Table 15: Comparison of strength subtest scores between Group A and Group B.

Discussion

The current study aimed to compare the effect of proprioceptive training exercises on gross motor coordination between individuals with and without sensorineural hearing loss using 4 subtests of BOT as outcome measure. The data was analyzed by using paired and unpaired ‘t’ test.

The result showed significant mean difference in Group B in two subtests which are running speed and agility with mean 6.27 ± 2.420 and balance with mean 3.37 ± 1.608 was compared with Group A data of running speed and agility with mean 2.00 ± 2.304 and balance with mean 1.63 ± 1.732 using unpaired ‘t’ test with level of significance set at 0.05 which gave unpaired ‘t’ value of 6.993 and 4.018 respectively using BOT-2 as outcome measure.

The result showed no significant mean difference in Group B in two subtests which are bilateral coordination with mean 2.17 ± 1.510 and strength with mean 3.37 ± 1.608 was compared with Group A data of bilateral coordination with mean 1.73 ± 1.112 and strength with mean 5.60 ± 3.450 using unpaired ‘t’ test with level of significance set at 0.05 which gave unpaired ‘t’ value of 1.265 and 1.810 respectively using BOT-2 as outcome measure.

In this study the proprioception training exercises were executed in a Closed Kinetic Chain (CKC), which bring about muscle contractions and entitles the mechanoreceptors in the skin, joints and capsules to function more constructively. Thus, the competence of the proprioceptive receptors is advocated. From this perspective the results of improvement in the post test data with mean 48.57± 3.224 in running speed and agility subtest of Group A with pretest data with mean 46.57± 4.797 was compared using paired ‘t’ test with level of significance set at 0.05 that gave paired ‘t’ value of 4.754 which is in agreement with findings of study. [11] who confirmed that agility is remarkably correlated with speed in both sexes, with power in females and with balance in males. Balance furtherance after proprioceptive training can further influence complex motions and could result in improved agility, as the agility training contains stops, changes of direction and accelerations. When stopping, the improved balance ensures a finer stability of the body, opposing the inertia and averting the body segments to carry on moving in the previous direction. This precipitates both a more economic change of direction and a more efficient acceleration [12].

In Group B the statistical analysis showed significant difference in running speed and agility subtest when pre data with mean 35.79± 6.085 and post data with mean 42.03± 5.883 was compared using paired ‘t’ test with level of significance set at 0.05 which gave paired ‘t’ value of 13.668 because proprioception provides cues solely on the stature of the internal body, with the expertise of proprioception individual can master new motor skills. proprioceptive capabilities are essential for orientation and moving in space and undertaking with the environment [9].

Vestibular receptors portray a principal role in basic movement reactions, as they receive cues admissible to the position of the head in space and spawn reflexes this suggests use of substitute pathways like that of proprioception in individuals with sensorineural hearing loss for adapting to varying speed, direction and movement pattern [13].

In comparison between the groups, Group A and Group B, for running speed and agility subtest scores group B showed comparative improvement statistically at values with unpaired ‘t’ test value of 6.993 with level of significance set at 0.05. Proprioception physiology in all likelihood is detailed in three ways as described in the literature. First, the information from the proprioception helps to cushion the joint from excessive and injurious motion via reflex mechanism. Second, it gives information about joint stabilization during static posture. Third, it will help in conducting coordination of the motion or complex motion in a precise manner. Also, person who does not receive audio signs or other kinesics from environment may perform motor tasks in different manner. Hearing disturbances cause the infirmity of proper motions production as stated therefore it is believed that proprioceptive training improves more motor output in Group B leading to a significant mean difference between the two groups [14].

In Group A the statistical analysis showed significant difference in balance subtest when pre data with mean 27.53± 3.192 and post data with mean 29.17± 1.913 was compared using paired ‘t’ test with level of significance set at 0.05 which gave paired ‘t’ value of 5.166 attributed to the fact that during movements proprioception has importance for: Feedback (responsive) control, feed forward (precursory) control and the regulation of muscle stiffness, to achieve specific roles for movement acuity, joint stability, co-ordination and balance [15].

In Group B the statistical analysis showed significant difference in balance subtest when pre data with mean 18.83± 5.050 and post data with mean 22.10± 4.981 was compared using paired ‘t’ test with level of significance set at 0.05 which gave paired ‘t’ value of 11.337. Studies have shown that proprioceptive feedback accord significantly to controlling opposite muscle torque, scheduling multi-joint movements, planning movement and providing internal models of body exposure that are essential for generating and endorse proficient movements [1]. This is the mechanism of improvement in balance subtest scores of individuals with sensorineural hearing loss.

In comparison between the groups, Group A and Group B, for balance subtest scores group B showed comparative improvement statistically at values with unpaired ‘t’ test value of 4.018 with level of significance set at 0.05. Proprioception is the most essential system for sensory balance control and helps the joints and body stability through feedback and feed-forward mechanisms [16]. The protocol included various exercises that challenged static as well as dynamic balance along with weekly progression this led to a marked increase in scores of balance subtest in group B than group A as group B relied more on other pathways like that of proprioception thereby giving them an edge over group A.

In Group A the statistical analysis showed significant difference in bilateral coordination subtest when pre data with mean 13.47 ± 1.756 and post data with mean 15.20 ± 1.827 was compared using paired ‘t’ test with level of significance set at 0.05 which gave paired ‘t’ value of 8.537 as the role of proprioception in sensorimotor control is multifold. To plan appropriate motor commands, the central nervous system needs an updated body architecture of the biomechanical and spatial properties of the body parts, supplied substantially by proprioceptors [17]

In Group B the statistical analysis showed significant difference in bilateral coordination subtest when pre data with mean 8.41 ± 1.570 and post data with mean 10.66 ± 0.857 was compared using paired ‘t’ test with level of significance set at 0.05 which gave paired ‘t’ value of 8.157 because proprioceptive deficits cause postural control or balance problems, difficulties and apprehension in many activities of daily living therefore proprioceptive abilities are essential for orientation and moving in space and engaging with the environment. Their functions are performance of motion sequences, controlling of aiming accuracy, control and correction of ceaseless movements, reaching and tracking movements like grasping and manipulating objects [18]. 

In comparison between the groups, Group A and Group B, for bilateral coordination subtest scores, Group B didn’t show comparative improvement statistically at values with unpaired ‘t’ test value of 1.265 with level of significance set at 0.05. The probable reason for this outcome could be the measurement tool; in essence the bilateral coordination subtest of BOT-2 examines coordination of upper extremities whereas the proprioceptive training exercise protocol focused primarily on lower extremities as it involved all weight bearing exercises. Moreover due to sensorineural hearing loss Group B wasn’t able to fully comprehend the tasks which assessed bilateral coordination in BOT-2.

In Group A the statistical analysis showed significant difference in strength subtest when pre data with mean 23.20 ± 3.316 and post data with mean 28.80 ± 4.788 was compared using paired ‘t’ test with level of significance set at 0.05 which gave paired ‘t’ value of 8.890 because proprioception is vital also after movement for comparison of actual movement with intended movement, as well as the predicted movement supplied by the efferent copy. This is suggested to have importance for motor learning by upgrading of the internal forward model of the motor command [19].

In Group B the statistical analysis showed significant difference in strength subtest when pre data with mean 21.14 ± 2.133 and post data with mean 25.48 ± 2.011 was compared using paired ‘t’ test with level of significance set at 0.05 which gave paired ‘t’ value of 16.180. This is because of activation of proprioceptive connections in absence of vestibular system integrity, increased proprioception paved way for increased enthusiasm for undergoing the protocol [20].

In comparison between the groups, Group A and Group B, for strength subtest scores, Group B didn’t show comparative improvement statistically at values with unpaired ‘t’ test value of 1.810 with level of significance set at 0.05. The probable reason for this is the non-uniformity of baseline in the pretest data [21]. Group A already had more strength when compared to their counterparts in Group B, but the protocol was totally identical including the number or repetitions and progression plan. Moreover the protocol didn’t involve extensive strengthening exercise which might have aided in a significant increase in strength of Group B when compared with Group A. On top of that the strength subtest of BOT-2 included only standing broad jump, sit ups and knee pushups which in themselves aren’t enough to measure complete strength [22].

Brown 2005 insinuated that excessively high or low muscle tone is usually correlated with poorly tempered tactile and proprioceptive senses in deaf children, tactile defensiveness may be present and awareness of touch, pain and temperature may be fluctuating.

Conclusion

The present study concludes that there was significant difference between the effect of proprioceptive training exercises on gross motor coordination between individuals with and without sensorineural hearing loss. Therefore, alternate hypothesis was accepted and null hypothesis was rejected. Moreover the protocol didn’t involve extensive strengthening exercise which might have aided in a significant increase in strength of Group B when compared with Group A. On top of that the strength subtest of BOT-2 included only standing broad jump, sit ups and knee pushups which in themselves aren’t enough to measure complete strength.

Limitations

• Sample size of the groups was small
• Outcome measure didn’t cover all domains of GMC

Future scope of the study

• Other parameters besides age, gender and BMI can be considered
• Tools other than BOT-2 could be of implicative value
• Further components of motor coordination apart from GMC can be explored
• Long term effects of the techniques can also be compared.
• Bigger sample of the individual can be used for comparison.

Declaration of Funding

No funding was received.

Disclosure of Interest 

There was no conflict of interest between the authors.

Data Availability

The data that support the findings of this study are available from the corresponding author, Kapoor A., upon reasonable request.

Author Contributions

Corresponding and first author: Dr. Abhay Kapoor (PT),

Second author: Dr. Amandeep Singh (PT),

 Third author: Dr. Saloni Aulakh (PT),

 Fourth author: Dr. Smriti Madaik (PT)

All four authors confirm that they fulfill the following criteria:

• Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work;
• Drafting the work or revising it critically for important intellectual content;
• Final approval of the version to be published; and
• Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

as per ICMJE recommendations for authorship.

Ethical Approval Statement

The faculty of physiotherapy of Baba Farid University of health sciences has approved the plan of this research project with ethical approval number stated as ASP-MPN-2020/01. All the subjects signed written consent before enrolling for the research project.

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