Our sensory system conveys the information we need to our brains so we can make the right decisions in daily life. Huge amounts of information flow in to our brain at all times and we must decide the importance or otherwise of this. Hearing, touch and sight are clearly used by use to manage our responses to the challenges of normal life but there are other sensory modalities which are just as important in our mobility. The feelings coming in from all our bodily structures such as our muscles, ligaments, discs and joints are very important for normal movement function. Joint position sense is more specifically related to our joints and is also called proprioception.
Waking up with a dead, completely numb arm is a good example of the loss of sensory input having a strong effect on what we can do. I woke up one night with an arm across my chest, making me hotter than I already was in bed. I was a bit irritable and moved the arm off my chest at least twice until I woke up a bit and began to realise what was going on. I followed the arm, which I couldn't feel at all, up to the shoulder only to find out it was mine. The profound loss of feeling in the arm meant I had no idea it was mine until I found out it was attached. I could do nothing with it independently.
In my work as a physiotherapist I have treated all kinds of conditions and some of these interactions were very instructive. A patient who had had a stroke got hold of my hand and moved it back and forth, bending and straightening the fingers and stretching the wrist. Suddenly I realised that he thought it was his arm! He could feel nothing from his own arm when he did the same movements to it, so moving my arm seemed entirely natural until he looked more closely at it and realised it wasn't his. The next time you get a dead arm in bed, try and move it. Apart from feeling unpleasant, the limb is extraordinarily difficult to move, it feels right out of control and just lies there despite you willing it to move.
Once when I was treating a stroke patient he started to manipulate my hand back and forwards, straightening and bending the fingers and the wrist. I was puzzled at first until I figured out he thought my hand was his. His arm was completely numb and gave him no feedback so he couldn't know that it wasn't his arm by moving it as he never felt anything form it, until he followed it with his eyes and saw it was mine. If you get a dead arm try and do something with it, you will know how it feels unpleasant but also that it is very hard to get the arm to do anything despite your efforts.
Looking at a stroke patient it is easy to see the loss of movement but the abnormality of the sensory system is hidden and may make a higher contribution to the patient's disability. Proprioception, also called joint position sense (JPS), is the ability of our brains to know where our joints are at every second. It informs us what the joint angle is, how much body weight is on it and how much muscular force is being exerted near the joint.
Monitoring of the positions, stresses and effort being exerted through all our joints is streaming in to our brains all the time from the joint position sense and other sense organs in our muscles and tendons. We need all this incoming information to make sense of where our limbs are so that we are in a position to do the next actions we desire. Accurate JPS information is essential if we are to be able to plan our next movement.
The ability to independently manage our day to day activities and mobility is dependent on accurately sensing our body parts and their positions and movement. Direct trauma to an individual nerve, paraplegia and stroke involve loss of joint position sense but smaller, less dramatic incidents can also cause JPS loss. Knee injuries such as anterior cruciate ligament rupture and ankle injuries such as a simple sprain can reduce our sensory feedback accuracy and require treatment. Proprioception treatment in routinely included in physiotherapists treatment programmes for many traumatic and disease related conditions. - 14130
Waking up with a dead, completely numb arm is a good example of the loss of sensory input having a strong effect on what we can do. I woke up one night with an arm across my chest, making me hotter than I already was in bed. I was a bit irritable and moved the arm off my chest at least twice until I woke up a bit and began to realise what was going on. I followed the arm, which I couldn't feel at all, up to the shoulder only to find out it was mine. The profound loss of feeling in the arm meant I had no idea it was mine until I found out it was attached. I could do nothing with it independently.
In my work as a physiotherapist I have treated all kinds of conditions and some of these interactions were very instructive. A patient who had had a stroke got hold of my hand and moved it back and forth, bending and straightening the fingers and stretching the wrist. Suddenly I realised that he thought it was his arm! He could feel nothing from his own arm when he did the same movements to it, so moving my arm seemed entirely natural until he looked more closely at it and realised it wasn't his. The next time you get a dead arm in bed, try and move it. Apart from feeling unpleasant, the limb is extraordinarily difficult to move, it feels right out of control and just lies there despite you willing it to move.
Once when I was treating a stroke patient he started to manipulate my hand back and forwards, straightening and bending the fingers and the wrist. I was puzzled at first until I figured out he thought my hand was his. His arm was completely numb and gave him no feedback so he couldn't know that it wasn't his arm by moving it as he never felt anything form it, until he followed it with his eyes and saw it was mine. If you get a dead arm try and do something with it, you will know how it feels unpleasant but also that it is very hard to get the arm to do anything despite your efforts.
Looking at a stroke patient it is easy to see the loss of movement but the abnormality of the sensory system is hidden and may make a higher contribution to the patient's disability. Proprioception, also called joint position sense (JPS), is the ability of our brains to know where our joints are at every second. It informs us what the joint angle is, how much body weight is on it and how much muscular force is being exerted near the joint.
Monitoring of the positions, stresses and effort being exerted through all our joints is streaming in to our brains all the time from the joint position sense and other sense organs in our muscles and tendons. We need all this incoming information to make sense of where our limbs are so that we are in a position to do the next actions we desire. Accurate JPS information is essential if we are to be able to plan our next movement.
The ability to independently manage our day to day activities and mobility is dependent on accurately sensing our body parts and their positions and movement. Direct trauma to an individual nerve, paraplegia and stroke involve loss of joint position sense but smaller, less dramatic incidents can also cause JPS loss. Knee injuries such as anterior cruciate ligament rupture and ankle injuries such as a simple sprain can reduce our sensory feedback accuracy and require treatment. Proprioception treatment in routinely included in physiotherapists treatment programmes for many traumatic and disease related conditions. - 14130
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Brighton or elsewhere in the UK.
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