A Validation Study of Force Sense Measurement
Condition: Knee Injuries; Proprioceptive Disorders
MeSH terms: Somatosensory Disorders; Knee Injuries
Study type: Observational

Summary: 
      The term proprioception was first introduced by Sherrington in 1906, who described it as a
      type of feedback from the limbs to the central nervous system. Based on the early
      descriptions by Sherrington and others, the contemporary terms of joint position sense (JPS),
      kinaesthesia (perception of active and passive motion), and sense of tension or force sense
      are considered sub modalities of proprioception.

      For the extremity joints, goniometers (universal, bubble, digital) can also be used to
      measure active JPS. Depending on the device used and the extremity joint measured,
      reliability and measurement error of active movement goniometry can range widely and this
      should be carefully considered if goniometry is used to measure active JPS of extremity
      joints. Kinesthesia, can be measured by calculating the passive motion detection threshold of
      individuals.

      The force sense (FS), commonly assessed using force reproduction, has also been used as a
      measure of proprioception. Assessing force reproduction by limb matching involves the use of
      a reference force, usually determined as a percentage of a Maximal Voluntary Isometric
      Contraction (MVIC), and attempting to replicate that force.

      Proprioception can be decreased in those who suffer from knee injury. Because patients with
      severe degenerative joint disease often require total knee arthroplasty to relieve pain,
      improve stability, and restore function. Due to problems such as oedema, immobilization and
      subjective pain after surgery, it is difficult to evaluate proprioception with joint
      repositioning method. In such cases, the assessment of FS could be of particular interest in
      the knee region. FS can also be measured by the accuracy of reproducing a specific target
      force. For example, the pressure biofeedback device (PBD) used for assessing the
      cranio-cervical flexion test could be considered a method of assessing force sense in the
      cervical spine. The ability to hold steadily or the accuracy in achieving and maintaining a
      desired pressure can be used. However, for the knee region, there is no method to measure the
      force sense via a device that can be used in clinical practice.

      The aim of this study was to establish a method for measuring FS that could be applied
      quickly and practically in the clinic, and to correlate the outcomes with surface
      electromyographic (EMG) muscle activation levels from M. Quadriceps femoris to demonstrate
      the applicability and objectivity of this method.
    


Intervention name(s): Test protocol for proprioceptive force sense in case group
Intervention type(s): Other
Intervention description(s): The FS in the knee region was measured by the pressure, biofeedback device (Stabilizer ™, Chattanooga Group Inc., Chattanooga, TN).
Surface EMG device (Noraxon USA, Inc., Scottsdale, AZ) was used to measure activation levels of M. Vastus Medialis Obliquus (VMO), M. Vastus Lateralis (VL) and M. Rectus Femoris (RF) muscles. Due to the characteristics of the Bipolar Ag/AgCl surface electrodes, the distance between the electrodes was set to 1 cm and the electrode width to 2 cm. The electrode placement was determined according to the SENIAM (Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles) criteria.
Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Healthy individuals without chronic knee problems were included in the study.
      
Keywords: force sense; knee joint; proprioception; sphygmomanometer; surface EMG