Joint Position Sense Error (JPSE) | Dizziness Assessment
In recent decades, several studies have examined the relationship between proprioceptive deficits and neck pain. Cervical proprioception can be measured using the Joint Position Sense Error abbreviated as JPSE, which reflects a person’s ability to accurately return his head to a predefined target after a cervical movement.
A review by de Vries et al. (2015) has shown that patients with traumatic neck pain had a significantly higher joint position sense error abbreviated as JPSE compared to healthy controls. In patients with non-traumatic neck pain, half of the studies show that patients have an enlarged JPSE.
A study by Treleaven et al. (2003) reports the same results where whiplash patients with dizziness displayed an even greater joint position error than those without dizziness.
According to Roren et al. (2009), laser measurement of the JPSE had substantial test-retest reliability with an ICC of 0.68 in healthy subjects and patients with neck pain. For this reason, the JPSE can be measured with confidence in practice.
To measure the joint position sense, have the patient in sitting position wearing a laser tracker pointing at a target (start position).
The distance from the target to a laser tracker is about 90 cm or 3 feet.
The patient is instructed to close his eyes and turn his head to the right side all the way.
Then the patient is asked to relocate the head back to the starting point. The error is measured with distance at the end point from the start point.
Afterward, the patient opens his eyes, recenters the laser at the bullseye, and closes his eyes again.
Repeat this procedure for at least 6 trials in total.
Afterwards, the same procedure is repeated for a turn to the left, as well as for cervical flexion and extension.
This test is positive for impaired cervical proprioception if the mean error for any direction is larger than 4.5°, which on this target is more than 6cm from the bullseye. This means that for at least half of the trials, the dots can be found outside of the second ring of the target.
It’s important that the patient moves his head in a relatively slow and steady motion. The faster the head moves, the more JPSE represents vestibular afferention rather than cervical afferention that we actually want to measure.
Next to the joint position sense error, your dizziness exam should include the following assessments:
- Gaze stability
- Saccadic Eye Movement
- Eye-Head Coordination
- Postural Stability
- Smooth Pursuit Neck Torsion Test
- Cervical Torsion Test
- Head-Neck Differentiation Test
de Vries, J., Ischebeck, B. K., Voogt, L. P., Van Der Geest, J. N., Janssen, M., Frens, M. A., & Kleinrensink, G. J. (2015). Joint position sense error in people with neck pain: a systematic review. Manual therapy, 20(6), 736-744.
Roren, A., Mayoux-Benhamou, M. A., Fayad, F., Poiraudeau, S., Lantz, D., & Revel, M. (2009). Comparison of visual and ultrasound based techniques to measure head repositioning in healthy and neck-pain subjects. Manual therapy, 14(3), 270-277.
Treleaven, J., Jull, G., & Sterling, M. (2003). Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Journal of rehabilitation medicine, 35(1), 36-43.
- Mads Louis25/11/22
Vestibular Rehabilitation EXCELLENT COURSE, THAT MAKES YOU READY TO TREAT DIZZINESS WITH CONFIDENCE
This course provides an excellent opportunity to learn how to treat and diagnose vertigo/dizziness patients, who previously were a mystery to treat.Jordi Holierhoek18/08/22
Vestibular Rehabilitation EXCELLENT COURSE!
Fantastic course, very practical with enough depth! I learned a lot from first. He is an excellent teacher who knows his stuff. I would totally recommend this course.Stephen08/08/22
Vestibular Rehabilitation GREAT COURSE FOR BEGINNERS AND THERAPISTS WITH SOME EXPERIENCE
Loved the course, can be done relatively quickly if you are like me and have a little bit of vestibular knowledge (it took me around 2 weeks), but the basics are all there so you can spend a bit more time getting into it if needed
I luckily had two patients in my ward needing vestibular rehabilitation just as I had finished this course, and I was able to help them straight away
- Kim Hansen30/03/22
Vestibular Rehabilitation VESTIBULAR REHABILITATION
Really good and professional layout with Firat's professional experience as well as nice software touches by Physiotutors with questions in some videos for example. Firat approaches you in different ways of teaching with small videos, summaries, lectures and so on. Also fun to see that some of his references are people that I have a cooperation with here in Sweden. Even if there’s a whole division of information regarding vestibular hypofunction it would still be fun to have separate chapter for vestibular neuritis, but that’s just a small note. On the whole I’m totally happy and satisfied with this course, really good job done by Firat and Physiotutors, I will be keeping an eye out for more advanced courses in the future regarding this topic, maybe Firat can do a Masterclass version?Steve van Rijen26/03/22
Vestibular Rehabilitation VESTIBULAR REHABILITATION
By far the best course i ever had.
It will take you a lot of time and effort to make it your own.
But i can tell, the reward is great.
you won’t be disappointedMarine Gandin27/01/22
Vestibular Rehabilitation REALLY COMPLETE COURSE AND EASY TO LEARN
It takes me 6 full days to finish that course but it was a really good course!
I enjoyed every part of the “vestibular rehabilitation” by Firat.
I’m excited to start doing some practice with patient!
I didn’t need any further explanation but I saw that Firat answers very fast to the question on the unit.
Thank you very much for this amazing course!
Even if it is in an other language than mine, it was really easy to understand.
- Christiena den Tek28/12/21
Vestibular Rehab COMPLETE COURSE ABOUT DIZZINESS AND THE WAY TO TREAT FOR PHYSIO'S
In the past I finished/followed a few courses about dizziness and treatment. I really enjoyed following this course because it’s very complete. There is overall information about the systems involved with dizziness problems, the pathologies, the exams and the overall physiotherapy treatment or other treatments. There is a nice mix between the way the information is given and the information is up to date science. The teacher (Firat) is a teacher that loves helping you out and if you have any questions he is quickly in his response.
I would recommened this course highly not only for those who just start learning things about the dizziness (patient) but also for those who are already working with these patients.Elisabetta12/12/21
Vestibular Rehabilitation INCREDIBLY THOROUGH COURSE
Such a fantastic course!
The learning experience is enhanced by interactive material found in each module.
The instructor provides clear information, both theoretical and practical, easy to apply in clinical practice.
This is an excellent course, and I would definitely recommend it!Physiotutors27/08/21
Vestibular Rehabilitation Firat really delivered on this course! While we have had some training in vestibular diagnostics and rehab in our own training, this course is on a whole other level! Building this course with Firat has increased our knowledge dramatically and we can absolutely recommend this course to any Physiotherapist as patients with vestibular problems will be among the most grateful patients when treated right.
- Anne Cahill02/08/21
Vestibular Rehabilitation Thank You!!
This is a brilliant course. The learning materials are concise, clear and comprehensive. All the information given is easy to navigate, up to date and very useful for daily clinical vestibular rehabilitation practice. It is a much appreciated educational resource. Amazing!! Thank you for this excellent course.Astrid Schubart27/06/21
Vestibular Rehabilitation I finished this course Vertigo this weekend and it’s been a long time since I’ve done such a great structured training. Lots of practical content. The lecturer shows in detail what is important. Firat Kesgin offers a lot of additional information and patient information.
I am really excited and looking forward to apply my new knowledge in practice.