The effectiveness of proprioceptive training for improving motor function: a systematic review

Abstract

Objective: Numerous reports advocate that training of the proprioceptive sense is a viable behavioral therapy for improving impaired motor function. However, there is little agreement of what constitutes proprioceptive training and how effective it is. We therefore conducted a comprehensive, systematic review of the available literature in order to provide clarity to the notion of training the proprioceptive system.

Methods: Four major scientific databases were searched. The following criteria were subsequently applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function. From a total of 1284 articles, 51 studies fulfilled all criteria and were selected for further review.

Results: Overall, proprioceptive training resulted in an average improvement of 52% across all outcome measures. Applying muscle vibration above 30 Hz for longer durations (i.e., min vs. s) induced outcome improvements of up to 60%. Joint position and target reaching training consistently enhanced joint position sense (up to 109%) showing an average improvement of 48%. Cortical stroke was the most studied disease entity but no clear evidence indicated that proprioceptive training is differentially beneficial across the reported diseases.

Conclusions: There is converging evidence that proprioceptive training can yield meaningful improvements in somatosensory and sensorimotor function. However, there is a clear need for further work. Those forms of training utilizing both passive and active movements with and without visual feedback tended to be most beneficial. There is also initial evidence suggesting that proprioceptive training induces cortical reorganization, reinforcing the notion that proprioceptive training is a viable method for improving sensorimotor function.

Keywords: balance; joint position sense; kinesthesia; proprioception; somatosensory; stroke; therapy.

Figure 1

Flow diagram of study selection process.

Figure 2

Effectiveness of proprioceptive training by type of intervention. Somatosensory, somatosensory-motor, balance and neurophysiological outcome measures were measured by device or instrument. If multiple outcome measures were reported from a single study that fell within the same classification (e.g., multiple clinical rating measures), only the most favorable result was reported. ^aStudies providing two types of intervention. ^bValues estimated from figures of the original article. ^cSignificant difference between pre- and post-test with no exact data reported. ^dMean percentage of improvement of each category. Studies not reporting exact data were not included in calculating the mean. Abbreviations: WBV, whole body vibration. TENS, transcutaneous electrical nerve stimulation.

Figure 3

Passive motion apparatus used for determining proprioceptive acuity and sensitivity. (A) A subject sitting with their right arm resting on a passive motion apparatus (PMA). The PMA is used for passively moving the subject's arm, in this case specifically the elbow, in order to determine proprioceptive acuity and sensitivity. (B) Stimuli intensities are plotted across the trials performed. In this case, an adaptive algorithm can be used, which determines the next delivered stimulus based on the correctness of the subject's previous response. (C) A psychophysical function is deduced from the responses of the subject, with a correct response level of 75% taken as the just-noticeable-different threshold.