Sensorimotor function in chronic neck pain: objective assessments and a novel method for neck coordination exercise
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
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.
Public Health, Global Health, Social Medicine and Epidemiology
Research subject Rehabilitation Medicine
IdentifiersURN: urn:nbn:se:umu:diva-22674ISBN: 978-91-7264-809-8OAI: oai:DiVA.org:umu-22674DiVA: diva2:217582
Distributor:Sjukgymnastik, 901 87, Umeå
2009-06-12, Aulan Vårdvetarhuset, Inst för samhällsmedicin och rehabilitering, Vårdvetarhuset, Umeå universitet, 901 87 Umeå, Umeå, 13:00 (English)
Karlberg, Mikael, Associate Professor
Djupsjöbacka, Mats, Med.Dr.Björklund, Martin, Med.Dr.Häger-Ross, Charlotte, Associate ProfessorLiebermann, Dario, Associate Professor
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