1. Proprioception & Body
Ownership

2. What is Proprioception?
Proprioception refers to sensations generated by the body’s own actions (Proske and
Gandevia, 2012).
By convention, these include four senses:
- movement and limb position (kinaes-thesia)
- the sense of tension or force;
- the sense of effort
- the sense of balance
(Proske and Gandevia, 2012)

3. How Proprioception Works
Muscle spindles detect changes in length and velocity of a muscle, and then transmit
that information to the central nervous system via sensory neurons.
Joint receptors
Skin receptors
Vibration
Motor equivalence
(Hepp-Reymond, M., Chakarov, V., Schulte-Mönting, J., Huethe, F., & Kristeva, R.
(2009). Role of proprioception and vision in handwriting. Brain Research Bulletin,
79(6), 365-370) (Hepp-Reymond, Chakarov, Schulte-Mönting, Huethe & Kristeva,

4. Brain and Proprioception
Sense of relative position and spatial orientation from stimuli within the body.
Multisensory regions in the parietal cortex as well as parts of more distributed
networks such as the frontal cortex and insula
Left parietal lesions are implicated in an alteration of body awareness in which patients
are unable to point to parts of their own body on verbal instruction, in spite of being
able to respond to verbal commands to move that part toward an external object (e.g.
touch the pedal of that bicycle) -
(Proske and Gandevia, 2012)

5. Phantom Limb Pain
- Perceptions that an individual experiences relating to a limb or an organ that is
not physically part of the body
- Limb loss is a result of either removal by amputation or congenital limb
deficiency
- Sensation of posture, movement, sensation, pain
- Peripheral and spinal mechanisms
- 80% of amputees experience phantom limb pain. (Meyer, 2012)
- Mirror box therapy
Ramachandran, V. S., Brang, D., & McGeoch, P. D. (2009). Size reduction using mirror
visual feedback (MVF) reduces phantom pain. Neurocase, 15(5), 357-360.

6. History of Proprioception
Theories about Muscle sense date all the way back to the 17th century.
One person that made a proposal for a 6th sense was Nicholas J Wade.
Bastian (17), who coined the term kinesthesis, was the only one at the time who
contemplated a hybrid theory, comprising both central and peripheral nervous system
components.
He later abandoned the idea for peripheral only components.
Sensation of innervations was replaced by an idea that focussed completely on
peripheral receptors.

7. History continued
Wrong since the main receptor type was thought to be joint receptors, not muscle
receptors
Now we know the importance of peripheral signs for passive proprioception but some
old ideas have come back as well such as sensation of innervations plays a large role in
active proprioception where the creation of peripheral signals is accompanied by
voluntary motor activity
The modern view has muscle spindles as the principal proprioceptors.
Proske, U., Gandevia, SC. (2012). The Proprioceptive Senses: Their Roles in Signaling Body Shape, Body Position and Movement, and Muscle
Force. American Physiological Society, 92, 1651–1697. doi:10.1152/physrev.00048.2011

8. Things that affect proprioception
● Age related
● Fatigue related
● Disease related
● Injury related
- Damage to central or peripheral nervous system can be followed by an
impairment of proprioception that leads to a movement disorder. (Dietz, 2002)

9. ● Age-related changes in central or peripheral somatosensory function, or both, likely underlie
proprioception declines in older adults. Evidence for peripheral changes include decreased number and
function of muscle spindles, cutaneous receptors, and joint receptors. (Wingert, 2014)
● A decline in hip proprioception due to age did disrupt performance in motor tasks requiring higher levels
of balance, such as anticipatory and compensatory postural adjustments and gait stability. Since
fall-related injuries tend to occur during dynamic activities. (Wingert, 2014)
● An increased reliance on vision for maintenance of balance in older adults may be a compensatory
strategy for proprioception deficits in the lower extremity. (Ingemanson, 2016)
(Wingert, 2014) (Wingert, 2014)
Aging

10. Fatigue and Injury
There are different hypotheses regarding the underlying causes of change in proprioception in the presence of fatigue:
1. Malfunction of joint and muscle receptors may contribute to the change in proprioception (Voight et al. 1996).
2. The Sense of Effort (Proske, 2005)
It is plausible that some forms of muscle spindle desensitization or the ligament relaxation and Golgi tendon desensitization occurs
with excessive fatigue (Hosseini et al., 2012), (Mc Gregor et al., 2011), (Purvi et al., 2012).
Fatigued muscles have been demonstrated in laboratory studies to be able to absorb less force than their non-fatigued counterparts.
It is this reduction in force attenuation that is considered to be the reason why fatigued muscles are at increased risk for injury. (Bahr
R. 2009).
The sense of effort is our perception of the heaviness of objects and the muscle forces we generate (McCloskey 1981).
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11. Parkinson’s Disease
● Research demonstrates that Parkinson’s Disease (PD) is associated with an array of perceptual deficits,
such as odor and tactile discrimination and detection, weight and pain perception, and the perception of
visual depth.
●
● Recent evidence suggests that kinaesthesia is especially affected by PD and that such loss of kinaesthetic
sensitivity is closely linked to the motor deficits. (Konczak, 2009)
● In general, the neurodegenerative processes associated with PD may lead to irregular neural hyper- or
hypoactivity in the basal ganglia and could act as a constant facilitator or brake on its efferent target
structures (Pessiglione et al., 2005).
● Monkeys were made parkinsonian through 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)
treatment, most neurons started responding to movements of several joints. Following MPTP-induced
parkinsonism, the tuning of the proprioceptive receptive fields of these thalamic neurons was largely
broadened thus providing much noisier and less differentiated proprioceptive information to cortical motor
regions.(Pessiglione et al., 2005)

12. Sport, injury prevention and Proprioception
- Proprioception is responsible for precise, smooth and
coordinated movement control in sports and daily
functional activities.. (dietz, 2002)
Better proprioception correlates with higher sport
performance
Han 2014 study on sport attainment and proprioception

13. Han study
(Han, 2014)

15. Proprioceptive training and injury prevention in sport
Specific proprioceptive training can be used to enhance
joint proprioception and balance control
Proprioception plays an important role in joint stability and
injury prevention in sport (Riva, 2016)
Injury prevalence is significantly greater in athletes with
poor balance control (Han, 2015)

16. What is proprioceptive training?
Proprioceptive exercises require the management of
instability.
- Many exercises can be defined as such
Relating to sport, proprioceptive training typically focuses
on balance and active movement exercises.
Main focus of proprioceptive training is on the use of somatosensory
signals such as proprioceptive or tactile afferents in the absence of
information from other modalities such as vision.
Balance control has been found to be a key predictor in injury, in both
athletes as well as elderly and diseased populations.

17. Proprioceptive training in Professional basketball players
- Study looked at effects of proprioceptive training over 6 years on incidence of ankle sprains, knee sprains,
and low back pain.
- 55 basketball players
- The 6 years were split into 3 bienniums
- 1st (2004-2006) classic proprioceptive exercises
- 2nd (2006-2008) interactive electronic postural proprioceptive stations
- 3rd (2008-2010) increased intensity and longer repetitions

19. Rehabbing injuries with proprioception
Proprioceptive deficit predisposes athletes to injuries (Lephart & Pincivero & Giraido & Fu, 1997)
Objective: retrain altered afferent pathways to enhance the sensation of joint
movements (Walsh & Moseley & Taylor & Gandevia, 2011)
Knee
● ACL and Meniscus Tear (Walsh et al. 2011)
Ankle
● Sprains (Kin Tape)(Walsh et al. 2011)
Shoulder
● Restore joint proprioception through the repair of traumatized tissue
(surgery) (Walsh et al. 2011)

20. K-Tape and support on proprioception
Kin Tape (KT) vs Athletic Tape (Spanos & Brunswic & Billis, 2008)
● KT- Waterproof and stretchable
● Athletic Tape- not elastic and restricts movement
Purpose: Provide immediate sensorimotor feedback (Kaya & Zinnurogu & Tugcu, 2011)
Pain attenuation was found to improve proprioception (Spanos et al. 2008)
Under-wrapping athletic tape affected cutaneous mechanoreceptors hence decreasing
proprioception (Spanos et al. 2008)

21. Romberg Test/ Sign
The Romberg test is administered as a test for neurological function. It is generally
administered to quantify the degree of neurological control a person holds over their
body, and is accordingly used by law enforcement for roadside sobriety field
examinations. It contains an element of proprioceptive difficulty.
The test is as follows: To pass an individual must maintain balance while standing on
one leg with the eyes closed. The reasoning for this is that is requires at least two of the
following three traits to complete: 1) Proprioception, 2) Vestibular control, and 3)
Vision.
Eliminating vision by closing the eyes allows impaired proprioception/ vestibular
control to present.

22. Clinical Application
● Most current ideas about treatment are in regards to muscle weakness and peripheral feedback
mechanisms.
● Some physiotherapists have begun using proprioception as a diagnostic tool in tests similar to the
Romberg test or functional movement screen (FMS).
● Poor proprioceptive scores can tell clinical practitioners about areas where muscle weakness or
misalignments.
Knowing where theses areas are allow practitioners to fine tune rehabilitation programs to make patients
more confident about joint positioning and limb placement.

23. What is body ownership?
The belief of what is a part of your body (what you own on your body)
Vision and hearing cannot differentiate between foreign body parts and our own
Ownership of an artificial limb does not need vision to be effective, a participant can
be blindfolded and experience ownership as well
Illusion is strong following local anesthesia of cutaneous and joint afferents in the
finger
Body Integrity Identity Disorder (BIID) and Rubber Hand Study

24. Rubber Hand Study
Participants rested their hands on the table and had a screen put up hiding one hand
from view and then placed a rubber hand in front of them.
The person running the study then touched the rubber hand and the participants hand
as close as possible to matching in time for a period of time while participants stared at
the rubber hand.
The completed questionnaires indicated that subjects experienced an illusion in which
they seemed to feel the touch not of the hidden brush but that of the viewed brush, as
if the rubber hand had sensed the touch.
Botvinick, M., & Cohen, J. (1998). Rubber hands 'feel' touch that eyes see. Nature, 391(6669), 756-756. doi:10.1038/35784

25. Rubber hand study

26. Body Integrity Identity Disorder (BIID)
People that have an extreme desire to amputate one of their healthy limbs due to a highly disturbed sense of
ownership for their limb(s) which makes them feel “incomplete” as long as the limb is there and they will not
accept it as a part of their body
Similar to somatoparaphrenia - believing that one’s own limb belongs to someone else
Sense of ownership relates to awareness of the body as belonging to yourself and feeling that a body part
belongs to your own body
Desire to amputate or to paralyze the limb
Dysfunctional activity of the right parietal lobe for tactile stimulation of the affected limb
Insua has also been found to be altered which is an area that is associated with higher order body
representations

27. Future Directions
Diffusion tensor imaging
Characterized microstructural changes or differences with neuropathology and
treatment
Motor cortical neurons
Brain does not care about information about muscle length changes provided by
individual afferents
Cares more about the population of muscle afferent signals coming about in
groups of muscles

28. Future
Senses of effort force and heaviness
Reafferent signal generated by the motor command plays a dominant role in
generating sensation
If experiments that happen support this view it makes us have to rethink the role of
muscle spindles and the fusimotor system

29. References[ [1] Bahr, R. , and Engebretsen, L.( 2009). "Sports Injury Prevention." Blackwell Publishing. P. 78- 112.
[2] Botvinick, M., & Cohen, J. (1998). Rubber hands 'feel' touch that eyes see. Nature, 391(6669), 756-756. doi:10.1038/35784
[3] Collins, A. T., Blackburn, J. T., Olcott, C. W., Miles, J., Jordan, J., Dirschl, D. R., & Weinhold, P. S. (2011). Stochastic resonance electrical
stimulation to improve proprioception in knee osteoarthritis. The Knee, 18(5), 317-322. doi:10.1016/j.knee.2010.07.001
[4] Dietz, V. (2002). Proprioception and locomotor disorders. Nature Reviews Neuroscience, 3(10), 781-790. http://dx.doi.org/10.1038/nrn939
[5] Escola, L., Michelet, T., Douillard, G., Guehl, D., Bioulac, B. and Burbaud, P. 2002. Disruption of the proprioceptive mapping in the medial
wall of parkinsonian monkeys. Annals of Neurology, 52: 581–587.
[6] Han, J., Anson, J., Waddington, G., & Adams, R. (2014). Sport Attainment and Proprioception.International Journal Of Sports Science And
Coaching, 9(1), 159-170. http://dx.doi.org/10.1260/1747-9541.9.1.159
[7] Hosseini, S., Rostamkhany, H., Panahi, M. and Darzi, R. L. (2012). "Exercise-Related Fatigue Change Dynamic Postural Control in Healthy
Males." Middle-East Journal of Scientific Research, 11 (2). P. 230-36.
[8] Ingemanson, M. L., Rowe, J. B., Chan, V., Wolbrecht, E. T., Cramer, S. C., & Reinkensmeyer, D. J. (2016). Use of a robotic device to measure
age-related decline in finger proprioception. Experimental Brain Research, 234(1), 83-93. doi:10.1007/s00221-015-4440-4
[9] Konczak, J., Corcos, D. M., Horak, F., Poizner, H., Shapiro, M., Tuite, P.. . Maschke, M. (2009). Proprioception and motor control in
parkinson's disease. Journal of Motor Behavior, 41(6), 543-552. doi:10.3200/35-09-002

30. References[10] McGregor, S. J., Yaggie, J. A., Bollt, E. M., and Parshad, J. J. (2011). "Lower extremity fatigue increases complexity of postural control
during a single-legged stance." Journal of NeuroEngineering and Rehabilitation, 8 (43). P. 2-10
[11] Pessiglione, M., Guehl, D., Rolland, A. S., Francois, C., Hirsch, E. C.Feger, J. 2005. Thalamic neuronal activity in dopamine-depleted
primates: Evidence for a loss of functional segregation within basal ganglia circuits. Journal of Neuroscience, 25: 1523–1531.
[12] Proske, U., Gandevia, SC. (2012). The Proprioceptive Senses: Their Roles in Signaling Body Shape, Body Position and Movement, and
Muscle Force. American Physiological Society, 92, 1651–1697. doi:10.1152/physrev.00048.2011
[13] Purvi, K. C., Selvamani, K., and Ramaprabhu. (2012). "A study to evaluate the effect of fatigue on knee joint proprioception and balance in
healthy individuals." International Journal of Engineering Research and Applications (IJERA), 2 (2). P. 645-49
[14] Seel, N. (2012). Encyclopedia of the sciences of learning. [Place of publication not identified]: Springer.
[15] Trans, T., Aaboe, J., Henriksen, M., Christensen, R., Bliddal, H., & Lund, H. (2009). Effect of whole body vibration exercise on muscle
strength and proprioception in females with knee osteoarthritis. The Knee, 16(4), 256-261. doi:10.1016/j.knee.2008.11.014
[16] Seel, N. (2012). Encyclopedia of the sciences of learning. [Place of publication not identified]: Springer.
[17] Wingert, J. R., Welder, C., & Foo, P. (2014). Age-Related Hip Proprioception Declines: Effects On Postural Sway and Dynamic Balance.
Archives of Physical Medicine and Rehabilitation, 95(2), 253. doi:10.1016/j.apmr.2013.08.012
[18] Yalfani, A., Gandomi, F., & Abbasi, H. (2013). the effect of fatigue on the ankle and knee proprioception and dynamic control of posture.
International Journal of Sports Sciences and Fitness, 3(2), 235