title: Increasing cutaneous afferent feedback improves proprioceptive accuracy at the knee in patients with sensory ataxia.
abstract: Hereditary sensory and autonomic neuropathy type III (HSAN III) features disturbed proprioception and a marked ataxic gait. We recently showed that joint angle matching error at the knee is positively correlated with the degree of ataxia. Using intraneural microelectrodes, we also documented that these patients lack functional muscle spindle afferents but have preserved large-diameter cutaneous afferents, suggesting that patients with better proprioception may be relying more on proprioceptive cues provided by tactile afferents. We tested the hypothesis that enhancing cutaneous sensory feedback by stretching the skin at the knee joint using unidirectional elasticity tape could improve proprioceptive accuracy in patients with a congenital absence of functional muscle spindles. Passive joint angle matching at the knee was used to assess proprioceptive accuracy in 25 patients with HSAN III and 9 age-matched control subjects, with and without taping. Angles of the reference and indicator knees were recorded with digital inclinometers and the absolute error, gradient, and correlation coefficient between the two sides calculated. Patients with HSAN III performed poorly on the joint angle matching test [mean matching error 8.0 ± 0.8° (±SE); controls 3.0 ± 0.3°]. Following application of tape bilaterally to the knee in an X-shaped pattern, proprioceptive performance improved significantly in the patients (mean error 5.4 ± 0.7°) but not in the controls (3.0 ± 0.2°). Across patients, but not controls, significant increases in gradient and correlation coefficient were also apparent following taping. We conclude that taping improves proprioception at the knee in HSAN III, presumably via enhanced sensory feedback from the skin.
authors.affiliation: School of Medicine, Western Sydney University, Sydney, Australia; and v.macefield@westernsydney.edu.au.
authors.forename: Vaughan G
authors.initials: VG
authors.lastname: Macefield
authors.affiliation: Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York.
authors.forename: Lucy
authors.initials: L
authors.lastname: Norcliffe-Kaufmann
authors.affiliation: Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York.
authors.forename: Niamh
authors.initials: N
authors.lastname: Goulding
authors.affiliation: Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York.
authors.forename: Jose-Alberto
authors.initials: JA
authors.lastname: Palma
authors.affiliation: Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fuente Mora
authors.affiliation: Dysautonomia Center, Department of Neurology, New York University School of Medicine, New York, New York.
authors.forename: Horacio
authors.initials: H
authors.lastname: Kaufmann
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004402:Dysautonomia, Familial / Q000503:physiopathology*; D056228:Feedback, Sensory; D005260:Female; D006801:Humans; D007717:Knee / Q000294:innervation* / Q000503:physiopathology; D008297:Male; D009475:Neurons, Afferent / Q000502:physiology; D011434:Proprioception; D012867:Skin / Q000294:innervation
keywords: HSAN III; cutaneous afferents; familial dysautonomia; muscle spindles; proprioception