Affiliations: [a] South Tees Hospitals NHS Foundation Trust, Redcar Physiotherapy Department, Redcar, UK | [b] School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK | [c] School of Health and Social Care, Teesside University, Middlesbrough, UK
Correspondence:
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Corresponding author: Cormac G. Ryan, Reader in Physiotherapy, Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK. Tel.: +44 0 01642 738253; E-mail: c.ryan@tees.ac.uk.
Abstract: PURPOSE: Working body schema (WBS) of the limbs may be indirectly assessed using left/right limb judgement (LRLJ) task performance. This study aimed to investigate if: 1) Total Knee Replacement (TKR) patients perform LRLJ tasks with reference to their WBS; 2) patients have a disrupted WBS following a TKR for the replaced knee compared to the contralateral knee; and 3) lower limb-based LRLJ task performance changes following post-surgical rehabilitation using change in upper limb-based LRLJ task performance as a control. METHODS: In a convenience sample (n= 18, age 69 ± 7 yrs, 12F 6M) of TKR patients < 1 month post-surgery, WBS was assessed using LRLJ task performance for the upper (pictures of the hand) and lower limb (pictures of the foot) before and after rehabilitation. Accuracy and response time (RT) were analysed using a series of 2 × 2 × 2 ANOVAs. RESULTS: LRLJ task performance for images corresponding with the operated and non-operated side were comparable for accuracy (p= 0.83) and RT (p= 0.28). Accuracy for hand images was comparable from baseline to post-rehabilitation (p= 0.54) whereas accuracy for feet images increased significantly (p= 0.03). Responses for awkward posture images were significantly slower than for more natural posture images (p= 0.001). CONCLUSIONS: LRLJ task performance data reflected the typical biomechanical constraints indicative of implicit motor imagery being performed by patients. There was no evidence of a disrupted LRLJ task performance for the replaced knee compared to the contralateral knee. Following post-surgical rehabilitation, patients’ lower limb LRLJ task performance improved whilst upper limb LRLJ task performance remained unchanged. These findings are the first to show that WBS improves with rehabilitation following TKR, and this may explain some of the clinical improvements observed. Undertaking LRLJ tasks could theoretically be a useful adjunct to current post-TKR rehabilitation.
Keywords: Total knee replacement, working body schema, implicit motor imagery
