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The ABCs of Proprioception

proprioception: the body’s ability to transmit afferent information regarding position sense, to interpret the information, and to respond consciously or unconsciously to stimulation through appropriate execution of posture and movement

Basic Concepts Basic Concepts of Proprioceptionof Proprioception

Involves agility, balance, and coordination

Targeted after flexibility, strength, and endurance have improved

Components of Proprioception

proprioceptors: afferent nerves that receive and send impulses from stimuli within skin, muscle, joints, and tendons to the central nervous system

An individual’s balance, agility, and coordination are determined by the reception, interpretation, and response that are initiated by proprioceptors.

Proprioceptive ReceptorsProprioceptive Receptors

Cutaneous receptors

Fast-adapting- responsible for vibration senses

Slow-adapting I and II-sensory perception such as skin stretching

Muscle spindles

Muscle and tendon receptors

GTOs

(continued)

Proprioceptive ReceptorsProprioceptive Receptors

Joint receptors

Collaboration of afferent receptors

Ligament receptors

Central Nervous System Central Nervous System Proprioceptor SitesProprioceptor Sites

Spinal cord

Brain stem

Cerebral cortex

balance: the body’s ability to maintain an equilibrium by controlling the body’s center of gravity over its base of support

BalanceBalance

Necessary for static and dynamic activities

Vestibular systemOculomotor system

Sensory input

Influenced by strength and by sensory input from CNS

Proprioceptor system

Balance tests: Romberg, stork stand

Feedback System Feedback System for Coordinationfor Coordination

coordination: the complex process by which a smooth pattern of activity is produced through a combination of muscles acting together with appropriate intensity and timing

CoordinationCoordination

Accomplished through a complex neural network

Strength and proper neural system function are necessary for coordination

Some muscles stimulated and others inhibited

Timing and intensity of muscle response are key

Components Components of Coordinationof Coordination

Activity perception

Inhibition

Feedback

Repetition

Progression Progression of Coordination of Coordination DevelopmentDevelopment

Start with static, simple exercises.

Stop when fatigue, lack of coordination begin to appear.

Progress to dynamic, more complex exercises.

Accuracy of performance is vital in exercise execution.

agility: the ability to control the direction of a body or its parts during rapid movement

AgilityAgility

Requires flexibility, strength, power, speed, balance, and coordination

Activities should resemble the patient’s sport activities

Involves rapid change of direction and sudden stopping and starting

Progression of therapeutic exercise for agility

Therapeutic Exercise Therapeutic Exercise for Proprioceptionfor Proprioception

Balance first, then coordination, then agility

Goal: to perform accurately

Simple to complex

Progression: to more complex, sport-like activities

Initial exercises performed slowly,in controlled situations

Advancement made only after the activity is mastered

Lower-Extremity Lower-Extremity ProgressionProgression

Stork stands: with eyes open, closed; on unstable surfaces; with distracting upper-extremity activity

Sport-specific activities

Dynamic activities: lateral, then change of direction; combined balance, coordination, agility; distracting upper-extremity activitiesPlyometrics

Upper-Extremity Upper-Extremity ProgressionProgression

Passive and active joint repositioning

Sport-specific activities

PNF rhythmic stabilization

Closed kinetic chain stabilizationStraight-plane and multiplane upper-extremity movements

Rubber tubing activities

Plyometrics