Internati

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ISSN: 2329-9096

International Journal of

Physical Medicine & RehabilitationHincapie and Ruiz, Int J Phys Med Rehabil 2017, 5:5

DOI: 10.4172/2329-9096.1000426

Short Communication Open Access

Volume 5 • Issue 5 • 1000426Int J Phys Med Rehabil, an open access journalISSN: 2329-9096

The Jp Sensometer: An Instrument to Train Joint Position Sense for the WristOlga L. Hincapie* and Natalia RuizNYU Langone Medical Center, Center for Musculoskeletal Care, New York, USA

*Corresponding author: Olga L. Hincapie, NYU Langone Medical Center, Center for Musculoskeletal Care, 333 East 38th street, 5th floor, New York 10016, USA, E-mail: olga.hincapie@nyumc.org

Received July 13, 2017; Accepted August 16, 2017; Published August 18, 2017

Citation: Hincapie OL, Ruiz N (2017) The Jp Sensometer: An Instrument to Train Joint Position Sense for the Wrist. Int J Phys Med Rehabil 5: 426. doi: 10.4172/2329-9096.1000426

Copyright: © 2017 Hincapie OL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

IntroductionJoint position sense assesses precision or accuracy in repositioning

a joint at a predetermined target angle [1]. Joint position sense is a sub modality of proprioception and contributes to the sensorimotor control of the joints [2,3].

Previously published studies have demonstrated significant wrist and hand sensorimotor impairment and functional deficits after distal radius fractures and carpal ligament injuries [4,6].

The importance of measuring and re-training joint position sense after wrist trauma has been drawing attention recently. Therefore, restoring joint position sense should be integrated into a rehabilitation program in patients with wrist trauma to re-establish the sensorimotor control of this joint.

Two methods have been described to measure joint position sense: Ipsilateral matching and contralateral matching [7]. Ipsilateral matching is performed by passively positioning the joint to a specific angle, then asking the patient to replicate the same position actively. Contralateral matching follows the same process, but the participant is asked to replicate the angle with the contralateral limb. (See protocol below). It has been suggested that for re training purposes, patients should start with ipsilateral matching and progress to contralateral matching, since the last one requires transmission between brain hemispheres in addition to working memory [6].

Measuring joint position sense of the wrist joint has been standardized by Karagiannopoulus et al. [8] using a standard goniometer. This method has demonstrated high intra-tester reliability and responsiveness [9].

Based on the studies mentioned above [8,9], hand therapists should teach patients to practice conscious joint position sense as part of their treatment and home exercise program. This can be accomplished at the clinic but requires the therapist to be present to obtain the measurements with a goniometer. In addition, it is difficult for patients to practice this exercise at home because there is no point of reference to monitor progress and independently assess accuracy of repositioning.

In a clinical setting, a skilled hand therapist can integrate joint position re-training into their treatment session with the use of a goniometer. However, this can be time-consuming for the therapist to track all changes. Additionally it is extremely challenging for patients to perform this activity at home independently.

To address these challenges, the authors created the JP Sensometer: a tool that provides immediate feedback and tracks progress. The JP Sensometer eliminates the need for a therapist to measure with a goniometer; the patients can perform the exercise independently and monitor progress themselves.

Description of the Jp SensometerThe template was developed using AutoCAD® computer software

utilized for Engineer and Architectural drafting to ensure accuracy in establishing angles within a 180 degree arch. The template was then printed onto a 12” × 9” wooden white board. Figure 1 depicts the JP Sensometer with the landmarks:

1. Center point indicated with a cross as “wrist resting point”.

2. Blue lines indicate 0° as neutral point for the 5th finger whenhand is on the ulnar side or the 3rd finger when hand is palmdown. There are 10° increments to each side, up to 90 degrees.

3. Green lines indicate 5° increments

4. Black lines indicate 1° increments

In addition, the authors developed a log in sheet (Figure 2) withpre-determined target angles and three trials per angle as a means to record progress.

How to Use the Jp SensometerThe patient’s forearm must be supported on a towel roll to

minimize cutaneous input. This practice is based on literature that considers that pure joint position sense should come from the stimulus of the muscle spindles and the Golgi organ and not cutaneous input [10].

The patient aligns the wrist onto the center point of the template, marked as “place the wrist here”. To perform wrist flexion and/or extension the forearm is positioned in neutral (Figure 3).

To perform ulnar and radial deviation, the forearm is positioned in pronation, the wrist aligned on the center point and the middle finger aligned at the 0º marker (Figure 4).

Once the patient becomes familiar with the goals of the JP

Figure 1: Depicts the JP Sensometer with the landmarks.

Citation: Hincapie OL, Ruiz N (2017) The Jp Sensometer: An Instrument to Train Joint Position Sense for the Wrist. Int J Phys Med Rehabil 5: 426. doi: 10.4172/2329-9096.1000426

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Volume 5 • Issue 5 • 1000426Int J Phys Med Rehabil, an open access journalISSN: 2329-9096

patients for 5-10 minutes within a single session. Patients are provided with a template printed on paper as part of their home exercise program with specific instructions, including taping the template to a table top.

ConclusionsThe JP sensometer is an instrument that allows patients with deficits

in joint position sense to re- train independently. The JP Sensometer does not intend to replace goniometry measurements taken by the therapist; however, it offers the patient the possibility to have immediate feedback about his performance when practicing joint position sense and can be incorporated easily into clinical practice.

References1. Roijezon U, Clark NC, Treleaven J (2015) Proprioception in musculoskeletal

rehabilitation. Part 1: Basic Science and principles of assessment and clinical interventions. Manual Therapy.

2. Riemann BL, Lephart SM (2002) The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train 37: 71-79.

3. Riemann BL, Lephart SM (2002) The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability. J Athl Train 37: 80-84.

4. Karagiannopoulos C, Sitler M, Michlovitz S, Tierney R (2013) A descriptive study on wrist and hand sensori-motor impairment and function following distal radius fracture intervention. J Hand Ther 26: 204-215.

5. Hagert E (2010) Proprioception of the wrist joint: A review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther 23: 2-17.

6. Hincapie OL, Vasquez-Welsh L, Elkins J (2010) Proprioception re training for a patient with chronic wrist pain secondary to ligament injury with no structural instability. J Hand Ther 29: 183-190.

7. Goble D (2010) Proprioceptive Acuity Assessment via Joint Position Matching: From Basic Science to General Practice. Phys Ther 90: 1176-1184.

8. Karagiannopoulus C, Michlovitz S (2016) Rehabilitation strategies for wrist sensorimotor impairment: From theory to practice. J Hand Therapy 29: 154-165.

9. Karagiannopoulus C, Sitler M, Michlovitz S, Tucker C, Tierney R (2016) Responsiveness of the wrist active joint position sense test after distal radius fracture intervention. J Hand Ther 29: 474-482.

10. Gay A, Harbst K, Kaufman K, Hansen D, Laskowski E, et al. (2010) New method of measuring wrist joint position sense avoiding cutaneous and visual inputs. J Neuroeng Rehabil 7: 5.

Sensometer, the patient initiates the re-training exercises starting with ipsilateral matching.

Protocol:

1. Patient positions hand on the center marker.

2. Patient positions the hand in the target angle and holds the position for 3 seconds [8].

3. Patient returns to starting position.

4. Patient replicates the angle with eyes closed.

5. Patient documents the angles in the log in sheet.

For contralateral matching training, 2 boards are used in the same manner described in the protocol above.

Authors have used the JP Sensometer in the clinic with their

JP SENSOMETER LOG IN SHEET NAME ____________________________________________

Date Predetermined angle First trial Second trial Third trial 25o Flexion

20o Extension 20o Flexion 30o Extension 10o Radial deviation 20o Ulnar deviation

Date Predetermined angle First trial Second trial Third trial 20o Flexion

25o Extension 25o Flexion 20o Extension 10o Radial deviation 25o Ulnar deviation

Date Predetermined angle First trial Second trial Third trial 15o Flexion

15o Extension 30o Flexion 35o Extension 5o Radial deviation 15o Ulnar deviation

Date Predetermined angle First trial Second trial Third trial 35o Flexion

15o Extension 40o Flexion 40o Extension 10o Radial deviation 20o Ulnar deviation

Figure 2: Log in sheet.

Figure 3: Shows wrist flexion and/or extension the forearm is positioned in neutral.

Figure 4: Forearm is positioned in pronation.