No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Muscle strength, balance and upper extremity function are not predictors of cervical proprioception in healthy young subjects
Abstract
Purpose/Aim: The aim of this study is to examine the relationship between cervical proprioception sense and balance, hand grip strength, cervical region muscle strength and upper extremity functionality in healthy young subjects.
Methods: A total of 200 people with a mean age of 20.8 ± 1.8 participated in the study. Cervical proprioception sense of the participants was evaluated with Cervical Joint Position Error Test (CJPET), balance with Biodex Stability System, hand grip strength with hand dynamometer, and upper extremity functionality with Perdue Pegboard test. The relationship of variables with cervical proprioception was evaluated with Pearson Correlation analysis.
Results: According to this study results, there was no significant relationship between CJPET (extension, left rotation, right rotation) and sub-parameters of dynamic balance (anteroposterior, mediolateral, overall), cervical muscle strength and hand grip strength (p > 0.05). There was a significant correlation between CJPET flexion and static balance variables (p < 0.05).
Conclusion: According to this study, there is no relationship between cervical proprioception and balance, hand grip muscle strength, cervical region muscle strength and upper extremity functionality in healthy young subjects.
... As a result, the contraction mechanism of the relevant muscle is impaired after tendon repair. Therefore, delayed rehabilitation after tendon injuries results in an increase in both motor and proprioceptive complications (5). However, based on the understanding that early mobilisation after tendon repair reduces tendon adhesion and promotes healing, early mobilisation has become the standard of care (6). ...
Purpose: The aim of this study was to evaluate the effectiveness of early rehabilitation in patients undergoing primary surgery after hand extensor tendon injury. Methods: Twelf cases (20 fingers) were included in this retrospective study. Early Active Motion (EAM) protocol was applied to the individuals who undergone primary extensor tendon repair. Patients were assessed with Duruöz Hand Index (DHI) and Total Active Motion (TAM). Results: The DHI scores of the subjects examined in the study improved significantly after the treatment (79.16±7.95-7.58±7.22, p<0.001). In the TAM evaluation, nine of the 20 fingers were excellent (45%), four were good (20%), and seven were fair (35%). Conclusion: EAM produced a moderate benefit to recovery of upper extremity functionality and TAM outcomes of patients with hand extansor tendon injury. Özet Amaç: Bu çalışmanın amacı, el ekstansör tendon yaralanmasını takiben primer cerrahi uygulanan hastalarda erken rehabilitasyonun etkinliğini değerlendirmektir. Yöntem: Bu retrospektif çalışmaya 12 olgu (20 parmak) dahil edildi. Primer ekstansör tendon onarımı yapılan bireylere Erken Aktif Hareket (EAH) protokolü uygulandı. Hastalar Duruöz El İndeksi (DEİ) ve Total Aktif Hareket (TAH) ile değerlendirildi. Bulgular: Çalışmada incelenen olguların DEİ skorları tedavi sonrasında anlamlı düzeyde iyileşme gösterdi (79.16±7.95-7.58±7.22, p<0.001). TAH değerlendirmesinde ise 20 parmaktan dokuzu mükemmel (45%), dördü iyi (20%), yedi tanesi ise orta (35%) olarak ölçüldü. Ayrıca tendon rüptürü veya ikincil cerrahi gibi komplikasyonlar da gelişmedi. Tartışma: EAH protokolü, el ekstansör tendon yaralanması olan hastaların üst ekstremite işlevselliği ve TAH sonuçları üzerinde orta düzeyde bir fayda sağlamıştır. Anahtar Kelimeler: Erken aktif hareket, El tendon yaralanmaları, ekstansör tendon 1. School of Physical Therapy and Rehabilitation, El ekstansör tendon yaralanmaları sonrası erken aktif hareket protokolünün rehabilitasyon sonuçları Rehabilitation results of early active motion protocol following hand extensor tendon injuries
... 26 The source for the electromyographic activity is muscle afferent input, particularly from the muscle spindle. 27 The presence of many muscle spindles and mechanoreceptors that provide proprioception in the suboccipital region where the cervical vertebrae are located makes the cervical region important between the spinal segments. 28 As a result of the cervical mobilisation used in this study, it was found that the participants' attention level and postural stabilisation increased. ...
Objective: This study aimed to investigate the immediate effects of cervical mobilization on acoustic properties and performance in female voice training students. Material-Method: Fifteen female volunteer students participated in the research. The study evaluated the acoustic properties of the voice, performance, and cervical mobility. A single session of cervical mobilization was administered by an experienced physiotherapist, after which assessments were repeated. Results: There was a significant increase in cervical flexion-extension (p=0.002), rotation (p=0.001), and lateral flexion (p=0.006) range of motion measurements after treatment compared to pre-treatment measurements. Head register analysis revealed a significant increase in mean pitch frequency measurements after treatment compared to pre-treatment measurements (p=0.036). Expert opinions obtained through interviews indicated a significant improvement in acoustic performance in the post-treatment status compared to the pre-treatment status (p=0.001). Conclusion: This study observed that a single session of cervical mobilization positively affected both acoustic performance and cervical mobility.
... Participants were then instructed to maintain this position during the test. The grip strength (GS) of both hands was measured using a hand dynamometer and the result was expressed in kg [12]. ...
ABSTRACT
Objectives
The purpose of this study was to investigate the efficacy of noninvasive auricular vagus nerve stimulation (AVNS) on sports performance.
Methods
The intervention group (n = 30) received a single session of AVNS, while the control group (n = 30) received a single session of sham AVNS. Pre- and post-treatment isometric quadriceps muscle strength, heart rate, lower extremity balance, and grip strength were measured.
Results
It was ascertained that the differences in heart rate (-0.73 pulse/min, p = 0.032) and modified Star Balance Test scores (anterior 2.72 cm, p = 0.000, posterolateral 3.65 cm, p = 0.000 and posteromedial 2.43 cm, p = 0.000) before and after AVNS were significant in subjects in the experimental group. The results of the one-way ANOVA analysis show that the differences obtained in all measurement parameters are not statistically significant (p > 0.05). Considering the partial eta squared (Ƞ2) obtained from the measurements, a small descriptive effect in favor of experimental group was obtained for the quadriceps strength (0.016) and anterior balance (0.054) measurements.
Conclusion
This study demonstrates that a single AVNS session compared to sham AVNS shows a modest benefit though not statistically significant improvement in athletic performance. Single-use of AVNS seems not effective in improving athletic performance.
... Chronic non-specific neck pain (CNNP) is known as a common public health problem in the modern world, (1) and although its lifetime prevalence is approaching 50% (2) it is frequently seen in adolescents (3). CNNP is considered severe discomfort in the lateral and posterior of the neck lasting more than 3 months (4) resulting from neck cancer, infection, poor posture, degenerative and mechanical changes (5,6). CNNP causes disability, limitation of activities of daily living, job dissatisfaction, and increased economic and social costs (7,8). ...
The aim of this study is to examine the effectiveness of conventional treatment and mobilization exercises in individuals with chronic nonspecific neck pain (CNNP). A total of 28 patients enrolled in the study. The Mobilization group (MG) completed a 4-week combined conservative physiotherapy and cervical mobilization program, whereas the control group (CG) received only the 4 weeks of conservative physiotherapy. Pain severity according to the Visual Analogue Scale (VAS) was used as primary outcome. Secondary outcomes were included the Bourdon Attention Test (BAT), Beck Anxsiety Scale (BAS), range of motion (ROM), muscle strength. All outcomes were assessed both prior to and following the treatment. In 2-way mixed-design repeated-measures ANOVA analysis, when the change in time was analyzed between the groups (Group*Time [interaction]), a statistical difference was found for the VAS (p = .000, ηp2 = .007), BAT score (p = .001, ηp2 = .082), BAS (p= .000, ηp2 = .001), ROM flexion (p= .000, ηp2 = .104), ROM extansion (p= .000, ηp2 = .076), ROM right rotation (p= .006, ηp2 = .033), ROM left rotation (p= .05, ηp2 = .006), ROM right lateral flexion (p= .000, ηp2 = .060), ROM left lateral flexion (p= .002, ηp2 = .019), muscle strength flexion (p= .000, ηp2 = .008), muscle strength extansion (p= .000, ηp2 = .019), muscle strength right rotation (p= .000, ηp2 = .012), muscle strength left rotation (p= .000, ηp2 = .001), muscle strength right lateral flexion (p= .000, ηp2 = .001) and muscle strength left lateral flexion (p= .000, ηp2 = .011) parameters in favour of MG. Cervical mobilization produced a significant benefit to recovery of pain, ROM, muscle strength, attention and anxiety outcomes of patients with CNNP when added to a conventional CNNP physical therapy program. The study was registered on the Clinical Trials Registry (registration number: NCT05377645) Özet Bu çalışmanın amacı kronik nonspesifik boyun ağrılı (KNBA) bireylerde mobilizasyon egzersizleri ile geleneksel tedavinin etkinliğinin karşılaştırılmasıdır. Çalışmaya 28 hasta dahil edildi. İki gruba da 4 hafta boyunca haftada 3 gün geleneksel tedavi uygulandı. Mobilizasyon grubuna (MG) geleneksel tedaviye ek olarak servikal mobilizasyon egzersizleri yapıldı. Primer sonuç ölçeği olarak ağrı, Vizüel Analog Skala (VAS) ile ölçüldü. Sekonder sonuç ölçeği olarak Burdon Dikkat Testi (BDT), Beck Anksiyete Skalası (BAS), eklem hareket açıklığı (ROM), kas gücü ölçümü yapıldı. Tüm ölçümler tedavi başlangıcında ve sonunda yapıldı. Gruplar arası iki yönlü tekrarlı ANOVA analizi sonucunda VAS (p = .000, ηp2 = .007), BDT skoru (p = .001, ηp2 = .082), BAS skoru (p= .000, ηp2 = .001), ROM fleksiyon (p= .000, ηp2 = .104), ROM ekstansiyon (p= .000, ηp2 = .076), ROM sağ rotasyon (p= .006, ηp2 = .033), ROM sol rotasyon (p= .05, ηp2 = .006), ROM sağ lateral fleksiyon (p= .000, ηp2 = .060), ROM sol lateral fleksiyon (p= .002, ηp2 = .019), fleksör kas gücü (p= .000, ηp2 = .008), ekstansör kas gücü (p= .000, ηp2 = .019), sağ rotasyon kas gücü (p= .000, ηp2 = .012), sol rotasyon kas gücü (p= .000, ηp2 = .001), sağ lateral fleksiyon kas gücü (p= .000, ηp2 = .001) ve sol lateral fleksiyon kas gücü (p= .000, ηp2 = .011) parametreleri mobilizasyon grubu lehine anlamlı bulunmuştur. KNBA'lı hastalarda konvansiyonel tedavi programına ek olarak uygulanan servikal mobilizasyon ağrı, ROM, kas gücü, dikkat ve anksiyete parametrelerinde sadece geleneksel tedavi uygulanan gruba göre anlamlı düzeyde iyileşme sağlamıştır. Anahtar Kelimeler: Kronik non-spesifik boyun ağrısı, servikal mobilizasyon, ağrı Bu çalışma klinik denemeler listesine kaydedilmiştir (kayıt numarası NTC05377645).
... Impaired spatial orientation, weakened muscles and slowed reaction time collectively compromise complex balance control mechanisms. This leads to difficulties in adapting to changes in surface, posture, or movement, increasing the risk of falls (13). Thus, an approach that includes parameters such as spatial orientation, reaction time and lower limb strength is necessary to reduce the risk of falls in patients with dementia. ...
Introduction: Dementia is an important disease leading to cognitive decline and dysfunction in geriatric individuals. The increased risk of falls in patients with dementia leads to decreased quality of life as well as increased health costs. This study aims to evaluate the relationship between fall risk, reaction time, spatial orientation, and lower extremity strength in patients with dementia by analyzing the interaction of cognitive and physical factors. Materials and Methods: Thirty participants with mild to moderate dementia were recruited from nursing homes in Ankara, Turkey. The participants were administered the Johns Hopkins Fall Risk Assessment Tool (JHDRDA), the Spatial Orientation Test, reaction time measurement and the 30 Second Sit and Stand Test. Correlation analyses were performed to examine the relationships between these factors. Results: Significant associations were found between JHFRAT scores and reaction time (r=0.518, p=0.004), spatial orientation (r=-0.389, p=0.037), and lower extremity strength (r=-0.478, p=0.009). These findings highlight the need for holistic fall prevention strategies addressing both cognitive impairments and physical limitations in dementia patients. Conclusion: As a result of the study, cognitive impairments and physical factors were found to be associated with the risk of falls in patients with dementia. To reduce the risk of falls and improve the quality of life of people with dementia, patients should be assessed comprehensively. These findings emphasize the need for holistic fall prevention strategies that address both cognitive impairments and physical limitations in patients with dementia. Keywords: dementia, falls, reaction time, spatial orientation, muscle strength
Amaç: Çalışmanın amacı, kronik boyun ağrısı (KBA) olan bireylerde ağrı şiddeti, servikal kas kuvveti, propriosepsiyon ve denge arasındaki ilişkileri incelemekti. Gereç ve Yöntem: Çalışmaya 45 KBA’lı birey ve 46 boyun ağrısı olmayan sağlıklı birey dahil edildi. KBA’lı bireylerde istirahat ve aktivite sırasındaki boyun ağrısı şiddetleri görsel analog skala ile, her iki gruptaki bireylerin servikal fleksör ve ekstansör kas kuvveti izometrik dinamometre ile, servikal bölge propriosepsiyon duyusu servikal eklem pozisyon hata testi ile ve statik ve dinamik denge Biodex denge sistemi ile değerlendirildi. Sonuçlar: Sağlıklı bireylerle karşılaştırıldığında KBA’lı bireylerin servikal fleksör ve ekstansör kas kuvvetlerinin daha düşük, servikal bölge propriosepsiyonunun ve statik ve dinamik dengelerinin daha kötü olduğu bulundu (p<0,05). KBA’lı
bireylerde, ağrı şiddeti ile, servikal kas kuvvetleri, servikal bölge propriosepsiyonu ve statik-dinamik denge ilişkiliydi (p<0,05). Ayrıca, KBA’lı bireylerde, servikal bölge propriosepsiyonu, servikal kas kuvvetleri ve statik-dinamik denge ile ilişkiliydi (p<0,05). Tartışma: KBA’da ağrı şiddetinin artmasıyla servikal kas kuvveti, propriosepsiyon ve denge zayıflayabilir, propriosepsiyonun zayıflaması dengeyi olumsuz etkileyebilir.
Unlabelled:
Early detection of decline in neurobehavioral (NB) performance requires reliable methods of testing. Although NB tests have been shown to be consistent and reliable in Western countries, there has been limited research in Asian populations.
Objective:
The purpose of this study was to investigate the test-retest reliability of NB tests in a Thai adult population and examine the impact of demographic data on NB tests. The aspects of the tests chosen were memory, attention, hand-eye coordination, motor speed, and dexterity.
Methods:
The three NB tests used were digit span, Purdue Pegboard, and visual-motor integration. All three were administered to a population of 30 Thai adults.
Results:
The outcomes of all Pearson's correlation coefficient tests (r) were positive and greater than 0.60, and subtest-retest reliability correlation coefficients ranged from 0.63 (p<0.001) to 0.81 (p<0.001). Interestingly, the outcomes of all of these tests were not affected by demographic data, with the exception of the Purdue Pegboard test, in which performance on the preferred hand and both hands assessment was weakly associated with age (β=-0.09, p<0.001 and β=-0.08, p<0.05, respectively).
Conclusions:
NB tests have adequate reliability and are useful for the evaluation of clinical memory, attention, hand-eye coordination, motor speed, and dexterity in Thai adults. These tests were not affected by demographic data. However, further studies to measure the validity of the digit span, Purdue Pegboard, and visual-motor integration tests are needed.
Proprioceptive abnormalities, balance, and postural disorders have been previously reported in fibromyalgia syndrome (FMS). Unlike previous research, the aim of this study was to compare the proprioception of the cervical region of patients with FMS with a healthy control group. The relationship between cervical proprioception impairment and loss of balance was also examined. A total of 96 female FMS patients and 96 female healthy control subjects were enrolled in this case–control study. The cervical joint position error test (CJPET) was administered to the patient and control groups for cervical proprioception evaluation. FMS patients were assessed with a visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ), and fatigue severity scale (FSS). Balance tests were applied to both groups. FMS patients had significantly impaired CJPET results in all directions (p < 0.001). There were significant positive correlations between FIQ scores and CJPET results (r = 0.542 and p < 0.001 for right rotation; r = 0.604 and p < 0.001 for left rotation; r = 0.550 and p < 0.001 for flexion; r = 0.612 and p < 0.001 for extension). Significant correlations were found between CJPET measurements and balance tests (for sit-to-stand test; r = 0.510 and p < 0.001 for right rotation; r = 0.431 and p < 0.001 for left rotation; r = 0.490 and p < 0.001 for flexion; r = 0.545 and p < 0.001 for extension), (for timed up and go test; r = 0.469 and p < 0.001 for right rotation; r = 0.378 and p < 0.001 for left rotation; r = 0.410 and p < 0.001 for flexion; r = 0.496 and p < 0.001 for extension) and (for one-legged balance test; r = −0.479 and p < 0.001 for right rotation; r = −0.365 and p < 0.001 for left rotation; r = −0.392 and p < 0.001 for flexion; r = −0.469 and p < 0.001 for extension). Cervical proprioception and balance were impaired in FMS patients. As the disease activity and fatigue level increased, so the deterioration in cervical proprioception became more evident. There were correlations that demonstrated an association between impaired cervical proprioception and poor balance tests. Therefore, proprioception and balance assessments should be integrated into the physical examination processes of FMS patients.
Purpose:
Balance impairment is one of the strongest risk factors for falls. Proprioception, cutaneous sensitivity, and muscle strength are 3 important contributors to balance control in older adults. The relationship that dynamic and static balance control has to proprioception, cutaneous sensitivity, and muscle strength is still unclear. This study was performed to investigate the relationship these contributors have to dynamic and static balance control.
Methods:
A total of 164 older adults (female=89, left dominant = 15, age: 73.5 ± 7.8 years, height: 161.6 ± 7.1 cm, weight: 63.7 ± 8.9 kg) participated in this study. It tested the proprioception of their knee flexion/extension and ankle dorsi/plantarflexion, along with cutaneous sensitivity at the great toe, 1st and 5th metatarsals, arch, and heel, and the muscle strength of their ankle dorsi/plantarflexion and hip abduction. The Berg Balance Scale (BBS) and the root mean square (RMS) of the center of pressure (CoP) were collected as indications of dynamic and static balance control. A partial correlation was used to determine the relationship between the measured outcomes variables (BBS and CoP-RMS) and the proprioception, cutaneous sensitivity, and muscle strength variables.
Results:
Proprioception of ankle plantarflexion (r = -0.306, p = 0.002) and dorsiflexion (r = -0.217, p = 0.030), and muscle strength of ankle plantarflexion (r = 0.275, p = 0.004), dorsiflexion (r = 0.369, p < 0.001), and hip abduction (r = 0.342, p < 0.001) were weakly to moderately correlated with BBS. Proprioception of ankle dorsiflexion (r = 0.218, p = 0.020) and cutaneous sensitivity at the great toe (r = 0.231, p = 0.041) and arch (r = 0.285, p = 0.023) were weakly correlated with CoP-RMS in the anteroposterior direction. Proprioception of ankle dorsiflexion (r = 0.220, p = 0.035), knee flexion (r = 0.308, p = 0.001) and extension (r = 0.193, p = 0.040), and cutaneous sensitivity at the arch (r = 0.206, p = 0.043) were weakly to moderately correlated with CoP-RMS in the mediolateral direction.
Conclusion:
There is a weak to moderate relationship between proprioception and dynamic and static balance control, a weak relationship between cutaneous sensitivity and static balance control, and a weak to moderate relationship between muscle strength and dynamic balance control.
The purpose of this study was to investigate the effect of flexion exercise of the deep cervical muscles on headache and sleep disorders in patients with tension headaches and forward head posture. A total of 32 patients with tension headaches and forward head posture were randomly assigned to two groups: an experimental group (n = 16) and a control group (n = 16). The experimental group performed cervical deep muscle flexion exercises for 4 weeks, whereas the control group performed stretching exercises for the same period. The Henry Ford Hospital Headache Disability Inventory (HDI) was used for headache assessment, and the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K) was used for sleep disorder assessment. The experimental group showed a significant reduction in both HDI and PSQI-K score after 4 weeks of intervention (p < 0.001), while no significant difference was found in the control group (p > 0.05). On comparing the experimental and control groups, we found a significant difference in changes in the HDI and PSQI-K between the groups (p < 0.05). The results indicate that flexion exercise of the deep cervical muscles in patients with tension headache and forward head posture will improve the quality of life and activities of daily life by mitigating headaches and sleep disorders.
Background:
Cervical proprioception is critical in the maintenance of posture and movements, so its assessment in different cervical conditions has gained importance in recent clinical practice. Studies reporting this assessment in subjects with cervical spondylosis (CS) have not previously been investigated. The goals of the study are (1) comparison of joint position error (JPE) in subjects with CS to healthy control group. (2) Correlation of neck pain intensity to cervical proprioception in patients with CS.
Methods:
In a Cross-sectional study, 132 subjects with CS and 132 healthy age-matched control subjects were evaluated for cervical JPE with the cervical range of motion device. The subjects were blindfolded and repositioned their heads to a target position, which was determined by the examiner previously and their repositioning accuracy (absolute error in degrees) was measured in the frontal (flexion and extension) and transverse planes (left rotation and right rotation). The CS subjects resting neck pain intensity was assessed using visual analog scale (VAS).
Results:
CS subjects showed statistically significantly larger JPEs compared to healthy control subjects in all the directions tested (flexion - 95% CI = 2.38-3.55, p < 0.001, extension - 95% CI =3.26-4.33, p < 0.001, left rotation - 95% CI = 2.64 - 3.83, p < 0.001, right rotation - 95% CI = 3.77-4.76, p < 0.001). The mean JPE errors in the CS group ranged from 6.27° to 8.28° and in the control group ranged from 2.36° to 4.48°. Pearson's correlation coefficient showed a significant and positive relationship between neck pain intensity and cervical proprioception (p ≤ 0.001).
Conclusions:
Proprioception is impaired in subjects with CS when compared to healthy control group. Higher pain intensity was associated with greater cervical JPE in patients with CS.
Rheumatoid arthritis (RA) involving the cervical spine can lead to various neurologic defects and impairment of proprioception is just one of them. The aim of this study was the assessment of cervical proprioception and its relation with radiographic, clinical, and functional characteristics of patients with RA. One hundred and six rheumatoid arthritis patients who diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria and age, gender, educational status matched one hundred and six healthy volunteers were enrolled in this study. Cervical joint position error test (CJPET) was applied to healthy volunteers and RA patients for cervical proprioception assessment. Fatigue, depression, balance, quality of life and balance scales were administered to all patients. Cervical radiography was used to assess cervical subluxations. Regression analysis was used for grading the factors which had relations with cervical proprioception. Mean age of patients and healthy volunteers was 51 ± 11.1 and 48.9 ± 9.2, respectively. Scores of CJPET were statistically significantly higher in RA group than healthy volunteers (p = 0.001). CJPET scores were negatively correlated with Berg balance scale findings in right rotation, left rotation, flexion and extension (rho = − 0.421,− 0.473,− 0.448,− 0.515). There was weak or not significant correlation between the scores of CJPET and fatigue, depression, and quality of life scales. Scores of CJPET in patients with atlantoaxial subluxations (AAS) were statistically significantly higher than those without AAS (p < 0.05). Regression analysis results showed that the AAS was related to impaired cervical proprioception on right and left rotations. There was no correlation between CJPET scores and functional parameters. Cervical proprioception impaired in RA patients. This impairment was related to the existence of AAS and balance problems.
Correlation in the broadest sense is a measure of an association between variables. In correlated data, the change in the magnitude of 1 variable is associated with a change in the magnitude of another variable, either in the same (positive correlation) or in the opposite (negative correlation) direction. Most often, the term correlation is used in the context of a linear relationship between 2 continuous variables and expressed as Pearson product-moment correlation. The Pearson correlation coefficient is typically used for jointly normally distributed data (data that follow a bivariate normal distribution). For nonnormally distributed continuous data, for ordinal data, or for data with relevant outliers, a Spearman rank correlation can be used as a measure of a monotonic association. Both correlation coefficients are scaled such that they range from -1 to +1, where 0 indicates that there is no linear or monotonic association, and the relationship gets stronger and ultimately approaches a straight line (Pearson correlation) or a constantly increasing or decreasing curve (Spearman correlation) as the coefficient approaches an absolute value of 1. Hypothesis tests and confidence intervals can be used to address the statistical significance of the results and to estimate the strength of the relationship in the population from which the data were sampled. The aim of this tutorial is to guide researchers and clinicians in the appropriate use and interpretation of correlation coefficients.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
The stroke is the leading cause of adult disability in the world. One of the main complaints of individuals post-stroke refers to the loss of function of the upper limb, as evidenced during the performance of activities of daily living. This difficulty may be related to an important component of sensorimotor control, joint position sense, a submodality of proprioception.
To investigate whether the proprioception of both shoulders of chronic hemiparetic patients is altered during abduction and flexion.
Thirteen subjects with chronic hemiparesis due to ischemic stroke and 13 healthy subjects matched for gender and age was included. The joint sense position was assessed using a dynamometer. Absolute error for shoulder abduction and flexion at the 30 and 60° was calculated.
No difference was found between the paretic and non-paretic limbs in movements at both 30 and 60°. Higher values of absolute error for both paretic and non-paretic limbs compared to the control were observed during abduction at 30 and at 60°.
Chronic ischemic post-stroke patients have bilateral proprioceptive deficits in the shoulder during abduction and flexion. But these deficits are dependent on the movement performed and the angle tested. The results demonstrate the need to include bilateral exercises and/or visual feedback in the rehabilitation program.
Proprioception is a vital aspect of motor control and when degraded or lost can have a profound impact on function in diverse clinical populations. This systematic review aimed to identify clinically related tools to measure proprioceptive acuity, to classify the construct(s) underpinning the tools, and to report on the clinimetric properties of the tools. We searched key databases with the pertinent search terms, and from an initial list of 935 articles, we identified 57 of relevance. These articles described 32 different tools or methods to quantify proprioception. There was wide variation in methods, the joints able to be tested, and the populations sampled. The predominant construct was active or passive joint position detection, followed by passive motion detection and motion direction discrimination. The clinimetric properties were mostly poorly evaluated or reported. The Rivermead Assessment of Somatosensory Perception was generally considered to be a valid and reliable tool but with low precision; other tools with higher precision are potentially not clinically feasible. Clinicians and clinical researchers can use the summary tables to make more informed decisions about which tool to use to match their predominant requirements. Further discussion and research is needed to produce measures of proprioception that have improved validity and utility.
© The Author(s) 2015.
To control movement, the brain has to integrate proprioceptive information from a variety of mechanoreceptors. The role of proprioception in daily activities, exercise and sport has been extensively investigated, using different techniques, yet the proprioceptive mechanisms underlying human movement control are still unclear. In the current work we have reviewed understanding of proprioception and the three testing methods: threshold to detection of passive motion, joint position reproduction, and active movement extent discrimination, all of which have been used for assessing proprioception. The origin of the methods, the different testing apparatus, and the procedures and protocols used in each approach are compared and discussed. Recommendations are made for choosing an appropriate technique when assessing proprioceptive mechanisms in different contexts.
Impairments in cervical kinematics are common in patients with neck pain. A virtual reality (VR) device has potential to be effective in the management of these impairments. The objective of this study was to investigate the effect of kinematic training (KT) with and without the use of an interactive VR device. In this assessor-blinded, allocation-concealed pilot clinical trial, 32 participants with chronic neck pain were randomised into the KT or kinematic plus VR training (KTVR) group. Both groups completed four to six training sessions comprising of similar KT activities such as active and quick head movements and fine head movement control and stability over five weeks. Only the KTVR group used the VR device. The primary outcome measures were neck disability index (NDI), cervical range of motion (ROM), head movement velocity and accuracy. Kinematic measures were collected using the VR system that was also used for training. Secondary measures included pain intensity, TAMPA scale of kinesiophobia, static and dynamic balance, global perceived effect and participant satisfaction. The results demonstrated significant (p<0.05) improvements in NDI, ROM (rotation), velocity, and the step test in both groups post-intervention. At 3-month post-intervention, these improvements were mostly sustained; however there was no control group, which limits the interpretation of this. Between-group analysis showed a few specific differences including global perceived change that was greater in the KTVR group.
This pilot study has provided directions and justification for future research exploring training using kinematic training and VR for those with neck pain in a larger cohort.
The trial was registered in the Australia New Zealand Trial registry ACTRN12612000677808.
This is a review of the proprioceptive senses generated as a result of our own actions. They include the senses of position and movement of our limbs and trunk, the sense of effort, the sense of force, and the sense of heaviness. Receptors involved in proprioception are located in skin, muscles, and joints. Information about limb position and movement is not generated by individual receptors, but by populations of afferents. Afferent signals generated during a movement are processed to code for endpoint position of a limb. The afferent input is referred to a central body map to determine the location of the limbs in space. Experimental phantom limbs, produced by blocking peripheral nerves, have shown that motor areas in the brain are able to generate conscious sensations of limb displacement and movement in the absence of any sensory input. In the normal limb tendon organs and possibly also muscle spindles contribute to the senses of force and heaviness. Exercise can disturb proprioception, and this has implications for musculoskeletal injuries. Proprioceptive senses, particularly of limb position and movement, deteriorate with age and are associated with an increased risk of falls in the elderly. The more recent information available on proprioception has given a better understanding of the mechanisms underlying these senses as well as providing new insight into a range of clinical conditions.
OBJECTIVE: To determine the reliability of 2 common measures of proprioception. DESIGN AND SETTING: Joint position sense (JPS) and force reproduction (FR) were measured in the dominant shoulder using internal-rotation (IR) and external-rotation (ER) target angles on 2 consecutive days. SUBJECTS: Thirty-one healthy subjects (age = 22.0 +/- 2.8 years, height = 171.8 +/- 9.2 cm, mass = 69.5 +/- 15.9 kg) who did not regularly compete in overhand sports volunteered to participate in the study. MEASUREMENTS: Error scores were calculated at 2 target angles by averaging the absolute difference of 3 trials of JPS and FR. Reliability was determined by comparing the error scores obtained on 2 consecutive days. RESULTS: The inclinometer was found to be a reliable instrument as both intertester (.999) and intratester (.999) intraclass correlation coefficients were high. The JPS and FR measurements were also found to be reliable, with intraclass correlation coefficients ranging from.978 to.984. No differences were observed between trials for either measure. CONCLUSIONS: The inclinometer was a reliable instrument and can provide an affordable and accurate measure of range of motion and JPS. Both JPS and FR were also reliable measures of proprioception in the shoulder. Further research is needed to identify the specific mechanism of proprioception during these tasks.
Objective:
To discuss the role of proprioception in motor control and in activation of the dynamic restraints for functional joint stability.
Data sources:
Information was drawn from an extensive MEDLINE search of the scientific literature conducted in the areas of proprioception, motor control, neuromuscular control, and mechanisms of functional joint stability for the years 1970-1999.
Data synthesis:
Proprioception is conveyed to all levels of the central nervous system. It serves fundamental roles for optimal motor control and sensorimotor control over the dynamic restraints.
Conclusions/applications:
Although controversy remains over the precise contributions of specific mechanoreceptors, proprioception as a whole is an essential component to controlling activation of the dynamic restraints and motor control. Enhanced muscle stiffness, of which muscle spindles are a crucial element, is argued to be an important characteristic for dynamic joint stability. Articular mechanoreceptors are attributed instrumental influence over gamma motor neuron activation, and therefore, serve to indirectly influence muscle stiffness. In addition, articular mechanoreceptors appear to influence higher motor center control over the dynamic restraints. Further research conducted in these areas will continue to assist in providing a scientific basis to the selection and development of clinical procedures.
Objective:
To define the nomenclature and physiologic mechanisms responsible for functional joint stability.
Data sources:
Information was drawn from an extensive MEDLINE search of the scientific literature conducted in the areas of proprioception, neuromuscular control, and mechanisms of functional joint stability for the years 1970 through 1999. An emphasis was placed on defining pertinent nomenclature based on the original references.
Data synthesis:
Afferent proprioceptive input is conveyed to all levels of the central nervous system. They serve fundamental roles in optimal motor control and sensorimotor control over functional joint stability.
Conclusions/applications:
Sensorimotor control over the dynamic restraints is a complex process that involves components traditionally associated with motor control. Recognizing and understanding the complexities involved will facilitate the continued development and institution of management strategies based on scientific rationales.
Introduction:
Combined action observation and motor imagery training (AO+MI training), which involves motor imagery during action observation and physical training, has been attracting attention as an effective strategy for learning motor skills. However, little has been reported on the effects of AO+MI training. In the present study, we compared the effects of AO+MI training to the effects of physical training on upper-extremity performance.
Materials and methods:
Ninety-six healthy participants were randomly assigned to either the control group or the experimental group. Sport stacking, which is often used to evaluate upper-extremity performance, was adopted for the task. The experiment was scheduled for three days. The training was 20 min per day. The control group performed only physical training, while the experimental group performed four 5-min AO+MI training sessions. Time taken to complete a sport stacking try (task completion time) was defined as the index of speed of upper-extremity performance and number of fallen cups as the index of its accuracy. The outcomes within each group and between the two groups were compared.
Results:
Both AO+MI training and physical training showed reduced task completion time and increased number of fallen cups. There were no significant differences in the degree of changes between the groups.
Conclusion:
Results from the present study showed that AO+MI training and physical training had almost the same influence on upper-extremity performance in the early stages of learning sport stacking. This result suggests that AO+MI training may be an effective and low-burden training method for participants.
Purpose
Neck pain is a musculoskeletal problem increasing with age. The disorders that occurs in the neck region may also affect the upper extremity due to its close anatomical relationships. The aim of this study was to determine whether neck pain affects shoulder position sense and upper extremity function in the older adults.
Methods
This cross-sectional study was carried out in nursing homes. The older adults over 65 years of age with chronic neck pain for the last 6 months were included. Pain intensity was evaluated with a Visual Analog Scale. Acumar dual digital inclinometer was used for the evaluation of shoulder position sense. 9-Hole Peg Test was used for the measure of upper extremity function.
Results
It was found dominant side shoulder position sense and the function of both upper extremities were different between the three groups (p < 0.05). Pain was correlated with dominant and non-dominant 60ᵒ flexion shoulder position sense and 60ᵒ abduction shoulder position sense (p < 0.05). Additionally, a relationship was found only between pain and non-dominant side upper extremity function (p < 0.05).
Conclusion
In conclusion, we found that in older adults with neck pain, position sense and function decreased in upper extremities. The findings from this study support that detailed evaluation of anatomically related regions as well as the cervical region where pain is felt is important in creating a more effective rehabilitation program.
This paper contains the account of a combined physiologic and orthopedic study of certain phenomena of infantile paralysis. The whole matter owes its inception and present status to the State Board of Health of Vermont, which by the generosity of an anonymous donor was enabled to finance a scheme for the study and treatment of the disease quite unprecedented in its scope and thoroughness. The entire work has been conducted under the direction of the board, which has borne the whole expense of the studies in Boston and Vermont.
The inquiry was started in the late autumn of 1914, the Rockefeller Institute through Dr. Simon Flexner taking charge of the epidemiologic end of the inquiry and opening a laboratory in Burlington, while to one of us (R. W. L.) was assigned the therapeutic side of the problem. Later, for reasons to be stated, the physiologic department of Harvard University was
Study Design. Repositioning error of the trunk was tested in 20subjects with chronic low back pain and in 20 control subjects. The 3S pace Tracker (Polhemus, Colchester, VT), a device that measures three-dimensional position in space, was used to determine the subject's trunk position. Objectives. To determine whether repositioning error is different in subjects with chronic low back pain than in control subjects. Summary of Background Data. Proprioception allows the body to maintain proper orientation during static and dynamic activities. In peripheral joint injuries, researchers have demonstrated a loss of some aspects of proprioception and improvement in outcome with retraining. Although the components of proprioception in subjects with low back pain have not been well studied, it is thought that these persons lose some elements of proprioception that can be measured in a quantifiable way. If so, then rehabilitation to improve these deficits is important. In this pilot study, one aspect of proprioception, repositioning error, was examined Methods. The subjects attempted to replicate target positions of the trunk in flexion, extension, lateral bending, and lateral rotation. Repositioning error was calculated as the absolute difference between the actual and the subject-replicated target positions. Results. No significant difference was found in repositioning error between the control subjects and the persons with chronic low back pain. Conclusions. Because proprioception is complex and entails the use of many afferent receptors, it is difficult to measure any one afferent deficiency discretely. The authors believe that this study, in which one aspect of proprioception was measured in an indirect manner, provides important background information on low back position sense. Further studies analyzing aspects of proprioception in subjects with low back pain are recommended.
The conventional cervical joint position error (JPE) test has been used as a measure of cervical afferent dysfunction in people with neck pain. However, head movement during the test may also stimulate the vestibular system. This study's objective is to investigate the effect of the modified JPE test with a neck torsion manoeuvre in order to determine if the new test is a more definitive measure of cervical afferent dysfunction. Twenty five volunteers with chronic neck pain and 26 healthy controls aged 18 to 60 were assessed on three tests of JPE: 'JPE conventional', 'JPE torsion' and 'Enbloc' (Control) using Fastrak and laser apparatus. The neck pain group was found to have significantly greater JPE in one conventional JPE test and almost all the torsion tests (p < 0.05). No differences in Enbloc(Control) tests were seen. Moderate to strong significant correlations were also seen between measures of JPE using the Fastrak and laser methodology (p ≤ 0.01). The results of this preliminary study indicate that 'JPE torsion' may be a more suitable test than 'JPE conventional' for cervical afferent dysfunction in people with chronic neck pain although future comparisons with people suffering from vestibulopathy is warranted to support these findings. Additionally, the laser method is comparable to Fastrak and may be useful as a clinical measure of repositioning errors for both conventional and torsion tests.
This study examined the reliability of measures of dynamic balance obtained using the Biodex Balance System (BBS). Twenty male (n = 10) and female (n = 10) active adults engaged in weight-bearing sports volunteered for this study. Dynamic balance was assessed using measures obtained from the BBS at a spring resistance level of 2. Spring resistance levels range from 1 (least stable) to 8 (most stable). The BBS uses a circular platform that is free to move in the anterior-posterior and medial-lateral axes simultaneously, which permits three measures to be obtained: an overall stability index (OSI), an anterior-posterior stability index (APSI), and a medial-lateral stability index (MLSI). Measures were obtained from 20-sec trials during which participants were asked to maintain an upright standing position on their dominant limb on the unstable surface of the BBS. An examination of measures obtained across 8 trials indicated that the BBS produced reliable measures as indicated by R = .94 (OSI), R = .95 (APSI), and R = .93 (MLSI). Based on findings in this study, the testing protocol recommended providing 2 practice trials (Trial 1 and Trial 2) followed by 2 test trials (Trial 3 and Trial 4). Reliability estimates for Trials 3 and 4 were R = .90 (OSI), R = .86 (APSI), and R = .76 (MLSI). Replication of this protocol with a separate group of 27 collegiate athletes resulted in reliability estimates of R = .92 (OSI), R = .89 (APSI), R = .93 (MLSI).
Head orientation in space makes use of multiple sensory afferents, among which the cervical proprioceptive cues could play a predominant role. To quantify the alteration of neck proprioception in patients with cervical pathology, we proposed a test for the clinical evaluation of the ability to relocate the head on the trunk after an active head movement, for 30 healthy subjects and 30 patients with cervical pain. The data demonstrated that this ability was significantly poorer in the patient group, indicating an alteration in neck proprioception. This test permits a discriminant classification of healthy and sick subjects, justifies proprioceptive rehabilitation programs, and allows a quantitative evaluation of their results.
Twenty-seven college women participated in a study to evaluate the reliability and validity of four tests of hand strength: grip, palmar pinch, key pinch, and tip pinch. Standardized positioning and instructions were followed. The results showed very high inter-rater reliability. Test-retest reliability was highest in all tests when the mean of three trials was used. Lower correlations were shown when one trial or the highest score of three trials were utilized. The Jamar dynamometer by Asimow Engineering and the pinch gauge by B&L Engineering demonstrated the highest accuracy of the instruments tested.
This study showed that fatigue of the ipsilateral medial gastrocnemius muscle caused a clear-cut reduction in the ability of ensembles of primary muscle spindle afferents from the lateral gastrocnemius muscle to discriminate between muscle stretches of varying amplitude. The results were probably caused by reflex-mediated effects from chemosensitive group III and IV afferents onto the gamma-motoneurons projecting to lateral gastrocnemius muscle spindles. The experiments were conducted on seven cats anaesthetized with alpha-chloralose and a total of 41 primary muscle spindle afferents from the lateral gastrocnemius were registered. Afferents were simultaneously recorded in ensembles of three to 10 afferents. A method based on principal component analysis and algorithms for quantification of stimulus discrimination in ensembles of muscle afferents was used prior to, immediately following and five or more minutes after muscle fatigue had been induced to the ipsilateral medial gastrocnemius muscle. It is well established that the primary muscle spindle afferents play an important role in proprioception and kinaesthesia. Therefore the decrease in the accuracy of the information transmitted by ensembles of primary muscle spindle afferents caused by fatigue in an ipsilateral muscle implies concomitant effects on proprioception and kinaesthesia.
Repositioning error of the trunk was tested in 20 subjects with chronic low back pain and in 20 control subjects. The 3Space Tracker (Polhemus, Colchester, VT), a device that measures three-dimensional position in space, was used to determine the subject's trunk position.
To determine whether repositioning error is different in subjects with chronic low back pain than in control subjects.
Proprioception allows the body to maintain proper orientation during static and dynamic activities. In peripheral joint injuries, researchers have demonstrated a loss of some aspects of proprioception and improvement in outcome with retraining. Although the components of proprioception in subjects with low back pain have not been well studied, it is thought that these persons lose some elements of proprioception that can be measured in a quantifiable way. If so, then rehabilitation to improve these deficits is important. In this pilot study, one aspect of proprioception, repositioning error, was examined.
The subjects attempted to replicate target positions of the trunk in flexion, extension, lateral bending, and lateral rotation. Repositioning error was calculated as the absolute difference between the actual and the subject-replicated target positions.
No significant difference was found in repositioning error between the control subjects and the persons with chronic low back pain.
Because proprioception is complex and entails the use of many afferent receptors, it is difficult to measure any one afferent deficiency discretely. The authors believe that this study, in which one aspect of proprioception was measured in an indirect manner, provides important background information on low back position sense. Further studies analyzing aspects of proprioception in subjects with low back pain are recommended.
Unlabelled:
This review constitutes the first of four reviews that systematically address contemporary knowledge about the mechanical behavior of the cervical vertebrae and the soft-tissues of the cervical spine, under normal conditions and under conditions that result in minor or major injuries. This first review considers the normal kinematics of the cervical spine, which predicates the appreciation of the biomechanics of cervical spine injury. It summarizes the cardinal anatomical features of the cervical spine that determine how the cervical vertebrae and their joints behave. The results are collated of multiple studies that have measured the range of motion of individual joints of the cervical spine. However, modern studies are highlighted that reveal that, even under normal conditions, range of motion is not consistent either in time or according to the direction of motion. As well, detailed studies are summarized that reveal the order of movement of individual vertebrae as the cervical spine flexes or extends. The review concludes with an account of the location of instantaneous centres of rotation and their biological basis.
Relevance:
The fact and precepts covered in this review underlie many observations that are critical to comprehending how the cervical spine behaves under adverse conditions, and how it might be injured. Forthcoming reviews draw on this information to explain how injuries might occur in situations where hitherto it was believed that no injury was possible, or that no evidence of injury could be detected.
The purpose of this study was to determine the effect of plyometric training of the shoulder internal rotators on proprioception, kinesthesia, and selected muscle performance characteristics in female swimmers. Twenty-four female division I swimmers were evaluated before and after a 6-week plyometric training program. Proprioception and kinesthesia were assessed for internal and external rotation at 0 degrees, 75 degrees, and 90% of the subject's maximum external rotation. The Biodex II was used to assess strength characteristics at 60 degrees /s, 240 degrees /s, and 450 degrees /s. Plyometric training sessions (2 times/week) involved 3 sets of 15 repetitions with a trampoline, weighted balls, and elastic tubing. A 2-way analysis of variance revealed significant improvement (P <.05) in proprioception at 0 degrees moving into external rotation, as well as 75 degrees and 90% moving into both internal and external rotation. Kinesthesia demonstrated significant improvement for all test conditions after plyometric training. Significant gains in selected muscle performance characteristics included time to peak torque (60 degrees /s and 240 degrees /s), amortization time (450 degrees /s), and torque decrement (240 degrees /s). This study suggests that plyometric activities may facilitate neural adaptations that enhance proprioception, kinesthesia, and muscle performance characteristics. Significant neuromuscular benefits may be attained if they are implemented earlier into shoulder rehabilitation programs.
Cross-sectional study.
This study compared neck muscle activation patterns during and after a repetitive upper limb task between patients with idiopathic neck pain, whiplash-associated disorders, and controls.
Previous studies have identified altered motor control of the upper trapezius during functional tasks in patients with neck pain. Whether the cervical flexor muscles demonstrate altered motor control during functional activities is unknown.
Electromyographic activity was recorded from the sternocleidomastoid, anterior scalenes, and upper trapezius muscles. Root mean square electromyographic amplitude was calculated during and on completion of a functional task.
A general trend was evident to suggest greatest electromyograph amplitude in the sternocleidomastoid, anterior scalenes, and left upper trapezius muscles for the whiplash-associated disorders group, followed by the idiopathic group, with lowest electromyographic amplitude recorded for the control group. A reverse effect was apparent for the right upper trapezius muscle. The level of perceived disability (Neck Disability Index score) had a significant effect on the electromyographic amplitude recorded between neck pain patients.
Patients with neck pain demonstrated greater activation of accessory neck muscles during a repetitive upper limb task compared to asymptomatic controls. Greater activation of the cervical muscles in patients with neck pain may represent an altered pattern of motor control to compensate for reduced activation of painful muscles. Greater perceived disability among patients with neck pain accounted for the greater electromyographic amplitude of the superficial cervical muscles during performance of the functional task.
Isometric cervical strength has been used for assessing the severity of cervical spine pathologies. However there is a conspicuous dearth of information relating to cervical strength data in patients suffering from chronic whiplash. Therefore the objective of this study was to compare absolute and ratio-based isometric cervical strength scores in chronic whiplash patients with reported corresponding scores in healthy subjects.
Isometric cervical strength was measured in the directions of flexion, extension, right and left lateral flexion in 97 patients, 51 women and 46 men, using a wall-mounted dynamometer.
Compared to published values of normal subjects, whiplash patients suffered sharp reductions of about 90% in both genders and in all directions. The consistency of the isometric cervical strength scores as indicated by the mean coefficient of variation was relatively low, 17% and 20% in men and women respectively. The flexion/extension strength ratio ranged 0.8--0.9, slightly higher than the reported range for normal subjects. This ratio was highly correlated (r=0.91, P=0.01) with the mean coefficient of variation in a subgroup of 9 patients.
In the absence of an obvious reason such as sever atrophy or grossly dysfunctional neurological control the indicated weakness of the cervical muscles may be associated with learned pain avoidance behavior which is typical among this group of patients.
Cervical proprioceptive system (CPS) consisting of mechanoreceptors of cervical intervertebral joints, mechanoreceptors of neck muscles and ligament's insertions, muscle spindles located in deep short muscles of cervical spine and sensitive fibers connecting neck's proprioceptors with neurons of cornu posteriori of spinal cord, plays an essential part in maintaining bodily balance. CPS, via tractus spinovestibularis, is connected to vestibular nuclei. Clinical and neurophysiological studies have shown that functional disorders and/or organic lesions of CPS cause identical symptoms as vestibular diseases: vertigo, nystagmus and balance disorders. Dysfunction (functional blockade) of craniocervical joints is the most frequent cause of cervicogenic proprioceptive vertigo (CPV). The constant tension of the capsule of a blocked joint irritates mechanoreceptors protecting the joint's capsules. The increased activity of mechanoreceptors results in confusion of vestibular system. That is, the impulses from the blocked craniocervical joints do not correspond to the impulses from the vestibular organ and other sensory systems that take part in maintaining bodily balance. The disharmony of impulses results in an inadequate vestibulo-spinal and vestibulo-ocular reaction manifesting as vertigo and nystagmus. Hyperactivity of craniocervical mechanoreceptors also causes disturbances in reflex regulation of postural muscle tonus manifesting as "general instability". Knowledge of CPV as a separate clinical entity is important from diagnostical and therapeutical aspect. As it concerns a peripheral vestibular disorder still unknown to a wider circle of physicians, the article describes etiopathogenesis, clinical manifestations, diagnosis and therapy of CPV with special emphasis on manual therapy.
The purpose of this brief review is to present evidence from experimental and clinical neck pain studies of pain-induced neuromuscular adaptations. It has been shown that clinical neck pain is associated with a substantial reorganization in the control strategies of cervical muscles during static and dynamic tasks. Experimental neck pain models allow local elicitation of nociceptive afferents, mimicking the sensory aspects of clinical pain, without major changes in muscle properties. These models may help understand the physiological mechanisms underlying the observations from clinical neck pain studies. The knowledge obtained from the interpretation of clinical findings with experimental pain models has relevance for the development of therapeutic interventions for the rehabilitation of patients with neck pain disorders.
Although impaired neck proprioception has been demonstrated in patients with chronic neck pain, previous studies have not consistently shown any association between pain intensity and proprioceptive performance. We therefore investigated whether temporal aspects of pain are associated with cervicocephalic kinesthetic sensibility. One hundred and twenty-seven adults with or without subclinical neck pain undertook two tasks, repositioning their heads to the neutral head position (head-to-NHP) and target position (head-to-target) in sagittal and transverse plane. Absolute error was calculated from position data recorded by an ultrasound-based motion analysis system. Pain frequency, duration, and intensity were evaluated using a questionnaire. A mixed effects model was constructed to test the effect on reposition error by different pain factors, with age, gender and maximal cervical range of motion as covariates. A higher pain frequency was associated with greater reposition errors for all movement directions in the head-to-NHP task. No consistent effect was observed for pain intensity or duration. In the case of the head-to-target task, no consistent effect was observed for any of the three pain factors. The findings reveal that pain frequency, not the intensity or duration of pain, is associated with neck proprioception in individuals with subclinical neck pain.
The receptors in the cervical spine have important connections to the vestibular and visual apparatus as well as several areas of the central nervous system. Dysfunction of the cervical receptors in neck disorders can alter afferent input subsequently changing the integration, timing and tuning of sensorimotor control. Measurable changes in cervical joint position sense, eye movement control and postural stability and reports of dizziness and unsteadiness by patients with neck disorders can be related to such alterations to sensorimotor control. It is advocated that assessment and management of abnormal cervical somatosensory input and sensorimotor control in neck pain patients is as important as considering lower limb proprioceptive retraining following an ankle or knee injury. Afferent information from the cervical receptors can be altered via a number of mechanisms such as trauma, functional impairment of the receptors, changes in muscle spindle sensitivity and the vast effects of pain at many levels of the nervous system. Recommendations for clinical assessment and management of such sensorimotor control disturbances in neck disorders are presented based on the evidence available to date.
€ Unl€ uer N € O, Ates¸Y. 2021. An investigation of neck pain in older adults, and its relation with shoulder position sense and upper extremity function
- F Ulutatar
- C Unal-Ulutatar
- M T Duruoz
Ulutatar F, Unal-Ulutatar C, Duruoz MT. 2019. Cervical proprioceptive
impairment in patients with rheumatoid arthritis. Rheumatol Int.
39(12):2043-2051.
€
Unl€ uer N €
O, Ates¸Y. 2021. An investigation of neck pain in older adults,
and its relation with shoulder position sense and upper extremity
function. Somatosensory & Motor Research. 38(4):333-338.