Effects of sensorimotor training volume on recovery of sensorimotor function in patients following lower limb arthroplasty

Abstract

Background: Sensorimotor function is degraded in patients after lower limb arthroplasty. Sensorimotor training is thought to improve sensorimotor skills, however, the optimal training stimulus with regard to volume, frequency, duration, and intensity is still unknown. The aim of this study, therefore, was to firstly quantify the progression of sensorimotor function after total hip (THA) or knee (TKA) arthroplasty and, as second step, to evaluate effects of different sensorimotor training volumes.

Methods: 58 in-patients during their rehabilitation after THA or TKA participated in this prospective cohort study. Sensorimotor function was assessed using a test battery including measures of stabilization capacity, static balance, proprioception, and gait, along with a self-reported pain and function. All participants were randomly assigned to one of three intervention groups performing sensorimotor training two, four, or six times per week. Outcome measures were taken at three instances, at baseline (pre), after 1.5 weeks (mid) and at the conclusion of the 3 week program (post).

Results: All measurements showed significant improvements over time, with the exception of proprioception and static balance during quiet bipedal stance which showed no significant main effects for time or intervention. There was no significant effect of sensorimotor training volume on any of the outcome measures.

Conclusion: We were able to quantify improvements in measures of dynamic, but not static, sensorimotor function during the initial three weeks of rehabilitation following TKA/THA. Although sensorimotor improvements were independent of the training volume applied in the current study, long-term effects of sensorimotor training volume need to be investigated to optimize training stimulus recommendations.

Trial registration: Clinical trial registration number: DRKS00007894.

Fig. 1

Gait Analysis. Changes in gait analysis parameter (a) step length operated leg, (b) step length not operated leg, (c) walking velocity). Data are mean ± 1 SE for the three experimental groups (light circle = 2 weekly sessions, grey triangle = 4 weekly sessions, black sqaure = 6 weekly sessions). * P ≤ 0.05 vs. pre, † P ≤ 0.05 vs. mid

Fig. 2

Stabilization Capacity. Changes in capability to restabilze a sudden pertubation of the underground (a) stabilization capacity medio-lateral (m-l), (b) stabilization capacity anterior-posterior (a-p)). Data are mean ± 1 SE for the three experimental groups (light circle = 2 weekly sessions, grey triangle = 4 weekly sessions, black sqaure = 6 weekly sessions). * P ≤ 0.05 vs. pre, † P ≤ 0.05 vs. mid

Fig. 3

Bipedal Stance. Course of static balance measurement with an unsystematic interaction between time and training volume in the bipedal stance with eyes closed condition (a) RMS medio-lateral bipedal stance with eyes open, (b) RMS medio-lateral bipedal stance with eyes closed, (c) RMS anterior-posterior bipedal stance with eyes open, (d) RMS anterior-posterior bipedal stance with eyes closed). Data are mean ± 1 SE for the three experimental groups (light circle = 2 weekly sessions, grey triangle = 4 weekly sessions, black sqaure = 6 weekly sessions). ‡ P ≤ 0.05 ANOVA interaction

Fig. 4

Semitandem Stance. Course of static balance measurement in semitandem stance conditions (a) RMS medio-lateral semitandem stance with operated leg positioned in front, (b) RMS medio-lateral semitandem stance with not-operated leg positioned in front, (c) RMS anterior-posterior semitandem stance with operated leg positioned in front, (d) RMS anterior-posterior semitandem stance with not-operated leg positioned in front). Data are mean ± 1 SE for the three experimental groups (light circle = 2 weekly sessions, grey triangle = 4 weekly sessions, black sqaure = 6 weekly sessions). * P ≤ 0.05 vs. pre, † P ≤ 0.05 vs. mid

Fig. 5

Proprioception. Proprioception measured by angle reproduction test (a) target angle 40° knee flexion, (b) target angle 60° knee flexion). Data are mean ± 1 SE for the three experimental groups (light circle = 2 weekly sessions, grey triangle = 4 weekly sessions, black sqaure = 6 weekly sessions)

Fig. 6

Self-Assessment. Changes in Lequesne Algofunctional Index in course of in-patient rehabilitation. Data are mean ± 1 SE for the three experimental groups (light circle = 2 weekly sessions, grey triangle = 4 weekly sessions, black sqaure = 6 weekly sessions). * P ≤ 0.05 vs. pre, † P ≤ 0.05 vs. mid