Testing Proprioception in the Hospital Setting as an OT
Proprioception was first identified in 1826 by a Scottish physiologist, Charles Bell. Bell wrote that “between the brain and the muscles there is a circle of nerve; one nerve (ventral roots) coveys the influence from the brain to the muscle, another (dorsal roots) gives the sense of the condition of the muscle to the brain.” Bell views “muscular sense” to a closed-loop system between the brain and the muscles: the afferent pathway from the brain to the muscles (Han et al., 2014).
Fast forward sixty years later, Henry Bastian, an English anatomist and pathologist introduced the term “kinaethesia” derived from two Greek words “kinein” (move) and “aisthesis” (sensation). Then, in 1960, the English Neurophysiologist Sir Charles Sherrington coined “proprioception” from a combination of the Latin “proprius” (one’s own) and “perception” to give a term for the sensory information derived from (neural) receptors embedded in joints, muscles, and tendons, that enable a person to know where parts of the body are located at any time (Han et al., 2014).
He (Bastian) referred to proprioception as “the perception of joint and body movement as well as position of the body, or body segments, in space.”
What causes poor proprioception?
Injuries or medical conditions that affect the neuromuscular system (muscles, nerves, and the cerebellum)
Consumption of alcohol
Age-related changes
How to Assess
Check level of arousal and cognition.
Ensure clearance for movement (check vitals, lines/tubes, etc.).
Explain what you are doing and why.
Avoid visual cues by asking the patient to close their eyes or look away.
Quick Proprioception Tests (UE-focused)
These are ideal when working at bedside or during an early mobility session.
1. Thumb-Find Test
Ask the patient to close their eyes.
Move their affected arm into space (e.g., above head or out to the side).
Ask them to use their unaffected arm to find and pinch their thumb.
Interpretation: Poor proprioception if they miss or hesitate significantly.
2. Joint Position Sense (JPS) Test
Test one joint at a time (commonly fingers, wrist, elbow).
Method:
Stabilize proximally (e.g., hold forearm while testing finger).
Move the distal segment up or down slowly.
Ask: “Is your [finger/wrist/elbow] going up or down?”
Test Bilaterally for comparison.
3. Mirroring Test (Matching)
Move the uninvolved limb to a position.
Ask the patient to match that position with their involved limb (eyes closed).
Common joints to test:
Shoulder abduction/flexion
Elbow flexion
Wrist extension
Clinical Tips:
Start distally (fingers/toes) and move proximally if deficits are found.
Observe for compensations (visual reliance, muscle guarding).
Document which joints were tested, method, and accuracy.
Relate findings to functional tasks (e.g., difficulty with feeding or transfers).
Reference:
Han, J., Waddington, G., Adams, R., Anson, J., & Liu, Y. (2016). Assessing proprioception: A critical review of methods. Journal of sport and health science, 5(1), 80–90. https://doi.org/10.1016/j.jshs.2014.10.004