a problem which seek the court is not easy and with little expense but rather the cost to be incurred for example using the services of professional lawyers prohibitively expensive while not all people can afford to pay. However, Indonesia as a legal state as mentioned in the Constitution of 1945 in Article 1 point (3) "Indonesia is a legal state" the state must guarantee equality of each citizen both before the law and protect all the rights to be treated before the law, and with the Legal aid society, especially in the city of Samarinda, in this case, it helps people, especially the underprivileged in right of defending their rights and being protected from discrimination apparatus or elements which are not responsible and the process of case investigation encountered can occur as supposed to be. Thus, the law agencies is indispensable for the people belonging to the poor economy.

Ankle Instability Effects on Joint Position Sense When Stepping Across the Active Movement Extent Discrimination Apparatus

Context Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. Objective To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. Design Descriptive laboratory study. Setting University clinical laboratory. Patients or Other Participants Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. Intervention(s) Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. Main Outcome Measure(s) Difference in scores between groups with stable and unstable ankles and between test repeats. Results Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). Conclusions The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus.

Visual Discrimination Learning in Rats with Lesions of Superior Colliculus: Door-Push and Approach Errors in Modified Jumping Stand

It has been suggested that, for some species, lesions of the superior colliculus affect visual discrimination learning, but only in certain conditions: (a) when problems are first learnt only after operation, or (b) when discriminanda require detailed scanning, or (c) when “approach” responses to the discriminanda are measured, rather than the response of actually touching them. These suggestions were examined in rats learning visual discriminations in a modified jumping-stand apparatus, after sustaining large lesions of the superior colliculus (and in some cases also of the pretectum). The lesions produced open-field hyperactivity and reduced exploration, indicating effective tectal damage, but the rats learnt a series of difficult discriminations in a door-push task as fast as normal rats, and they did not make more approach errors. Their main abnormality in the discrimination apparatus was that they looked less often between the stimulus doors before stepping across to one of them from the central platform. It is suggested that in rats, as in other animals, lesions of the superior colliculus disrupt the control of scanning head and eye movements; in rats, however, such disruption need not affect discrimination learning (at least in some kinds of apparatus), possibly because the retina of the rat has a relatively poorly developed area centralis.

Dadta III: An on-Line Computerized System for the Experimental Analysis of Behavior

A fully computerized, low-cost behavioral testing device is described which has been in continuous operation for 3 yr. Named DADTA III (Discrimination Apparatus for Discrete Trial Analysis) it is characterized by flexibility, available software (programs), and on-line data analysis capability. The operation of the setup is detailed, the experiments completed to date are reviewed and an example of work in progress (ROC analysis) is presented.