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Position-matching and goal-directed reaching acuity of the upper limb in chronic neck pain: associations to self-rated characteristics
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Neck-shoulder pain is common in the general population and causes individual suffering as well as large costs for the society. Despite substantial efforts, there is still a shortage of methods for objective diagnosis and effective rehabilitation of such disorders. Thus, there is a great need to develop and evaluate new methods for these purposes. From clinical observations and recent research it has become evident that sensorimotor control can be impaired in people with neck-shoulder pain and may play a role in the pathogenesis of these disorders. In this thesis, precision of goal-directed arm movements, a previously unstudied class of movements in neck-shoulder pain, was studied.

The main aim of the thesis was to investigate if people with chronic neck-shoulder pain have a reduced acuity of goal-directed movements of the upper extremity. A second aim was to study associations between reduced movement acuity and symptoms and self-rated characteristics.

Upper limb repositioning acuity was assessed in blindfolded subjects performing tests of active, ipsilateral position-matching of two target positions (long and short) in movements constrained to horizontal-adduction of the shoulder. Reduced repositioning acuity, suggesting impaired shoulder proprioception, was found for both subjects with whiplash associated disorders (WAD) and non-specific neck-shoulder pain (NS). The degree of reduced acuity was shown to correlate with self-ratings of various health concepts, functioning and pain. A conspicuous finding was that there was lack of correlation between short and long target errors, along with the fact that associations between repositioning acuity and symptoms and self-rated characteristics was primarily found for the short target position.

To further investigate the possible mechanisms underlying the disassociation between long and short target movement control, the association pattern between the outcome of several variants of ipsilateral position matching and velocity-discrimination tests, were studied. It was found that the perception of limb position in position-matching of short target locations appears to be predominantly based on movement velocity, whereas perception of limb position in movements to longer target locations may rely on a location-based perception mechanism.

To extend the research on reduced upper extremity proprioception in neck-shoulder pain to a more natural movement situation, acuity of goal-directed pointing including full vision and 3D multi-joint movements was investigated in WAD, NS and healthy controls subjects. The results revealed a reduced acuity for both neck-pain groups. Moreover, distinct associations between end-point acuity and neck movement problems, limitations of some physical functions and, in WAD; some aspects of pain, were revealed.

The findings demonstrate that the precision of upper limb movements can be reduced in chronic neck-shoulder pain. Substantial associations with symptoms and self-rated functioning suggest a clinical relevance of acuity measures of goal-directed arm movements. The findings indicate that tests of sensorimotor control can provide objective measures that may be useful in biopsychosocial profiling and characterization of subgroups of patients with chronic neck-shoulder pain, and that training target control of goal-directed movements should be considered in rehabilitation programs of people with these disorders.

Place, publisher, year, edition, pages
Umeå: Kirurgisk och perioperativ vetenskap , 2008. , 93 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1182
Keyword [en]
Neck pain, whiplash injuries, shoulder, proprioception, kinesthesis, vision, psychophysiology, somatosensory disorders, psychomotor performance, self assessment
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-1635ISBN: 978-91-7264-569-1 (print)OAI: oai:DiVA.org:umu-1635DiVA: diva2:141629
Public defence
2008-05-22, Stora hörsalen, entréplan fd. Arbetslivsinstitutet, Johan Bures väg 5, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-05-02 Created: 2008-05-02 Last updated: 2010-01-18Bibliographically approved
List of papers
1. Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders
Open this publication in new window or tab >>Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders
Show others...
2006 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, no 1, 44-49 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate whether patients suffering from whiplash-associated disorders have impaired shoulder proprioception and whether the acuity of shoulder proprioception is reflected in the patients’ symptoms and self-rated function.

Design: A comparative group design, including a correlation design for the patient group.

Subjects: Patients with chronic whiplash-associated disorders (n/37) and healthy subjects (n/41). The groups were matched for age and gender.

Methods: All subjects underwent a shoulder proprioception test involving active ipsilateral arm position-matching. Group difference was evaluated by multiple analysis of variance and analysis of variance. The patient group completed questionnaires addressing functioning and health and performed pain ratings. Associations between proprioceptive acuity and selfrated functioning and symptoms were studied by correlation and regression analyses.

Results: The patient group showed significantly lower acuity of shoulder proprioception. Moderate correlations were found between proprioceptive acuity and questionnaire scores representing physical functioning, so that low proprioceptive acuity was associated with low self-rated physical functioning. Scores representing pain-intensity did not correlate with proprioceptive acuity.

Conclusion: The results show that, at the group level, patients with whiplash-associated disorders have impaired shoulder proprioception. The clinical relevance of this finding is strongly supported by the association between shoulder proprioceptive acuity and self-rated functioning in the patient group.

Place, publisher, year, edition, pages
Taylor & Francis, 2006
Keyword
Adult, Female, Humans, Male, Neck Pain/diagnosis/physiopathology/rehabilitation, Pain Measurement, Posture, Predictive Value of Tests, Prognosis, Proprioception/*physiology, Questionnaires, Range of Motion; Articular/physiology, Recovery of Function, Shoulder Joint/*physiopathology, Whiplash Injuries/diagnosis/*physiopathology/rehabilitation
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-17017 (URN)10.1080/16501970510042847 (DOI)16548086 (PubMedID)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2017-12-14Bibliographically approved
2. Shoulder proprioception in chronic neck pain: associations with symptoms and self-rated characteristics
Open this publication in new window or tab >>Shoulder proprioception in chronic neck pain: associations with symptoms and self-rated characteristics
Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-3143 (URN)
Available from: 2008-05-02 Created: 2008-05-02 Last updated: 2010-01-13Bibliographically approved
3. Effect of target presentation mode and movement extent on correlations of ipsilateral position-matching test outcomes
Open this publication in new window or tab >>Effect of target presentation mode and movement extent on correlations of ipsilateral position-matching test outcomes
(English)Manuscript (Other (popular science, discussion, etc.))
Identifiers
urn:nbn:se:umu:diva-3144 (URN)
Available from: 2008-05-02 Created: 2008-05-02 Last updated: 2010-01-14Bibliographically approved
4. Acuity of goal-directed arm movements to visible targets in chronic neck pain
Open this publication in new window or tab >>Acuity of goal-directed arm movements to visible targets in chronic neck pain
2008 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 5, 366-374 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate end-point acuity in goal-directed arm movements in subjects with chronic neck pain, while taking the trade-off between speed and accuracy into account, and to evaluate associations between reduced acuity and self-rated characteristics.

Design: Single-blinded, controlled, comparative group study.

Subjects: Forty-five subjects with chronic non-traumatic, non-specific neck pain (n = 24) and whiplash-associated disorders (n = 21). Healthy subjects served as controls (n = 22). The groups were age- and sex-matched.

Methods: Subjects performed fast and accurate pointing movements to a visual target. Group differences in end-point variability, controlled for peak velocity, were evaluated. Associations between end-point variability and self-rated symptoms, functioning, self-efficacy and kinesiophobia were analysed.

Results: End-point acuity, controlled for peak velocity, was reduced for both neck-pain groups. Similar spatial error patterns across all groups indicated no direction-specific reduction. For both neck-pain groups, associations were found between end-point acuity and neck movement deficits, physical functioning and, in whiplash, also balance and pain.

Conclusion: Acuity of goal-directed arm movements can be reduced in chronic neck pain. Associations between acuity and self-rated characteristics support the clinical validity of the results and indicate that impaired neck function contributes to reduced end-point acuity. The results can be of importance for characterization and rehabilitation of neck disorders.

Place, publisher, year, edition, pages
Foundation of Rehabilitation Information, 2008
Keyword
neck pain, whiplash injuries, somatosensory disorders, motor activity, psychomotor performance, proprioception, kinaesthesis, vision
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-3145 (URN)10.2340/16501977-0175 (DOI)18461262 (PubMedID)
Conference
The International Association for the Study of Pain (IASP) symposium “Fundamentals of musculoskeletal pain”, on May 7–9, 2007 in Aalborg, Denmark and the PREMUS conference, on August 27–30, 2007 in Boston, USA
Note

This paper was presented as a poster at the International Association for the Study of Pain (IASP) symposium “Fundamentals of musculoskeletal pain”, on May 7–9, 2007 in Aalborg, Denmark and the PREMUS conference, on August 27–30, 2007 in Boston, USA.

Available from: 2008-05-02 Created: 2008-05-02 Last updated: 2017-12-14Bibliographically approved

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