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Giancatarina M, Grandperrin Y, Nicolier M, Gimenez P, Vidal C, Tio G, Haffen E, Bennabi D, Grosprêtre S. Acute effect of transcranial direct current stimulation (tDCS) on postural control of trained athletes: A randomized controlled trial. PLoS One 2024; 19:e0286443. [PMID: 38236903 PMCID: PMC10795979 DOI: 10.1371/journal.pone.0286443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/20/2023] [Indexed: 01/22/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is used to modulate brain function, and can modulate motor and postural control. While the acute effect of tDCS is well documented on patients, little is still known whether tDCS can alter the motor control of healthy trained participants. This study aimed to assess the acute effect of tDCS on postural control of parkour practitioners, known for their good balance abilities and their neuromuscular specificities that make them good candidates for tDCS intervention. Eighteen parkour practitioners were tested on three occasions in the laboratory for each stimulation condition (2 mA; 20 minutes)-primary motor cortex (M1), dorsolateral prefrontal cortex (dlPFC) and sham (placebo). Postural control was evaluated PRE and POST each stimulation by measuring Center of Pressure (CoP) displacements on a force platform during static conditions (bipedal and unipedal stance). Following M1 stimulation, significant decreases were observed in CoP area in unipedal (from 607.1 ± 297.9 mm2 to 451.1 ± 173.9 mm2, P = 0.003) and bipedal (from 157.5 ± 74.1 mm2 to 117.6 ± 59.8 mm2 P<0.001) stances. As well, the CoP total length was significantly reduced in bipedal (from 3416.8 ± 295.4 mm to 3280.6 ± 306.2 mm, P = 0.005) as well as in unipedal stance (from 4259.6 ± 398.4 mm to 3846.5 ± 468.9 mm, P<0.001), only after M1 stimulation. Relative pre-post changes observed after M1 stimulation were negatively correlated to experience in parkour only after unipedal stance (r = 0.715, P<0.001), meaning that the more participants were trained the less tDCS was effective. No significant changes were noticed after sham and dlPFC stimulation. These results suggested that the modulation of gait performance in athletes following an acute intervention of tDCS is specific to the targeted brain region, and that postures with reduced base of support (such as unipedal stance) were more sensitive to tDCS.
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Affiliation(s)
- Mary Giancatarina
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
| | - Yohan Grandperrin
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Magali Nicolier
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Philippe Gimenez
- EA4660, C3S Culture Sport Health Society, Université de Franche -Comté, UFR STAPS, Besançon, France
| | - Chrystelle Vidal
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Gregory Tio
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Emmanuel Haffen
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Universitaire de Besançon Besançon, France
| | - Djamila Bennabi
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Universitaire de Besançon Besançon, France
| | - Sidney Grosprêtre
- EA4660, C3S Culture Sport Health Society, Université de Franche -Comté, UFR STAPS, Besançon, France
- Institut Universitaire de France (IUF), Paris, France
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Luo S, Deng L, Chen Y, Zhou W, Canavese F, Li L. Does enhanced cognitive performance reduce fracture risk? a Mendelian randomization study. Aging (Albany NY) 2023; 15:14985-14995. [PMID: 38112588 PMCID: PMC10781472 DOI: 10.18632/aging.205325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE While observational studies have suggested a link between cognitive performance and fracture risk, the causality and site-specific nature are unclear. We applied Mendelian randomization (MR) to elucidate these associations. METHODS 147 single-nucleotide polymorphisms (SNPs) tied strongly to cognitive performance (p< 5e-8) were selected. We performed MR analysis to investigate the causal relationship between cognitive performance and fractures at specific sites, including the wrist, upper arm, shoulder, ribs, sternum, thoracic spine, lumbar spine, pelvis, femur, leg, and ankle. The primary estimate was determined using the inverse variance-weighted method. Additionally, we examined heterogeneity using the MR Pleiotropy RESidual Sum Outlier test and Cochran Q, and employed MR-Egger regression to identify horizontal pleiotropy. RESULTS MR analysis identified a causal association between cognitive performance and fractures at the lumbar-spine-pelvis (odds ratio [OR] = 0.727, 95% CI = 0.552-0.956, p = 0.023), and ribs-sternum-thoracic spine sites (OR = 0.774, 95% CI = 0.615-0.974, p = 0.029). However, no causal association was found for fractures at other sites. CONCLUSIONS This study provided evidence of a causal connection between cognitive performance and fracture risk at certain locations. These findings underline the potential of cognitive enhancement strategies as innovative and effective methods for fracture prevention.
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Affiliation(s)
- Shaoting Luo
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Linfang Deng
- Department of Nursing, Jinzhou Medical University, Jinzhou 121001, Liaoning, P.R. China
| | - Yufan Chen
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Lille 59000, Nord Department, France
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
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Symptomatic individuals with Lumbar Disc Degeneration use different anticipatory and compensatory kinematic strategies to asymptomatic controls in response to postural perturbation. Gait Posture 2022; 94:222-229. [PMID: 33980472 PMCID: PMC9099249 DOI: 10.1016/j.gaitpost.2021.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lumbar Disc Degeneration (LDD) is associated with recurrent low back pain (LBP) (symptomatic). However, in some instances of LDD, people do not experience LBP (asymptomatic). RESEARCH QUESTION As a step towards understanding why some people with LDD experience LBP and others do not, the primary aim of this study was to examine differences in anticipatory (APA) and compensatory postural adjustments (CPA), between symptomatic LDD patients (LDD pain) and asymptomatic LDD controls (LDD no pain) during postural perturbation. The secondary aim was to determine simultaneous differences in mental health, disability and quality of life status. METHODS 3 T MRI was used to acquire T2 weighted images (L1-S1) from LDD no pain (n = 34) and LDD pain groups (n = 34). In this observational study, responses to predicted and unpredicted forward perturbations were examined using three dimensional motion capture. A Mann Whitney U test was conducted to examine group differences in sagittal spine and lower limb kinematics (integrated angular displacements during four established APA and CPA time intervals), anxiety, depression, disability and quality of life. RESULTS The LDD pain group exhibited lower hip and knee displacements (p = 0.049-0.040) than the LDD no pain group during predicted and unpredicted perturbation. The LDD pain group also exhibited higher compensatory lumbar displacement than the LDD no pain group (p = 0.040-0.005) in the predicted condition but there was no difference observed in the unpredicted condition. The LDD pain group experienced higher levels of depression, anxiety and disability (p < 0.0001) and lower quality of life (p = 0.0001) than LDD controls. SIGNIFICANCE Symptomatic LDD patients are different from LDD controls; they exhibit different kinematic strategies, levels of disability, anxiety, depression and quality of life. Effective care may benefit from evaluating and targeting these differences.
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Zheng X, Reneman MF, Echeita JA, Schiphorst Preuper RHR, Kruitbosch H, Otten E, Lamoth CJC. Association between central sensitization and gait in chronic low back pain: Insights from a machine learning approach. Comput Biol Med 2022; 144:105329. [DOI: 10.1016/j.compbiomed.2022.105329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
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Amiaz R, Kimel Naor S, Caspi A, Czerniak E, Noy S, Pelc T, Mintz M, Plotnik M. Responses to balance challenges in persons with panic disorder: A pilot study of computerized static and dynamic balance measurements. Brain Behav 2022; 12:e2411. [PMID: 34843172 PMCID: PMC8785611 DOI: 10.1002/brb3.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/22/2021] [Accepted: 09/05/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Several studies have shown an association between panic disorder (PD) and reduced balance abilities, mainly based on functional balance scales. This pilot study aims to demonstrate the feasibility of studying balance abilities of persons with PD (PwPD) using computerized static and, for the first time, dynamic balance measurements in order to characterize balance control strategies employed by PwPD. METHODS Twelve PwPD and 11 healthy controls were recruited. PD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and the severity of symptoms was evaluated using the Hamilton Anxiety Scale (HAM-A), PD Severity Scales (PDSS), and Panic and Agoraphobia Scale (PAS). Balance was clinically assessed using the Activities-Specific Balance Confidence (ABC) scale and physically by the Mini-Balance Evaluation Systems Test (Mini-BESTest). Dizziness was evaluated using the Dizziness Handicap Inventory (DHI) scale. Postural control was evaluated statically by measuring body sway and dynamically by measuring body responses to rapid unexpected physical perturbations. RESULTS PwPD had higher scores on the HAM-A (17.6 ± 10.3 vs. 3.0 ± 2.9; p < .001), PDSS (11.3 ± 5.1 vs. 0; p < .001), and PAS (20.3 ± 8.7 vs. 0; p < .001) questionnaires and lower scores on the balance scales compared to the controls (ABC scale: 156.2 ± 5.9 vs. 160 ± 0.0, p = .016; Mini-BESTest: 29.4 ± 2.1 vs. 31.4 ± 0.9, p = .014; DHI: 5.3 ± 4.4 vs. 0.09 ± 0.3, p < .001). In the static balance tests, PwPD showed a not-significantly smaller ellipse area of center of pressure trajectory (p = .36) and higher body sway velocity (p = .46), whereas in the dynamic balance tests, PwPD had shorter recovery time from physical perturbations in comparison to controls (2.1 ± 1.2s vs. 1.6 ± 0.9 s, p = .018). CONCLUSION The computerized balance tests results point to an adoption of a ''postural rigidity'' strategy by the PwPD, that is, reduced dynamic adaptations in the face of postural challenges. This may reflect a nonsecure compensatory behavior. Further research is needed to delineate this strategy.
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Affiliation(s)
- Revital Amiaz
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Kimel Naor
- The Center of Advanced Technologies in Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Caspi
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Czerniak
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Noy
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Pelc
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Matti Mintz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Meir Plotnik
- The Center of Advanced Technologies in Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nishi Y, Shigetoh H, Fujii R, Osumi M, Morioka S. Changes in Trunk Variability and Stability of Gait in Patients with Chronic Low Back Pain: Impact of Laboratory versus Daily-Living Environments. J Pain Res 2021; 14:1675-1686. [PMID: 34140804 PMCID: PMC8203190 DOI: 10.2147/jpr.s310775] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/20/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individuals with chronic low back pain (CLBP) experience changes in gait control due to pain and/or fear. Although CLBP patients' gait has been performed in laboratory environments, changes in gait control as an adaptation to unstructured daily living environments may be more pronounced than the corresponding changes in laboratory environments. We investigated the impacts of the environment and pathology on the trunk variability and stability of gait in CLBP patients. METHODS CLBP patients (n=20) and healthy controls with no low-back pain history (n=20) were tasked with walking in a laboratory or daily-living environment while wearing an accelerometer on the low back. We calculated the stride-to-stride standard deviation and multiscale sample entropy as indices of "gait variability" and the maximum Lyapunov exponent as an index of "gait stability" in both the anterior-posterior and medial-lateral directions. The participants were assessed on the numerical rating scale for pain intensity, the Tampa Scale for Kinesiophobia, and the Roland-Morris Disability Questionnaire for quality of life (QOL). RESULTS In a repeated-measures ANOVA, the standard deviation was affected by environment in the anterior-posterior direction and by group and environment in the medial-lateral direction. Multiscale sample entropy showed no effect in the anterior-posterior direction and showed both effects in the medial-lateral direction. Maximum Lyapunov exponents showed both effects in the anterior-posterior direction, but none in the medial-lateral direction. These changes of trunk motor control by CLBP patients were found to be related to pain intensity, fear of movement, and/or QOL in the daily-living environment but not in the laboratory environment. CONCLUSION These results revealed that CLBP patients exhibit changes in trunk variability and stability of gait depending on the environment, and they demonstrated that these changes are related to pain, fear, and QOL. We propose useful accelerometer-based assessments of qualitative gait in CLBP patients' daily lives, as it would provide information not available in a general practice setting.
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Affiliation(s)
- Yuki Nishi
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Hayato Shigetoh
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
| | - Ren Fujii
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
| | - Michihiro Osumi
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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Deane JA, Lim AKP, McGregor AH, Strutton PH. Understanding the impact of lumbar disc degeneration and chronic low back pain: A cross-sectional electromyographic analysis of postural strategy during predicted and unpredicted postural perturbations. PLoS One 2021; 16:e0249308. [PMID: 33793605 PMCID: PMC8016216 DOI: 10.1371/journal.pone.0249308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
People with chronic low back pain (LBP) exhibit changes in postural control. Stereotypical muscle activations resulting from external perturbations include anticipatory (APAs) and compensatory (CPAs) postural adjustments. The aim and objective of this study was to determine differences in postural control strategies (peak amplitude, APAs and CPAs) between symptomatic and asymptomatic adults with and without Lumbar Disc Degeneration (LDD) using surface electromyography during forward postural perturbation. Ninety-seven subjects participated in the study (mean age 50 years (SD 12)). 3T MRI was used to acquire T2 weighted images (L1-S1). LDD was determined using Pfirrmann grading. A bespoke translational platform was designed to deliver horizontal perturbations in sagittal and frontal planes. Electromyographic activity was analysed bilaterally from 8 trunk and lower limb muscles during four established APA and CPA epochs. A Kruskal-Wallis H test with Bonferroni correction for multiple comparisons was conducted. Four groups were identified: no LDD no pain (n = 19), LDD no pain (n = 38), LDD pain (n = 35) and no LDD pain (n = 5). There were no significant differences in age or gender between groups. The most significant difference between groups was observed during forward perturbation. In the APA and CPA phases of predictable forward perturbation there were significant differences ankle strategy between groups (p = 0.007–0.008); lateral gastrocnemius and tibialis anterior activity was higher in the LDD pain than the LDD no pain group. There were no significant differences in the unpredictable condition (p>0.05). These findings were different from the remaining groups, where significant differences in hip strategy were observed during both perturbation conditions (p = 0.004–0.006). Symptomatic LDD patients exhibit different electromyographic strategies to asymptomatic LDD controls. Future LBP electromyographic research should benefit from considering assessment of both lower limbs in addition to the spine. This approach could prevent underestimation of postural control deficits and guide targeted rehabilitation.
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Affiliation(s)
- Janet A Deane
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Health Sciences, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Adrian K P Lim
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Imaging, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Paul H Strutton
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Foot Arch Support Effect on Lumbo-Pelvic Kinematics and Centre of Pressure Excursion During Stand-to-Sit Transfer in Different Foot Types. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00499-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
Compared to healthy individuals, patients with low back pain demonstrate differences in all aspects of trunk motor control that are most often studied as differences in muscle activity and kinematics. However, differences in these aspects of motor control are largely inconsistent. We propose that this may reflect the existence of 2 phenotypes or possibly the ends of a spectrum, with "tight control" over trunk movement at one end and "loose control" at the other. Both may have beneficial effects, with tight control protecting against large tissue strains from uncontrolled movement and loose control protecting against high muscle forces and resulting spinal compression. Both may also have long-term negative consequences. For example, whereas tight control may cause high compressive loading on the spine and sustained muscle activity, loose control may cause excessive tensile strains of tissues. Moreover, both phenotypes could be the result of either an adaptation process aimed at protecting the low back or direct interference of low back pain and related changes with trunk motor control. The existence of such phenotypes would suggest different motor control exercise interventions. Although some promising data supporting these phenotypes have been reported, it remains to be shown whether these phenotypes are valid, how treatment can be targeted to these phenotypes, and whether this targeting yields superior clinical outcomes. J Orthop Sports Phys Ther 2019;49(6):370-379. Epub 12 Jun 2018. doi:10.2519/jospt.2019.7917.
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Solana-Tramunt M, Morales J, Cabedo-Sanromà J, Guerra-Balic M. The use of an electrogoniometer to assess both lumbar range of movement and its conscious control: a comparison between healthy subjects and elite swimmers. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mi J, Ye J, Zhao X, Zhao J. Effects of lumbosacral orthoses on postural control in individuals with or without non-specific low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:180-186. [PMID: 29071410 DOI: 10.1007/s00586-017-5355-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the effect of lumbosacral orthoses (LSOs) on postural control in individuals with or without non-specific low back pain (NSLBP). METHODS Individuals with NSLBP (n = 28) and healthy controls (n = 28) were enrolled to assess the postural control with or without LSOs. Postural control was tested using the Balance Master® NeuroCom system by the modified clinical test of sensory interaction and balance. RESULTS Relative to controls, patients with NSLBP had deficits in postural control with greater center of pressure (COP) sway velocity when standing on firm surface (with eyes open: p = 0.002; with eyes closed: p = 0.002) and standing on foam surface (with eyes open: p = 0.024; with eyes closed: p < 0.001). In the braced condition, the COP sway decreased in all subjects with or without NSLBP when standing on foam surface. There was no significant difference in the effect of LSOs on postural control between NSLBP group and healthy controls. CONCLUSION Individuals with NSLBP have poorer postural control than controls. LSOs seem to improve postural control when standing on unstable surfaces in subjects with or without NSLBP. The effect of LSOs on postural control may not depend on the level of baseline.
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Affiliation(s)
- Jie Mi
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Jiling Ye
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Xin Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial. Complement Ther Med 2017; 34:104-110. [PMID: 28917361 DOI: 10.1016/j.ctim.2017.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 08/04/2017] [Accepted: 08/05/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain. DESIGN Controlled laboratory design. SETTINGS AND MAIN OUTCOME MEASURES Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed. INTERVENTION The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach. RESULTS At baseline, no differences were found between groups. The Pilates group improved in all the postural sway values (area of CoP: 11.5±3.4 to 9.7±2.7cm2, p=0.002 and CoP velocity: 2.8±0.6 to 2.3±0.5cm/s, p<0.001) and in the Star Excursion Balance Test. Control group only improved in CoP velocity, however, this improvement was significantly inferior compared to the Pilates group. CONCLUSIONS Pilates exercises immediately improved postural sway and dynamic balance in young adults with non-specific low back pain.
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Lee PY, Lin SI, Liao YT, Lin RM, Hsu CC, Huang KY, Chen YT, Tsai YJ. Postural Responses to a Suddenly Released Pulling Force in Older Adults with Chronic Low Back Pain: An Experimental Study. PLoS One 2016; 11:e0162187. [PMID: 27622646 PMCID: PMC5021337 DOI: 10.1371/journal.pone.0162187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/18/2016] [Indexed: 02/02/2023] Open
Abstract
Chronic low back pain (CLBP), one of the most common musculoskeletal conditions in older adults, might affect balance and functional independence. The purpose of this study was to investigate the postural responses to a suddenly released pulling force in older adults with and without CLBP. Thirty community-dwelling older adults with CLBP and 26 voluntary controls without CLBP were enrolled. Participants were required to stand on a force platform while, with one hand, they pulled a string that was fastened at the other end to a 2-kg or to a 4-kg force in the opposite direction at a random order. The number of times the participants lost their balance and motions of center of pressure (COP) when the string was suddenly released were recorded. The results demonstrated that although the loss of balance rates for each pulling force condition did not differ between groups, older adults with CLBP had poorer postural responses: delayed reaction, larger displacement, higher velocity, longer path length, and greater COP sway area compared to the older controls. Furthermore, both groups showed larger postural responses in the 4-kg pulling force condition. Although aging is generally believed to be associated with declining balance and postural control, these findings highlight the effect of CLBP on reactive balance when responding to an externally generated force in an older population. This study also suggests that, for older adults with CLBP, in addition to treating them for pain and disability, reactive balance evaluation and training, such as reaction and movement strategy training should be included in their interventions. Clinicians and older patients with CLBP need to be made aware of the significance of impaired reactive balance and the increased risk of falls when encountering unexpected perturbations.
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Affiliation(s)
- Pei-Yun Lee
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sang-I Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ting Liao
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ruey-Mo Lin
- Department of Orthopedic, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - Che-Chia Hsu
- Department of Orthopedic, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kuo-Yuan Huang
- Department of Orthopedic, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Ting Chen
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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Hoffman J, Gabel CP. Letter to the Editor Re: Merger of models on clinical instability - Misleading for patients and clinicians. MANUAL THERAPY 2016; 23:e10. [PMID: 26993742 DOI: 10.1016/j.math.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
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Fujiwara K, Irei M, Kiyota N, Yaguchi C, Maeda K. Event-related brain potential and postural muscle activity during standing on an oscillating table while the knee, hip, and trunk are fixed. J Physiol Anthropol 2016; 35:6. [PMID: 26888333 PMCID: PMC4758168 DOI: 10.1186/s40101-016-0088-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/10/2016] [Indexed: 11/24/2022] Open
Abstract
Background In this study, a cast brace was used to immobilize the knee, hip, and trunk, and relations between the event-related brain potential (ERP) and postural muscle activity were investigated while standing on an oscillating table. Methods Twelve healthy young adults maintained a standing posture for 1 min per trial while oscillating in the anteroposterior direction at 0.5 Hz with a 2.5-cm amplitude. Trials were performed without and with the cast brace (no-fixation and fixation condition, respectively) until the subject had adapted to the floor oscillation. The ERP from the Cz electrode, postural muscle activity, and joint movement range were analyzed for the first and last two trials (before and after adaptation, respectively). Results Movement range of the hip and knee was lower in the fixation condition than in the no-fixation condition, and postural control was achieved by pivoting at the ankle. Peak muscle activity was largest in the gastrocnemius (GcM) in both conditions. GcM activity significantly increased after fixation and then decreased with adaptation. The time of peak erector spinae (ES) activity in the fixation condition was significantly earlier than in the no-fixation condition and was not significantly different from the time of the anterior reversal and peak of triceps surae activity. The negative ERP peaked approximately 80 ms after the anterior reversal. Significant correlations between the time of the peak negative ERP and the peak GcM, soleus, and ES activity were observed only after the adaptation, and were greater in the fixation condition (r = 0.83, 0.84, and 0.83, respectively) than in the no-fixation condition (r = 0.62, 0.73, and 0.51, respectively). Conclusion All joints of the leg and trunk except for the ankle were rigidly fixed by the cast brace, and the phase differences between body segments were very small in the fixation condition. High correlations between the time of the peak negative ERP and the peak GcM, soleus, and ES activity after adaptation in the fixation condition suggest that attention would be more focused on anticipatory processing of muscle sensory information from the triceps surae and/or ES, particularly GcM, which had the greatest activation.
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Affiliation(s)
- Katsuo Fujiwara
- Department of Sports and Health, Kanazawa Gakuin University, 10 Sue-machi, Kanazawa, 920-1392, Japan.
| | - Mariko Irei
- Department of Rehabilitation Science, Osaka Health Science University, 1-9-27 Tenma, Kita-ku, Osaka, 530-0043, Japan.
| | - Naoe Kiyota
- Department of Rehabilitation, Japan Health Care College, 6-17-3 Megumino-nishi, Eniwa, 061-1373, Japan.
| | - Chie Yaguchi
- Department of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, 5-196-1, Kogane-chuo, Eniwa, 061-1449, Japan.
| | - Kaoru Maeda
- Department of Physical Therapy, Morinomiya University of Medical Sciences, 1-26-16 Nanko-kita, Suminoe-ku, Osaka, 559-8611, Japan.
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Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R, Troosters T, Brumagne S. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc 2016; 47:12-9. [PMID: 24870567 DOI: 10.1249/mss.0000000000000385] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We have shown that individuals with recurrent nonspecific low back pain (LBP) and healthy individuals breathing against an inspiratory load decrease their reliance on back proprioceptive signals in upright standing. Because individuals with LBP show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated. The purpose of this study was to investigate whether inspiratory muscle training (IMT) affects proprioceptive use during postural control in individuals with LBP. METHODS Twenty-eight individuals with LBP were assigned randomly into a high-intensity IMT group (high IMT) and low-intensity IMT group (low IMT). The use of proprioception in upright standing was evaluated by measuring center of pressure displacement during local muscle vibration (ankle, back, and ankle-back). Secondary outcomes were inspiratory muscle strength, severity of LBP, and disability. RESULTS After high IMT, individuals showed smaller responses to ankle muscle vibration, larger responses to back muscle vibration, higher inspiratory muscle strength, and reduced LBP severity (P < 0.05). These changes were not seen after low IMT (P > 0.05). No changes in disability were observed in either group (P > 0.05). CONCLUSIONS After 8 wk of high IMT, individuals with LBP showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.
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Affiliation(s)
- Lotte Janssens
- 1KU Leuven Department of Rehabilitation Sciences, University of Leuven, Leuven, BELGIUM; 2Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, UNITED KINGDOM; 3KU Leuven Department of Rehabilitation Sciences, University of Leuven, Kulab, Bruges, BELGIUM; 4Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, BELGIUM; 5Respiratory Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, BELGIUM
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Pool-Goudzwaard A. Merger of models on clinical instability--misleading for patients and clinicians? MANUAL THERAPY 2016; 21:1. [PMID: 26762660 DOI: 10.1016/s1356-689x(15)00235-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Maaswinkel E, Griffioen M, Perez R, van Dieën J. Methods for assessment of trunk stabilization, a systematic review. J Electromyogr Kinesiol 2016; 26:18-35. [DOI: 10.1016/j.jelekin.2015.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 12/03/2015] [Accepted: 12/20/2015] [Indexed: 11/27/2022] Open
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Janssens L, Brumagne S, Claeys K, Pijnenburg M, Goossens N, Rummens S, Depreitere B. Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy. Clin Biomech (Bristol, Avon) 2016; 32:40-8. [PMID: 26795132 DOI: 10.1016/j.clinbiomech.2015.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. METHODS Patients were randomly assigned into transmuscular (n=12) or paramedian lumbar surgery (n=13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n=12) or usual care (n=13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. FINDINGS Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P<0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P<0.005), although not seen in the paramedian group and usual care group (P>0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P<0.05). INTERPRETATION Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery. CLINICAL TRIAL NUMBER NCT01505595.
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Affiliation(s)
- Lotte Janssens
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium.
| | - Simon Brumagne
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Kurt Claeys
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Campus Brugge, Bruges, Belgium.
| | | | - Nina Goossens
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Sofie Rummens
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium.
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
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Smith MD, Chang AT, Hodges PW. Balance recovery is compromised and trunk muscle activity is increased in chronic obstructive pulmonary disease. Gait Posture 2016; 43:101-7. [PMID: 26471324 DOI: 10.1016/j.gaitpost.2015.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 08/27/2015] [Accepted: 09/04/2015] [Indexed: 02/02/2023]
Abstract
Increased respiration in chronic obstructive pulmonary disease (COPD) requires greater abdominal muscle activation, which may impact on contribution of the trunk to postural control. This study aimed to determine whether recovery of balance from postural perturbations and trunk muscle activity differs in people with and without COPD before and/or after exercise. Electromyography (EMG) of the obliquus internus (OI) and externus (OE) abdominis, rectus abdominis (RA), erector spinae (ES) and deltoid muscles was recorded with surface electrodes during rapid shoulder flexion and extension. Time taken to regain baseline centre of pressure velocity (vCOP) and the number of postural adjustments following arm movement was calculated from force plate data. Time to recover balance in the direction of postural disturbance (anteroposterior vCOP) was longer in COPD, particularly more severe COPD, than controls. Mediolateral vCOP (perpendicular to the perturbation) and the number of postural adjustments did not differ between groups, but people with more severe COPD were less successful at returning their mediolateral vCOP to baseline. Abdominal muscle EMG was similar between groups, but controls had greater ES EMG during arm movements. Individuals with more severe COPD had greater OE and RA EMG both before and during arm movement compared to those with less severe COPD and controls. Following exercise, OE and ES EMG increased in people with less severe COPD. This study shows that severe COPD is associated with impaired ability to recover balance and greater trunk muscle activity during postural challenges. Augmented trunk muscle activity may limit the contribution of trunk movements to balance recovery and could contribute to increased falls risk.
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Affiliation(s)
- Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia 4072, QLD, Australia.
| | - Angela T Chang
- The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia 4072, QLD, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia 4072, QLD, Australia
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van den Hoorn W, Hug F, Hodges PW, Bruijn SM, van Dieën JH. Effects of noxious stimulation to the back or calf muscles on gait stability. J Biomech 2015; 48:4109-4115. [PMID: 26602375 DOI: 10.1016/j.jbiomech.2015.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/17/2015] [Accepted: 10/10/2015] [Indexed: 11/27/2022]
Abstract
Gait stability is the ability to deal with small perturbations that naturally occur during walking. Changes in motor control caused by pain could affect this ability. This study investigated whether nociceptive stimulation (hypertonic saline injection) in a low back (LBP) or calf (CalfP) muscle affects gait stability. Sixteen participants walked on a treadmill at 0.94ms(-1) and 1.67ms(-1), while thorax kinematics were recorded using 3D-motion capture. From 110 strides, stability (local divergence exponent, LDE), stride-to-stride variability and root mean squares (RMS) of thorax linear velocities were calculated along the three movement axes. At 0.94ms(-1), independent of movement axes, gait stability was lower (higher LDE) and stride-to-stride variability was higher, during LBP and CalfP than no pain. This was more pronounced during CalfP, likely explained by the biomechanical function of calf muscles in gait, as supported by greater mediolateral RMS and stance time asymmetry than in LBP and no pain. At 1.67ms(-1), independent of movement axes, gait stability was greater and stride-to-stride variability was smaller with LBP than no pain and CalfP, whereas CalfP was not different from no pain. Opposite effects of LBP on gait stability between speeds suggests a more protective strategy at the faster speed. Although mediolateral RMS was greater and participants had more asymmetric stance times with CalfP than LBP and no pain, limited effect of CalfP at the faster speed could relate to greater kinematic constraints and smaller effects of calf muscle activity on propulsion at this speed. In conclusion, pain effects on gait stability depend on pain location and walking speed.
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Affiliation(s)
- Wolbert van den Hoorn
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health & Rehabilitation Sciences, Brisbane, Queensland 4072, Australia.
| | - François Hug
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health & Rehabilitation Sciences, Brisbane, Queensland 4072, Australia; University of Nantes, Laboratory "Motricité, Interactions, Performance" (EA 4334), Nantes, France
| | - Paul W Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health & Rehabilitation Sciences, Brisbane, Queensland 4072, Australia
| | - Sjoerd M Bruijn
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Deficits in foot skin sensation are related to alterations in balance control in chronic low back patients experiencing clinical signs of lumbar nerve root impingement. Gait Posture 2015; 41:923-8. [PMID: 25887249 DOI: 10.1016/j.gaitpost.2015.03.345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/17/2015] [Accepted: 03/26/2015] [Indexed: 02/02/2023]
Abstract
Chronic low back pain (LBP) patients with radiculopathy, or sciatica, experience pain, tingling or numbness radiating down their leg due to compression of the lumbar nerve root. The resulting reduction in somatosensory information from the foot sole may contribute to deficits in standing balance control. This work was designed to investigate the relationship between foot skin sensitivity and standing balance control in chronic LBP patients with associated radiculopathy. Patients (n=9) and matched healthy controls (n=9) were recruited to the study, and were tested for balance control in both quiet standing as well as during rapid arm raise perturbation trials on a force plate. Foot skin sensitivity was tested bilaterally for vibratory threshold (3, 40 and 250 Hz) and touch (monofilament) threshold. Results demonstrate that patients had reduced sensitivity to 250 Hz vibration in their affected compared to unaffected foot (at the great toe and heel), as well as compared to controls (at the great toe), but there were no differences with lower frequency vibratory testing or with monofilament testing. While there were no significant between-group differences in balance measures, moderate statistically significant correlations between 250 Hz sensitivity and quiet standing balance parameters were uncovered. Thus, patients demonstrate reduced high-frequency vibratory sensitivity at the foot sole, and correlations with quiet standing balance measures indicate a connection between these foot skin sensitivity deficits and alterations in balance control. Clinically, this identifies high frequency vibration testing as an important measure of skin sensitivity in patients with radiculopathy.
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Govender S, Dennis DL, Colebatch JG. Axially evoked postural reflexes: influence of task. Exp Brain Res 2014; 233:215-28. [PMID: 25300958 PMCID: PMC4289977 DOI: 10.1007/s00221-014-4105-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/14/2014] [Indexed: 11/28/2022]
Abstract
Postural reflexes were recorded in healthy subjects (n = 17) using brief axial accelerations and tap stimuli applied at the vertebra prominens (C7) and manubrium sterni. Short latency (SL) responses were recorded from the soleus, hamstrings and tibialis anterior muscles and expressed as a percentage of the background EMG prior to stimulus onset. In the majority of postural conditions tested, subjects were recorded standing erect and leaning forward with their feet together. The SL response was larger for soleus than for the hamstrings during standing (soleus vs hamstrings; 70.4 vs 28.1 %), whereas the opposite occurred during kneeling (25.3 vs 127.3 %). Concordant head and trunk accelerations produced larger SL responses than discordant accelerations for soleus and hamstrings, but the evoked excitatory response was independent of head direction and as expected for the direction of truncal acceleration. Postural reflexes for soleus and tibialis anterior were strongly affected by conditions that posed a significant threat to postural stability; stimulation at C7 was associated with significant SL enhancement for soleus during anterior lean while sternal stimulation showed SL enhancement for tibialis anterior during posterior lean. Cutaneous anaesthesia applied over the C7 stimulation site had no significant effect on EMG responses, nor did vision or surface type (rigid or compliant). This study provides further evidence that postural reflexes produced by brief axial accelerations are independent of cutaneous receptors, vestibular afferents and ankle proprioceptors, and demonstrates that postural tasks and truncal orientation significantly affect the evoked response, consistent with a role in stabilising posture.
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Affiliation(s)
- Sendhil Govender
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
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