Bilateral deficits in fine motor control ability and manual dexterity in women with fibromyalgia syndrome

Behavioral and Electrocortical Response to a Sensorimotor Conflict in Individuals with Fibromyalgia

People with fibromyalgia have been shown to experience more somatosensory disturbances than pain-free controls during sensorimotor conflicts (i.e., incongruence between visual and somatosensory feedback). Sensorimotor conflicts are known to disturb the integration of sensory information. This study aimed to assess the cerebral response and motor performance during a sensorimotor conflict in people with fibromyalgia. Twenty participants with fibromyalgia and twenty-three pain-free controls performed a drawing task including visual feedback that was either congruent with actual movement (and thus with somatosensory information) or incongruent with actual movement (i.e., conflict). Motor performance was measured according to tracing error, and electrocortical activity was recorded using electroencephalography. Motor performance was degraded during conflict for all participants but did not differ between groups. Time-frequency analysis showed that the conflict was associated with an increase in theta power (4-8 Hz) at conflict onset over the left posterior parietal cortex in participants with fibromyalgia but not in controls. This increase in theta suggests a stronger detection of conflict in participants with fibromyalgia, which was not accompanied by differences in motor performance in comparison to controls. This points to dissociation in individuals with fibromyalgia between an altered perception of action and a seemingly unaltered control of action.

The sensorimotor theory of pathological pain revisited

Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.

Gross and fine motor function in fibromyalgia and chronic fatigue syndrome

Purpose

This paper aimed to investigate motor proficiency in fine and gross motor function, with a focus on reaction time (RT) and movement skill, in patients with fibromyalgia (FM) and chronic fatigue syndrome (CFS) compared to healthy controls (HC).

Methods

A total of 60 individuals (20 CFS, 20 FM, and 20 HC), age 19–49 years, participated in this study. Gross motor function in the lower extremity was assessed using a RT task during gait initiation in response to an auditory trigger. Fine motor function in the upper extremity was measured during a precision task (the Purdue Pegboard test) where the number of pins inserted within 30 s was counted.

Results

No significant differences were found between FM and CFS in any parameters. FM and CFS groups had significantly longer RT than HC in the gait initiation (p=0.001, and p=0.004 respectively). In the Purdue Pegboard test, 20% in the FM group, 15% in the CFS groups, and 0% of HC group, scored below the threshold of the accepted performance. However, there were no significant differences between FM, CFS, and HC in this task (p=0.12).

Conclusion

Compared to controls, both CFS and FM groups displayed significantly longer RT in the gait initiation task. Generally, FM patients showed the worst results in both tests, although no group differences were found in fine motor control, according to the Purdue Pegboard test.

Cross-Cultural Adaptation and Validation of the Jebsen-Taylor Hand Function Test in an Italian Population

Objective. This paper describes the Italian translation and adaptation to the Italian culture of the original version of the Jebsen-Taylor hand function test and conveys the procedure for testing its validity and reliability. Design. The cultural adaptation process and validation were based on data from a group of people with no clinical evidence of disease or impairment of the upper limbs. The process required a forward and reverse translation in its original language. The scale obtained was reviewed by 8 experts in the field of psychometrics dealing with statistical methods that are useful for the behavioral and social sciences. The Italian adapted version of the JTHFT was then produced and validated. Participants. The test was submitted to 320 people with no clinical evidence of disease in order to test its acceptability and consistency. Results. The total time required to perform each subtest was 80.16 ± 43.13 seconds for the nondominant hand (NDH) and 49.97 ± 27.28 seconds for the dominant hand (DH). The internal consistency (assessed with Pearson's r) and the reliability or the construct validity (assessed with Cronbach's alpha) are significative. Conclusions. This is the first study reporting the result of the translation, cultural adaptation, and validation protocols of the JTHFT in Italian. It provides a new tool for Italian professionals to measure the functionality of the hand in participants with various upper limb pathologies.

Micro movements of the upper limb in fibromyalgia: The relation to proprioceptive accuracy and visual feedback

The purpose of this study was to explore the role of visual and proprioceptive feedback in upper limb posture control in fibromyalgia (FM) and to assess the coherence between acceleration measurements of upper limb micro movements and surface electromyography (sEMG) of shoulder muscle activity (upper trapezius and deltoid). Twenty-five female FM patients and 25 age- and sex-matched healthy controls (HCs) performed three precision motor tasks: (1) maintain a steady shoulder abduction angle of 45° while receiving visual feedback about upper arm position and supporting external loads (0.5, 1, or 2kg), (2) maintain the same shoulder abduction angle without visual feedback (eyes closed) and no external loading, and (3) a joint position sense test (i.e., assessment of proprioceptive accuracy). Patients had more extensive increase in movement variance than HCs when visual feedback was removed (P<0.03). Proprioceptive accuracy was related to movement variance in HCs (R⩾0.59, P⩽0.002), but not in patients (R⩽0.25, P⩾0.24). There was no difference between patients and HCs in coherence between sEMG and acceleration data. These results may indicate that FM patients are more dependent on visual feedback and less reliant on proprioceptive information for upper limb posture control compared to HCs.

Assessing Cognitive and Psychomotor Performance in Patients with Fibromyalgia Syndrome

Introduction

Patients with fibromyalgia syndrome (FMS) generally present with chronic widespread pain, accompanied by a range of additional and non-specific symptoms, such as fatigue, disturbed sleep, and cognitive dysfunction, which tend to increase with overall severity. Previous studies have shown moderate cognitive impairment in patients with FMS, but there are few valid data explicitly assessing the relevance of these findings to everyday functions, such as driving ability. Therefore, we studied patients with FMS to assess the impact of FMS on tests that predict driving ability.

Methods

Female patients with FMS were prospectively compared to a historical control group of healthy volunteers. The test battery comprised assessments of visual orientation, concentration, attention, vigilance, motor coordination, performance under stress, and reaction time.

Results

A total of 43 patients were matched to 129 controls. The results indicated that the patients’ psychomotor and cognitive performances were significantly non-inferior when compared to healthy controls (with 0.05% alcohol), with the exception of motor coordination. Patients and healthy controls showed an age-related decline in test performance. Correlations were smaller in patients and reversed for vigilance which was linked to a greater FMS symptom load in younger patients.

Conclusion

The results of the present study demonstrate that, in general, the driving ability of patients with FMS was not inferior to that of healthy volunteers based on a standardized computer-based test battery. However, variables, such as younger age, depression, anxiety, fatigue, pain, and poor motor coordination, likely contribute to the subjective perception of cognitive dysfunction in FMS.

Electronic supplementary material

The online version of this article (doi:10.1007/s40122-014-0028-0) contains supplementary material, which is available to authorized users.