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A novel method for neck coordination exercise: a pilot study on persons with chronic non-specific neck pain
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden; Alfta Research Foundation, Alfta, Sweden .
Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden; Alfta Research Foundation, Alfta, Sweden.ORCID iD: 0000-0001-7543-4397
Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden Department of Surgery, Central Hospital Karlstad, Karlstad, Sweden.
Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
2008 (English)In: Journal of NeuroEngineering and Rehabilitation, ISSN 1743-0003, Vol. 5, 36- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chronic neck pain is a common problem and is often associated with changes in sensorimotor functions, such as reduced proprioceptive acuity of the neck, altered coordination of the cervical muscles, and increased postural sway. In line with these findings there are studies supporting the efficacy of exercises targeting different aspects of sensorimotor function, for example training aimed at improving proprioception and muscle coordination. To further develop this type of exercises we have designed a novel device and method for neck coordination training. The aim of the study was to investigate the clinical applicability of the method and to obtain indications of preliminary effects on sensorimotor functions, symptoms and self-rated characteristics in non-specific chronic neck pain

METHODS: The study was designed as an uncontrolled clinical trial including fourteen subjects with chronic non-specific neck pain. A new device was designed to allow for an open skills task with adjustable difficulty. With visual feedback, subjects had to control the movement of a metal ball on a flat surface with a rim strapped on the subjects' head. Eight training sessions were performed over a four week period. Skill acquisition was measured throughout the intervention period. After intervention subjects were interviewed about their experience of the exercise and pain and sensorimotor functions, including the fast and slow components of postural sway and jerkiness-, range-, position sense-, movement time- and velocity of cervical rotation, were measured. At six-month follow up, self-rated pain, health and functioning was collected.

RESULTS: The subjects improved their skill to perform the exercise and were overall positive to the method. No residual negative side-effects due to the exercise were reported. After intervention the fast component of postural sway (p = 0.019) and jerkiness of cervical rotation (p = 0.032) were reduced. The follow up showed decreased disability (one out of three indices) and fear of movement, and increased general health (three out of eight dimensions).

CONCLUSION: The results support the clinical applicability of the method. The improvements in sensorimotor functions may suggest transfer from the exercise to other, non-task specific motor functions and justifies a future randomized controlled trial.

Place, publisher, year, edition, pages
BioMed Central, 2008. Vol. 5, 36- p.
National Category
URN: urn:nbn:se:umu:diva-22122DOI: 10.1186/1743-0003-5-36PubMedID: 19105826OAI: diva2:212719
Available from: 2009-04-23 Created: 2009-04-23 Last updated: 2015-08-25Bibliographically approved
In thesis
1. Sensorimotor function in chronic neck pain: objective assessments and a novel method for neck coordination exercise
Open this publication in new window or tab >>Sensorimotor function in chronic neck pain: objective assessments and a novel method for neck coordination exercise
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results.

The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (>3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS).

Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances.

Postural control was assessed in quiet standing on a force platform without vision. The center of pressure signal was decomposed into it’s slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain.

Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a sub-group of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain.

The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quiet standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up.

In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.

Place, publisher, year, edition, pages
Umeå: Institutionen för samhällsmedicin och rehabilitering, 2009. 88 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1273
Neck pain, Whiplash, Sensorimotor, Motor Control, Motor Learning, Neck Coordination Exercise, Postural Control, Cervical kinematics, Reliability.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Rehabilitation Medicine
urn:nbn:se:umu:diva-22674 (URN)978-91-7264-809-8 (ISBN)
Sjukgymnastik, 901 87, Umeå
Public defence
2009-06-12, Aulan Vårdvetarhuset, Inst för samhällsmedicin och rehabilitering, Vårdvetarhuset, Umeå universitet, 901 87 Umeå, Umeå, 13:00 (English)
Available from: 2009-05-20 Created: 2009-05-14 Last updated: 2015-11-13Bibliographically approved

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