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Lee SP, Smith JA, Kimber M, Houk K. Insertion and Presence of Fine-Wire Intramuscular Electrodes to the Lumbar Paraspinal Muscles Do Not Affect Muscle Performance and Activation During High-Exertion Spinal Extension Activities. PM R 2018; 10:1192-1197. [PMID: 29775800 DOI: 10.1016/j.pmrj.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/26/2018] [Accepted: 05/05/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (ie, multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions. OBJECTIVE To examine the effects of insertion and presence of fine-wire EMG electrodes in the lumbar multifidus on muscle strength, endurance, and activation profiles during high-exertion spinal extension muscle contractions. DESIGN Single-blinded, repeated measures intervention trial. SETTING University clinical research laboratory PARTICIPANTS: Twenty individuals between the ages of 18-40 free of recent and current back pain. METHODS Muscle performance was assessed during 3 conditions (with [WI] and without [WO] presence of intramuscular electrodes, and insertion followed by removal [IO]). Isometric spinal extension strength was assessed with a motorized dynamometer. Muscle endurance was assessed using the Sorensen test with neuromuscular activation profiles analyzed during the endurance test. MAIN OUTCOME MEASUREMENTS Spinal extensor muscle strength, endurance, and activation. RESULTS Our data showed no significant difference in isometric strength (P = .20) between the 3 conditions. A significant difference in muscle endurance was found (P = .03). Post hoc analysis showed that the muscle endurance in the IO condition was significantly higher than the WO condition (161.3 ± 58.3 versus 142.1 ± 48.2 seconds, P = .04), likely due to a learning effect. All 3 conditions elicited minimal pain (range 0-4/10) and comparable muscle activation profiles. CONCLUSION Our findings suggested the sonographically guided insertion and presence of fine-wire intramuscular EMG electrodes in the lumbar multifidus muscles had no significant impact on spinal extension muscle function. This study provides evidence that implementing intramuscular EMG does not affect muscle performance during high-exertion contractions in individuals with no current back pain. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV 89154-3029(∗).
| | - Jo Armour Smith
- Department of Physical Therapy, Chapman University, Orange, CA(†)
| | - Matthew Kimber
- Department of Physical Therapy, University of Nevada, Las Vegas, NV(‡)
| | - Kelsey Houk
- Department of Physical Therapy, University of Nevada, Las Vegas, NV(§)
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Janssens L, Goossens N, Wand BM, Pijnenburg M, Thys T, Brumagne S. The development of the Dutch version of the Fremantle Back Awareness Questionnaire. Musculoskelet Sci Pract 2017; 32:84-91. [PMID: 28917134 DOI: 10.1016/j.msksp.2017.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/05/2017] [Accepted: 09/04/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Disturbed body perception may play a role in the aetiology of chronic low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is currently the only self-report questionnaire to assess back-specific body perception in individuals with LBP. OBJECTIVES To perform a cross-cultural adaptation of the FreBAQ into Dutch. DESIGN Psychometric study. METHODS A Dutch version of the FreBAQ was generated through forward-backward translation, and was completed by 73 patients with LBP and 73 controls to assess discriminant validity. Structural validity was assessed by principal component analysis. Internal consistency was assessed by the Cronbach's alpha coefficient. Construct validity was assessed by examining the relationship with clinical measures (Numerical Rating Scale pain, Oswestry Disability Index (ODI), Tampa Scale for Kinesiophobia). Test-retest reliability was assessed in a subgroup (n = 48 with LBP and 48 controls) using intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimal detectable change (MDC 95%) RESULTS: The Dutch FreBAQ showed one component with eigenvalue >2. Cronbach's alpha values were respectively 0.82 and 0.73 for the LBP and control group. ICC values were respectively 0.69 and 0.70 for the LBP and control group. In the LBP group, the SEM was 3.9 and the MDC (95%) was 10.8. The LBP group (ODI 22 ± 21%) scored significantly higher on the Dutch FreBAQ than the control group (ODI 0%) (11 ± 7 vs. 3 ± 9, p < 0.001). Within the LBP group, higher Dutch FreBAQ scores correlated significantly with higher ODI scores (rho = 0.30, p = 0.010), although not with pain (rho = 0.10, p = 0.419) or kinesiophobia (r = 0.14, p = 0.226). CONCLUSIONS The Dutch version of the FreBAQ can be considered as unidimensional and showed adequate internal consistency, sufficient test-retest reliability and adequate discriminant and construct validity in individuals with and without LBP. It can improve our understanding on back-specific perception in the Dutch-speaking population with LBP.
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Affiliation(s)
- Lotte Janssens
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Hasselt University, BIOMED, REVAL, Agoralaan, 3590 Diepenbeek, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Nina Goossens
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, 32 Mouat Street, Fremantle, WA 6959, Australia.
| | - Madelon Pijnenburg
- Department of Allied Health Professions, Fontys University of Applied Sciences, Ds. Th. Fliednerstraat 2, 5631 BN Eindhoven, The Netherlands.
| | - Tinne Thys
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Simon Brumagne
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Wand BM, Elliott RL, Sawyer AE, Spence R, Beales DJ, O'Sullivan PB, Smith AJ, Gibson W. Disrupted body-image and pregnancy-related lumbopelvic pain. A preliminary investigation. Musculoskelet Sci Pract 2017; 30:49-55. [PMID: 28531793 DOI: 10.1016/j.msksp.2017.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/24/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent investigations have suggested that disrupted body-image may contribute to the lumbopelvic pain experience. The changes in body shape and size associated with pregnancy suggest that pregnancy-related lumbopelvic pain might be a problem in which alterations in body-image are particularly relevant. OBJECTIVES To investigate if self-reported body-image is related to lumbopelvic pain status in women during pregnancy and explore the factors that might contribute to changes in body-image in women experiencing pregnancy-related lumbopelvic pain. DESIGN Cross-sectional cohort study. METHOD Forty-two women in the third trimester of pregnancy were recruited regardless of clinical status. Pain intensity and disability were measured to estimate clinical severity. The Fremantle Back Awareness Questionnaire was used to assess body-image. Participants also completed a series of questionnaires and physical tests to explore factors that might be associated with altered body-image. RESULTS The median Fremantle Back Awareness Questionnaire score for the pain free women was 1 (IQR 0-1.5) and the median score for those in pain was 3.5 (IQR 2-8). This difference was statistically significant (p = 0.005). The questionnaire score was significantly correlated with pain intensity but not with disability. Of the measured variables only pain catastrophisation was significantly associated with disrupted body-image. CONCLUSIONS Self-reported disruption of body-image was significantly greater in pregnant women who were experiencing lumbopelvic pain than those who weren't and the extent of body-image disruption was associated with pain intensity. Only pain related catastrophisation was related to disrupted body-image.
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Affiliation(s)
- Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat St, Fremantle, WA, 6959, Australia.
| | - Rhianne L Elliott
- Central West Health and Rehabilitation, Urch St, Geraldton, WA, 6530, Australia
| | - Abbey E Sawyer
- Physiotherapy Department, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia
| | - Rory Spence
- RediMed Total Health Solutions, 1 Frederick Street, Belmont, WA, 6104, Australia
| | - Darren J Beales
- School of Physiotherapy and Exercise Science, Curtin University, PO Box U1987, Perth, WA, 6845, Australia
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, PO Box U1987, Perth, WA, 6845, Australia
| | - Anne J Smith
- School of Physiotherapy and Exercise Science, Curtin University, PO Box U1987, Perth, WA, 6845, Australia
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat St, Fremantle, WA, 6959, Australia
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Behrendt F, de Lussanet MHE, Zentgraf K, Zschorlich VR. Motor-Evoked Potentials in the Lower Back Are Modulated by Visual Perception of Lifted Weight. PLoS One 2016; 11:e0157811. [PMID: 27336751 PMCID: PMC4919087 DOI: 10.1371/journal.pone.0157811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/06/2016] [Indexed: 12/04/2022] Open
Abstract
Facilitation of the primary motor cortex (M1) during the mere observation of an action is highly congruent with the observed action itself. This congruency comprises several features of the executed action such as somatotopy and temporal coding. Studies using reach-grasp-lift paradigms showed that the muscle-specific facilitation of the observer’s motor system reflects the degree of grip force exerted in an observed hand action. The weight judgment of a lifted object during action observation is an easy task which is the case for hand actions as well as for lifting boxes from the ground. Here we investigated whether the cortical representation in M1 for lumbar back muscles is modulated due to the observation of a whole-body lifting movement as it was shown for hand action. We used transcranial magnetic stimulation (TMS) to measure the corticospinal excitability of the m. erector spinae (ES) while subjects visually observed the recorded sequences of a person lifting boxes of different weights from the floor. Consistent with the results regarding hand action the present study reveals a differential modulation of corticospinal excitability despite the relatively small M1 representation of the back also for lifting actions that mainly involve the lower back musculature.
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Affiliation(s)
- Frank Behrendt
- University Children’s Hospital Basle, Basle, Switzerland
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- * E-mail: (FB); (KZ)
| | | | - Karen Zentgraf
- Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
- * E-mail: (FB); (KZ)
| | - Volker R. Zschorlich
- Institute of Sport Science, Department of Kinesiology, University of Rostock, Rostock, Germany
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Vrana A, Hotz-Boendermaker S, Stämpfli P, Hänggi J, Seifritz E, Humphreys BK, Meier ML. Differential Neural Processing during Motor Imagery of Daily Activities in Chronic Low Back Pain Patients. PLoS One 2015; 10:e0142391. [PMID: 26569602 PMCID: PMC4646462 DOI: 10.1371/journal.pone.0142391] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/21/2015] [Indexed: 11/18/2022] Open
Abstract
Chronic low back pain (chronic LBP) is both debilitating for patients but also a major burden on the health care system. Previous studies reported various maladaptive structural and functional changes among chronic LBP patients on spine- and supraspinal levels including behavioral alterations. However, evidence for cortical reorganization in the sensorimotor system of chronic LBP patients is scarce. Motor Imagery (MI) is suitable for investigating the cortical sensorimotor network as it serves as a proxy for motor execution. Our aim was to investigate differential MI-driven cortical processing in chronic LBP compared to healthy controls (HC) by means of functional magnetic resonance imaging (fMRI). Twenty-nine subjects (15 chronic LBP patients, 14 HC) were included in the current study. MI stimuli consisted of randomly presented video clips showing every-day activities involving different whole-body movements as well as walking on even ground and walking downstairs and upstairs. Guided by the video clips, subjects had to perform MI of these activities, subsequently rating the vividness of their MI performance. Brain activity analysis revealed that chronic LBP patients exhibited significantly reduced activity compared to HC subjects in MI-related brain regions, namely the left supplementary motor area and right superior temporal sulcus. Furthermore, psycho-physiological-interaction analysis yielded significantly enhanced functional connectivity (FC) between various MI-associated brain regions in chronic LBP patients indicating diffuse and non-specific changes in FC. Current results demonstrate initial findings about differences in MI-driven cortical processing in chronic LBP pointing towards reorganization processes in the sensorimotor network.
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Affiliation(s)
- Andrea Vrana
- University Hospital of Balgrist, Zurich, Switzerland
- Department of Health Sciences and Technology, Human Movement Sciences, ETH Zurich, Switzerland
| | | | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- MR-Center of the Psychiatric Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | | | - Michael L. Meier
- University Hospital of Balgrist, Zurich, Switzerland
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Roosink M, McFadyen BJ, Hébert LJ, Jackson PL, Bouyer LJ, Mercier C. Assessing the perception of trunk movements in military personnel with chronic non-specific low back pain using a virtual mirror. PLoS One 2015; 10:e0120251. [PMID: 25799009 PMCID: PMC4370585 DOI: 10.1371/journal.pone.0120251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/31/2015] [Indexed: 12/19/2022] Open
Abstract
Chronic pain, including chronic non-specific low back pain (CNSLBP), is often associated with body perception disturbances, but these have generally been assessed under static conditions. The objective of this study was to use a "virtual mirror" that scaled visual movement feedback to assess body perception during active movement in military personnel with CNSLBP (n = 15) as compared to military healthy control subjects (n = 15). Subjects performed a trunk flexion task while sitting and standing in front of a large screen displaying a full-body virtual mirror-image (avatar) in real-time. Avatar movements were scaled to appear greater, identical, or smaller than the subjects' actual movements. A total of 126 trials with 11 different scaling factors were pseudo-randomized across 6 blocks. After each trial, subjects had to decide whether the avatar's movements were "greater" or "smaller" than their own movements. Based on this two-alternative forced choice paradigm, a psychophysical curve was fitted to the data for each subject, and several metrics were derived from this curve. In addition, task adherence (kinematics) and virtual reality immersion were assessed. Groups displayed a similar ability to discriminate between different levels of movement scaling. Still, subjects with CNSLBP showed an abnormal performance and tended to overestimate their own movements (a right-shifted psychophysical curve). Subjects showed adequate task adherence, and on average virtual reality immersion was reported to be very good. In conclusion, these results extend previous work in patients with CNSLBP, and denote an important relationship between body perception, movement and pain. As such, the assessment of body perception during active movement can offer new avenues for understanding and managing body perception disturbances and abnormal movement patterns in patients with pain.
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Affiliation(s)
- Meyke Roosink
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
| | - Bradford J. McFadyen
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Luc J. Hébert
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
- Canadian Forces Health Services Group Headquarters, Directorate of Medical Policy (Physiotherapy), Valcartier Garrison, Québec, Québec, Canada
- Department of Radiology, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Philip L. Jackson
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- School of Psychology, Laval University, Québec, Québec, Canada
| | - Laurent J. Bouyer
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
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Hotta J, Harno H, Nummenmaa L, Kalso E, Hari R, Forss N. Patients with complex regional pain syndrome overestimate applied force in observed hand actions. Eur J Pain 2015; 19:1372-81. [DOI: 10.1002/ejp.669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 02/02/2023]
Affiliation(s)
- J. Hotta
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Finland
| | - H. Harno
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Finland
- Pain Clinic; Department of Anaesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Finland
| | - L. Nummenmaa
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
- Turku PET Centre; University of Turku; Finland
| | - E. Kalso
- Pain Clinic; Department of Anaesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Finland
| | - R. Hari
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
| | - N. Forss
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Finland
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Roosink M, Robitaille N, McFadyen BJ, Hébert LJ, Jackson PL, Bouyer LJ, Mercier C. Real-time modulation of visual feedback on human full-body movements in a virtual mirror: development and proof-of-concept. J Neuroeng Rehabil 2015; 12:2. [PMID: 25558785 PMCID: PMC4326499 DOI: 10.1186/1743-0003-12-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022] Open
Abstract
Background Virtual reality (VR) provides interactive multimodal sensory stimuli and biofeedback, and can be a powerful tool for physical and cognitive rehabilitation. However, existing systems have generally not implemented realistic full-body avatars and/or a scaling of visual movement feedback. We developed a “virtual mirror” that displays a realistic full-body avatar that responds to full-body movements in all movement planes in real-time, and that allows for the scaling of visual feedback on movements in real-time. The primary objective of this proof-of-concept study was to assess the ability of healthy subjects to detect scaled feedback on trunk flexion movements. Methods The “virtual mirror” was developed by integrating motion capture, virtual reality and projection systems. A protocol was developed to provide both augmented and reduced feedback on trunk flexion movements while sitting and standing. The task required reliance on both visual and proprioceptive feedback. The ability to detect scaled feedback was assessed in healthy subjects (n = 10) using a two-alternative forced choice paradigm. Additionally, immersion in the VR environment and task adherence (flexion angles, velocity, and fluency) were assessed. Results The ability to detect scaled feedback could be modelled using a sigmoid curve with a high goodness of fit (R2 range 89-98%). The point of subjective equivalence was not significantly different from 0 (i.e. not shifted), indicating an unbiased perception. The just noticeable difference was 0.035 ± 0.007, indicating that subjects were able to discriminate different scaling levels consistently. VR immersion was reported to be good, despite some perceived delays between movements and VR projections. Movement kinematic analysis confirmed task adherence. Conclusions The new “virtual mirror” extends existing VR systems for motor and pain rehabilitation by enabling the use of realistic full-body avatars and scaled feedback. Proof-of-concept was demonstrated for the assessment of body perception during active movement in healthy controls. The next step will be to apply this system to assessment of body perception disturbances in patients with chronic pain.
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Affiliation(s)
| | | | | | | | | | | | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), 525 Boul Hamel, Québec, QC G1M 2S8, Canada.
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Brain activity for visual judgment of lifted weight. Hum Mov Sci 2013; 32:924-37. [DOI: 10.1016/j.humov.2013.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 03/19/2013] [Accepted: 06/05/2013] [Indexed: 11/20/2022]
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