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Sensorimotor function in chronic neck pain: objective assessments and a novel method for neck coordination exercise
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. (Centrum för belastningsskadecentrum)
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.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1273
Keyword [en]
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
Identifiers
URN: urn:nbn:se:umu:diva-22674ISBN: 978-91-7264-809-8 (print)OAI: oai:DiVA.org:umu-22674DiVA: diva2:217582
Distributor:
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)
Opponent
Supervisors
Available from: 2009-05-20 Created: 2009-05-14 Last updated: 2015-11-13Bibliographically approved
List of papers
1. 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
2. The slow and fast components of postural sway in chronic neck pain
Open this publication in new window or tab >>The slow and fast components of postural sway in chronic neck pain
2011 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 16, no 3, 273-278 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the slow and fast components of postural control in quiet stance in subjects with chronic neck pain, associations between postural sway and self-rated characteristics and to study the impact of anthropometrics on postural sway.

Design: A single-blinded cross-sectional study including two separate data collections.

Subjects: Sample 1: Persons with chronic non-specific neck pain (NS, n=24), whiplash associated disorders (WAD, n=21). Healthy subjects were controls (CON, n=21). Sample 2: Women only, 98 NS and 32 CON subjects.

Methods: Subject performed a quiet stance test with eyes closed on a force platform while the center of pressure (CoP) trajectory was measured. Sample 1 was tested on a firm surface for 30 seconds, while sample 2 was tested on both firm and foam surfaces for 190 seconds. The CoP signal was decomposed into the slow and fast components and the magnitude of these signals were calculated. Anthropometrics were included as covariate in the analysis of group differences if correlated with postural sway variables. Group differences in the sway variables were evaluated, as well as association between postural sway and self-ratings of symptoms, functioning and kinesiophobia.

Results: Increased magnitude of the slow sway component was found for both neck pain groups. Increasing age was associated with increased magnitude of the fast component. Surface conditions had no effect on group difference. For WAD, associations were found between the magnitude of the slow component and self-rated characteristics related to physical functioning, sensory alterations and psychosocial functioning. For NS, concurrent low back pain was associated with increased postural sway.

Conclusion: Postural control can be altered in chronic neck pain. This effect was present only for the slow sway component, which implies aberration in sensory feedback or processing of sensory information. Associations between postural sway and self-rated characteristics in WAD support the clinical validity of postural control assessment in this group. Increased postural sway found in NS with concurrent low back pain suggests an important role of generalised spinal pain on postural control alterations.

Keyword
Neck pain, Whiplash injuries, Low back pain, Musculoskeletal disorders, Postural control
National Category
Physiotherapy
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-22672 (URN)10.1016/j.math.2010.11.008 (DOI)21185768 (PubMedID)
Note

Manuscript included in medical doctorial thesis

Available from: 2009-05-14 Created: 2009-05-14 Last updated: 2017-12-13Bibliographically approved
3. Kinematics of fast cervical rotations in persons with chronic neck pain: a cross-sectional and reliability study
Open this publication in new window or tab >>Kinematics of fast cervical rotations in persons with chronic neck pain: a cross-sectional and reliability study
Show others...
2010 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 11, 222- p.Article in journal (Other academic) Published
Abstract [en]

Background

Assessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self-paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before.

Methods

Cervical kinematics was assessed during fast axial head rotations in 118 women with chronic nonspecific neck pain (NS) and compared to 49 healthy controls (CON). The relationship between cervical kinematics and symptoms, self-rated functioning and fear of movement was evaluated in the NS group. A sub-sample of 16 NS and 16 CON was re-tested after one week to assess the reliability of kinematic variables. Six cervical kinematic variables were calculated: peak speed, range of movement, conjunct movements and three variables related to the shape of the speed profile.

Results

Together, peak speed and conjunct movements had a sensitivity of 76% and a specificity of 78% in discriminating between NS and CON, of which the major part could be attributed to peak speed (NS: 226 ± 88 °/s and CON: 348 ± 92 °/s, p < 0.01). Peak speed was slower in NS compared to healthy controls and even slower in NS with comorbidity of low-back pain. Associations were found between reduced peak speed and self-rated difficulties with running, performing head movements, car driving, sleeping and pain. Peak speed showed reasonably high reliability, while the reliability for conjunct movements was poor.

Conclusions

Peak speed of fast cervical axial rotations is reduced in people with chronic neck pain, and even further reduced in subjects with concomitant low back pain. Fast cervical rotation test seems to be a reliable and valid tool for assessment of neck pain disorders on group level, while a rather large between subject variation and overlap between groups calls for caution in the interpretation of individual assessments.

Place, publisher, year, edition, pages
BioMed Central, 2010
Keyword
Neck pain, Low back pain, Cervical kinematics, Test-retest reliability, Musculoskeletal disorders, Motor control
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-22673 (URN)10.1186/1471-2474-11-222 (DOI)000283236800003 ()20875135 (PubMedID)
Note

Vid avhandlingens utgivning menuskript med titeln "Kinematics of fast cervical rotations: alterations in chronic neck pain and retest reliability ".

Available from: 2009-05-14 Created: 2009-05-14 Last updated: 2017-12-13Bibliographically approved
4. A novel method for neck coordination exercise: a pilot study on persons with chronic non-specific neck pain
Open this publication in new window or tab >>A novel method for neck coordination exercise: a pilot study on persons with chronic non-specific neck pain
2008 (English)In: Journal of NeuroEngineering and Rehabilitation, ISSN 1743-0003, E-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
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-22122 (URN)10.1186/1743-0003-5-36 (DOI)19105826 (PubMedID)
Available from: 2009-04-23 Created: 2009-04-23 Last updated: 2017-12-13Bibliographically approved

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Citation style
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  • modern-language-association-8th-edition
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  • en-US
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  • nn-NO
  • nn-NB
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More languages
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