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Biomechanical assessment of head and neck movements in neck pain using 3D movement analysis
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Three-dimensional movement analysis was used to evaluate head and neck movement in patients with neck pain and matched controls. The aims were to further develop biomechanical models of head and neck kinematics, to investigate differences between subjects with non-specific neck pain and whiplash associated disorders (WAD), and to evaluate the potential of objective movement analysis as a decision support during diagnosis and follow-up of patients with neck pain.

Fast, repetitive head movements (flexion, extension, rotation to the side) were studied in a group of 59 subjects with WAD and 56 controls. A back propagation artificial neural network classified vectors of collected movement variables from each individual according to group membership with a predictivity of 89%. The helical axis for head movement were analyzed in two groups of neck pain patients (21 with non-specific neck pain and 22 with WAD) and 24 matched controls. A moving time window with a cut-off angle of 4° was used to calculate finite helical axes. The centre of rotation of the finite axes (CR) was derived as the 3D intersection point of the finite axes. A downward migration of the axis during flexion/extension and a change of axis direction towards the end of the movements were observed. CR was at its most superior position during side rotations and at its most inferior during ball catching. This could relate to that side rotation was mainly done in the upper spine, while all cervical vertebrae were recruited to stabilize the head in the more complex catching task. Changes in movement strategy were observed in the neck pain groups: Neck pain subjects had lower mean velocities and ranges of movements as compared with controls during ball catching, which could relate to a stiffer body position in neck pain patients in order to stabilize the neck. In addition, the WAD group had a displaced axis position during head repositioning after flexion, while CR was displaced during fast side rotations in the non-specific neck pain group. Pain intensity correlated with axis and CR position, and may be one reason for the movement strategy changes.

Increased amount of irregularities in the trajectory of the axis was found in the WAD group during head repositioning, fast repetitive head movements and catching. This together with an increased constant repositioning error during repositioning after flexion indicated motor control disturbances. A higher group standard deviation in neck pain groups indicated heterogeneity among subjects in this disturbance.

Wireless motion sensors and electro-oculography was used simultaneously, as an initial step towards a portable system and towards a method to quantify head-eye co-ordination deficits in individuals with WAD. Twenty asymptomatic control subjects and six WAD subjects with eye disturbances (e.g. dizziness and double vision) were studied. The trial-to-trial repeatability was moderate to high for all evaluated variables (single intraclass correlation coefficients >0.4 in 28 of 32 variables). The WAD subjects demonstrated decreased head velocity, decreased range of head movement during gaze fixation and lowered head stability during head-eye co-ordination as possible deficits.

In conclusion, kinematical analyses have a potential to be used as a support for physicians and physiotherapists for diagnosis and follow-up of neck pain patients. Specifically, the helical axis method gives information about how the movement is performed. However, a flexible motion capture system (for example based on wireless motion sensors) is needed. Combined analysis of several variables is preferable, as patients with different neck pain disorders seem to be a heterogeneous group.

Place, publisher, year, edition, pages
Umeå: Strålningsvetenskaper , 2008. , 85 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1160
Keyword [en]
movement analysis, kinematics, helical axis, neck pain, whiplash, cervical spine, pattern classification, motor control, head-eye co-ordination, head movement
National Category
Medical and Health Sciences
Research subject
Biomedical Radiation Science
Identifiers
URN: urn:nbn:se:umu:diva-1600ISBN: 978-91-7264-518-9 (print)OAI: oai:DiVA.org:umu-1600DiVA: diva2:141517
Public defence
2008-04-18, Hörsal B, Umeå Universitetssjukhus, NUS, UMEÅ, 09:00 (English)
Opponent
Available from: 2008-03-31 Created: 2008-03-31 Last updated: 2011-11-21Bibliographically approved
List of papers
1. Chronic whiplash associated disorders and neck movement measurements: an instantaneous helical axis approach.
Open this publication in new window or tab >>Chronic whiplash associated disorders and neck movement measurements: an instantaneous helical axis approach.
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2003 (English)In: IEEE transactions on information technology in biomedicine, ISSN 1089-7771, E-ISSN 1558-0032, Vol. 7, no 4, 274-282 p.Article in journal (Refereed) Published
Abstract [en]

This paper presents an assessment tool for objective neck movement analysis of subjects suffering from chronic whiplash-associated disorders (WAD). Three-dimensional (3-D) motion data is collected by a commercially available motion analysis system. Head rotation, defined in this paper as the rotation angle around the instantaneous helical axis (IHA), is used for extracting a number of variables (e.g., angular velocity and range, symmetry of motion). Statistically significant differences were found between controls and subjects with chronic WAD in a number of variables.

National Category
Physiology Neurosciences
Identifiers
urn:nbn:se:umu:diva-22045 (URN)15000354 (PubMedID)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2017-12-13
2. Classification of neck movement patterns related to whiplash-associated disorders using neural networks
Open this publication in new window or tab >>Classification of neck movement patterns related to whiplash-associated disorders using neural networks
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2003 (English)In: IEEE transactions on information technology in biomedicine, ISSN 1089-7771, Vol. 7, no 4, 412-418 p.Article in journal (Refereed) Published
Abstract [en]

This paper presents a new method for classification of neck movement patterns related to Whiplash-associated disorders (WAD) using a resilient backpropagation neural network (BPNN). WAD are a common diagnosis after neck trauma, typically caused by rear-end car accidents. Since physical injuries seldom are found with present imaging techniques, the diagnosis can be difficult to make. The active range of the neck is often visually inspected in patients with neck pain, but this is a subjective measure, and a more objective decision support system, that gives a reliable and more detailed analysis of neck movement pattern, is needed. The objective of this study was to evaluate the predictive ability of a BPNN, using neck movement variables as input. Three-dimensional (3-D) neck movement data from 59 subjects with WAD and 56 control subjects were collected with a ProReflex system. Rotation angle and angle velocity were calculated using the instantaneous helical axis method and motion variables were extracted. A principal component analysis was performed in order to reduce data and improve the BPNN performance. BPNNs with six hidden nodes had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88, which are very promising results. This shows that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD, even though further evaluation of the method is needed.

National Category
Neurosciences Physiology
Identifiers
urn:nbn:se:umu:diva-3066 (URN)15000367 (PubMedID)
Available from: 2008-03-31 Created: 2008-03-31 Last updated: 2017-06-01Bibliographically approved
3. Variations in the axis of motion during head repositioning: a comparison of subjects with whiplash-associated disorders or non-specific neck pain and healthy controls
Open this publication in new window or tab >>Variations in the axis of motion during head repositioning: a comparison of subjects with whiplash-associated disorders or non-specific neck pain and healthy controls
2007 (English)In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 22, no 8, 865-873 p.Article in journal (Refereed) Published
Keyword
Axis of motion, helical axis, whiplash, neck pain, proprioception, fear avoidance, movement analysis, variance
National Category
Neurosciences Physiology
Identifiers
urn:nbn:se:umu:diva-16169 (URN)10.1016/j.clinbiomech.2007.05.008 (DOI)17619066 (PubMedID)
Available from: 2007-08-27 Created: 2007-08-27 Last updated: 2017-06-01Bibliographically approved
4. Cervical helical axis characteristics and its centre of rotation during active head movements: comparisons of whiplash-associated disorders, non-specific neck pain and asymptomatic individuals
Open this publication in new window or tab >>Cervical helical axis characteristics and its centre of rotation during active head movements: comparisons of whiplash-associated disorders, non-specific neck pain and asymptomatic individuals
2008 (English)In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 41, no 13, 2799-2805 p.Article in journal (Refereed) Published
Abstract [en]

The helical axis model can be used to describe translation and rotation of spine segments. The aim of this study was to investigate the cervical helical axis and its center of rotation during fast head movements (side rotation and flexion/extension) and ball catching in patients with non-specific neck pain or pain due to whiplash injury as compared with matched controls. The aim was also to investigate correlations with neck pain intensity. A finite helical axis model with a time-varying window was used. The intersection point of the axis during different movement conditions was calculated. A repeated-measures ANOVA model was used to investigate the cervical helical axis and its rotation center for consecutive levels of 15° during head movement. Irregularities in axis movement were derived using a zero-crossing approach. In addition, head, arm and upper body range of motion and velocity were observed. A general increase of axis irregularity that correlated to pain intensity was observed in the whiplash group. The rotation center was superiorly displaced in the non-specific neck pain group during side rotation, with the same tendency for the whiplash group. During ball catching, an anterior displacement (and a tendency to an inferior displacement) of the center of rotation and slower and more restricted upper body movements implied a changed movement strategy in neck pain patients, possibly as an attempt to stabilize the cervical spine during head movement.

Place, publisher, year, edition, pages
Elsevier, 2008
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3068 (URN)10.1016/j.jbiomech.2008.07.005 (DOI)
Available from: 2008-03-31 Created: 2008-03-31 Last updated: 2017-06-01Bibliographically approved
5. Head eye co-ordination and gaze stability using simultaneous measurement of eye in head and head in space movements: potential for use in subjects with a whiplash injury
Open this publication in new window or tab >>Head eye co-ordination and gaze stability using simultaneous measurement of eye in head and head in space movements: potential for use in subjects with a whiplash injury
2009 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 23, no 1, 31-40 p.Article in journal (Refereed) Published
Abstract [en]

Objective. Describe reproducibility of a measurement method to investigate deficits in eye-head co-ordination.

Methods. Combined recordings of head and eye rotation using wireless motion sensors and electro-oculography (EOG) were used as an initial step towards a method to quantify eye-head co-ordination deficits. Head rotation to the side during gaze fixation and sequential head and eye movements were studied on 20 asymptomatic control subjects and six subjects with chronic whiplash disorders. All included whiplash subjects reported eye disturbances according to a vision symptom questionnaire.

Results. The trial-to-trial reproducibility was moderate to high for 24 of 28 variables (Intraclass Correlation Coefficient 0.44 to 0.87). Velocity gain (ratio of eye and head velocities) was on average close to unity in both groups. Head stability was high in control subjects, while three of six whiplash subjects demonstrated head instability during eye movement. Whiplash subjects also demonstrated a decreased range of head movement during gaze fixation and lower head velocities as compared with the asymptomatics.

Conclusions. The method of combined head and eye motion appears to give accurate, repeatable measurements. Case studies of whiplash subjects indicated deficits in head eye co-ordination. The method could be useful in further clinical research into eye and head movement in those with neck disorders.

Keyword
whiplash, head eye coordination, head movement, gaze stability, eye disturbances, monitoring
Identifiers
urn:nbn:se:umu:diva-3069 (URN)10.1007/s10877-009-9160-5 (DOI)
Available from: 2008-03-31 Created: 2008-03-31 Last updated: 2017-12-14Bibliographically approved

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