High variability of the subjective visual vertical test of vertical perception, in some people with neck pain - Should this be a standard measure of cervical proprioception?

Interoceptive accuracy and bias in somatic symptom disorder, illness anxiety disorder, and functional syndromes: A systematic review and meta-analysis

Somatic symptom disorder, illness anxiety disorder, and functional syndromes are characterized by burdensome preoccupation with somatic symptoms. Etiological models propose either increased interoceptive accuracy through hypervigilance to the body, or decreased and biased interoception through top-down predictions about sensory events. This systematic review and meta-analysis summarizes findings of 68 studies examining interoceptive accuracy and 8 studies examining response biases in clinical or non-clinical groups. Analyses yielded a medium population effect size for decreased interoceptive accuracy in functional syndromes, but no observable effect in somatic symptom disorder and illness anxiety disorder. The overall effect size was highly heterogeneous. Regarding response bias, there was a small significant effect in somatic symptom disorder and illness anxiety disorder. Our findings strengthen the notion of top-down factors that result in biased rather than accurate perception of body signals in somatic symptom disorder and illness anxiety disorder.

Proprioceptive Disturbance in Chronic Neck Pain: Discriminate Validity and Reliability of Performance of the Clinical Cervical Movement Sense Test

Chronic neck pain is associated with sensorimotor dysfunctions, which may develop symptoms, affect daily activities, and prevent recovery. Feasible, reliable, and valid objective methods for the assessment of sensorimotor functions are important to identify movement impairments and guide interventions. The aim of this study was to investigate the discriminative validity of a clinical cervical movement sense test, using a laser pointer and an automatic video-based scoring system. Individuals with chronic neck pain of idiopathic onset (INP), traumatic onset (TNP), and healthy controls (CON) were tested. Associations between movement sense and neck disability were examined and the repeatability of the test was investigated. A total of 106 participants (26 INP, 28 TNP, and 52 CON) were included in a cross-sectional study. Acuity, Speed, Time, and NormAcuity (i.e., normalized acuity by dividing acuity with movement time) were used as outcome measures. ANOVAs were used for group comparisons and Pearson correlations for associations between movement sense variables and neck disability index (NDI). Notably, 60 of the participants (30 CON, 17 INP, and 13 TNP) performed the test on a second occasion to explore test-retest reliability. Results revealed a reduced NormAcuity for both INP and TNP compared with CON (p < 0.05). The neck pain groups had similar Acuity but longer Time compared with CON. Among TNP, there was a fair positive correlation between Acuity and NDI, while there was a negative correlation between Acuity and NDI among INP. Reliability measures showed good to excellent ICC values between tests, but standard error of measurements (SEM) and minimal detectable change (MDC) scores were high. The results showed that NormAcuity is a valuable measure to identify disturbed cervical movement sense among INP and TNP. While Acuity was similar between the groups, different strategies, such as longer Time, to perform the task among neck patient groups were used. Few differences were identified between the neck pain groups, but altered strategies may exist. Reliability was acceptable, and the test is feasible to perform in the clinic. However, the technical complexity of the automated image analysis is a concern. Future developments will provide more feasible solutions.

Effects of experimental pain on the cervical spine reposition errors

Background

Healthy subjects showed normal variance of cervical spine reposition errors of approximately 2 degrees. Effects of experimental pain on cervical spine reposition errors were unknown; thus, the purpose of this study was to investigate the effects of experimental pain on cervical spine reposition errors.

Methods

A repeated measured study design was applied. Thirty healthy subjects (12 males) were recruited. Reposition errors were extracted from upright cervical positions before and after cervical flexion movement in healthy subjects before and during experimental neck pain. Cervical spine reposition errors were calculated based on anatomical landmarks of each cervical joint. Reposition errors were extracted in degrees as constant errors and absolute errors for further statistical analysis. Repeated measures analysis of variance (RM-ANOVA) was applied to analyse experimental pain effects on either constant errors or absolute errors of different cervical joints.

Results

The cervical spine showed non-significant difference in reposition errors regarding the constant errors (P>0.05) while larger reposition errors regarding the absolute errors during experimental pain compared to before experimental pain (P<0.001). In addition, the pain level joint (C4/C5) and its adjacent joints (C3/C4 and C5/C6) indicated larger reposition errors regarding absolute errors (P=0.035, P=0.329 and P=0.103, respectively).

Conclusions

This study firstly investigated the cervical spine reposition errors in experimental neck pain and further found the joints adjacent to the pain level showed larger errors compared to the distant joints regarding absolute errors. It may imply that the larger reposition errors in specific cervical joint indicate probable injury or pain existed adjacent to the joints.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05170-7.

Symptom severity is associated with leftward lateralization upon contextual modulation of visual vertical in patients with schizophrenia

BACKGROUND

Contextual processing dysfunction in patients with schizophrenia (SCZ) is not uniform and task-dependent. In SCZ, studies on the rod and frame test (RFT), which evaluates contextual modulation of verticality perception, are sparse. A main study that utilized a two-alternative forced choice design for judging rod verticality reported equivalent strength of RFT contextual modulation in healthy controls and SCZ. The current study aims to uncover any potential differences in contextual modulation between controls and SCZ with an adjustment method on a computerized RFT.

MATERIALS AND METHODS

A total of 17 healthy controls and 15 SCZ aligned an oriented rod to their perceived vertical with a computer mouse under four randomized frame presentations: absent frame, non-tilted (Frame^0°), or tilted by 18 degrees leftward (Frame^-18°) or rightward (Frame^+18°). Rod deviation error was assigned a negative or positive value when aligned leftward or rightward, respectively, of 0°. Signed and absolute errors, the rod and frame effect (RFE), and intra-individual variability (inconsistency) were used for analysis.

RESULTS

There was no group difference in rod alignment errors or derived measures, except that SCZ displayed greater inconsistency in rod alignment, compared to controls. The negative symptom scale (PANSS-N) scores correlated positively with the variability measure and with unsigned Frame^-18° error.

CONCLUSIONS

Only the variability measure was sensitive enough to distinguish between controls and SCZ. SCZ with more severe negative symptoms had larger variability in rod alignment, probably reflecting a state of indifference. The larger deviation errors only with a leftward tilted frame, as PANSS-N scores increased, may indicate a lateralized attentional abnormality that is correlated with severity of symptoms in SCZ.

The effect of giving verbal feedback during neck stabilisation exercise as an addition to physical therapy in patients with chronic neck pain: A randomised controlled trial

OBJECTIVES

To study the addition of feedback-guided neck strength home exercise to physical therapy as an enhanced rehabilitation programme in the treatment of patients with chronic neck pain.

DESIGN

A prospective randomised controlled trial.

SETTING

Rehabilitation department of an academic hospital.

SUBJECTS

Patients with chronic neck pain.

INTERVENTIONS

The patients in both groups received supervised physical therapy sessions 3 times a week for 12 weeks. Patients in Group A (N = 38) used the neck strengthening exerciser device for 20 min daily at home for 6 weeks and patients in Group B (N = 20) performed 20 min of daily regular neck exercise at home for 6 weeks.

OUTCOME MEASURES

Neck disability index, pain visual analogue scale, active range of motion of the neck, Patient Global Assessment and patient evaluation of treatment effect. All subjects were assessed at baseline as well as at 6- and 12-week follow-ups.

RESULTS

At the 6-week follow-up, Group A exhibited significantly greater improvements (P < 0.05) in pain Visual Analogue Scale (Group A: 2.97 ± 1.57; Group B: 4.20 ± 1.82), neck disability index (Group A: 13.95 ± 8.07; Group B: 20.07 ± 9.14) and active cervical extension (Group A: 65.26 ± 12.76; Group B: 51.45 ± 11.78). At 12-week follow-up, Group A also exhibited significantly greater active cervical extension (Group A: 67.74 ± 11.94; Group B: 53.85 ± 14.09; P < 0.05).

CONCLUSION

Adding neck strengthening exerciser home training to physical therapy was demonstrated to be more effective than physical therapy alone for patients with chronic neck pain.

Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review

Neck pain is very common, but most of the causes are unknown, making diagnosis and treatment extremely challenging. Current studies have found that one of the main problems in patients with neck pain is the impairment of cervical proprioception, which subsequently leads to cervical sensorimotor control disturbances. Cervical spine has a very delicate proprioceptive system that plays a crucial role in controlling posture and balance. Cervical proprioceptive impairment in neck pain occurs through a variety of mechanisms. Experimental neck muscle pain induced by injection of hypertonic saline results in inhibition of the activation of painful muscle; chronic neck pain causes structural and functional impairment of cervical muscles; excessive activation of mechanoreceptors in degenerative cervical discs and facet joints produces a large number of erroneous sensory signals. Clinical examinations to assess the link between structural pathology and neck pain have been unsuccessful, opening the way for the development of function-based tests. To date, eight neck sensorimotor control tests have been reported to evaluate patients with chronic neck pain. Although some tests may involve different subsystems (such as oculomotor system and vestibular system), all tests measure sensorimotor control in the neck, and the most commonly used is cervical joint position error (JPE) test. Current studies support the effectiveness of exercises targeting different aspects of sensorimotor function, in particular retraining aimed at improving cervical proprioception and muscle coordination. Based on the available evidence, it is recommended that patients with neck pain should be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances.

Visual Verticality Perception in Spinal Diseases: A Systematic Review and Meta-Analysis

Patients diagnosed with traumatic or non-traumatic spinal pain and idiopathic scoliosis frequently suffer from imbalance. The evaluation of the perception of verticality by means of visual tests emerges as a quick and easy tool for clinical management of the balance disorders. Several studies have assessed the visual perception of verticality in spinal diseases obtaining controversial results. The aim of our study is to analyze the perception of visual verticality in subjects with several spinal diseases in comparison with healthy subjects. A meta-analysis was carried out. PubMed MEDLINE, Scopus, WoS, CINAHL, and SciELO databases were searched until January 2020. The standardized mean difference (SMD) was calculated to analyze differences between patients and healthy controls. Fifteen studies with a total of 2052 patients were included. In comparison with healthy subjects, a misperception of verticality was found in patients with spinal pain when the perception of the verticality was assessed with the rod and frame test (SMD = 0.339; 95% confidence interval (CI) = 0.181, 0.497; p < 0.001). It seems that the perception of visual verticality is not altered in patients with idiopathic scoliosis (p = 0.294). The present meta-analysis shows a misperception of visual verticality only in patients with spinal pain.

Explicit and Implicit Own's Body and Space Perception in Painful Musculoskeletal Disorders and Rheumatic Diseases: A Systematic Scoping Review

Background: Pain and body perception are essentially two subjective mutually influencing experiences. However, in the field of musculoskeletal disorders and rheumatic diseases we lack of a comprehensive knowledge about the relationship between body perception dysfunctions and pain or disability. We systematically mapped the literature published about the topics of: (a) somatoperception; (b) body ownership; and (c) perception of space, analysing the relationship with pain and disability. The results were organized around the two main topics of the assessment and treatment of perceptual dysfunctions.

Methods: This scoping review followed the six-stage methodology suggested by Arksey and O'Malley. Ten electronic databases and grey literature were systematically searched. The PRISMA Extension for Scoping Reviews was used for reporting results. Two reviewers with different background, independently performed study screening and selection, and one author performed data extraction, that was checked by a second reviewer.

Results: Thirty-seven studies fulfilled the eligibility criteria. The majority of studies (68%) concerned the assessment methodology, and the remaining 32% investigated the effects of therapeutic interventions. Research designs, methodologies adopted, and settings varied considerably across studies. Evidence of distorted body experience were found mainly for explicit somatoperception, especially in studies adopting self-administered questionnaire and subjective measures, highlighting in some cases the presence of sub-groups with different perceptual features. Almost half of the intervention studies (42%) provided therapeutic approaches combining more than one perceptual task, or sensory-motor tasks together with perceptual strategies, thus it was difficult to estimate the relative effectiveness of each single therapeutic component.

Conclusions: To our knowledge, this is the first attempt to systematically map and summarize this research area in the field of musculoskeletal disorders and rheumatic diseases. Although methodological limitations limit the validity of the evidence obtained, some strategies of assessment tested and therapeutic strategies proposed represent useful starting points for future research. This review highlights preliminary evidence, strengths, and limitations of the literature published about the research questions, identifying key points that remain opened to be addressed, and make suggestions for future research studies. Body representation, as well as pain perception and treatment, can be better understood if an enlarged perspective including body and space perception is considered.

Cervical Sensorimotor Control Does Not Change Over Time and Is Not Related to Chronic Idiopathic Neck Pain Characteristics: A 6-Month Longitudinal Observational Study

BACKGROUND

Cervical sensorimotor control (CSMC) outcomes have been suggested to be important in the assessment of individuals with neck pain, despite the lack of consistent supporting evidence that CSMC skills are related to neck pain.

OBJECTIVE

The aim of this study was to investigate whether CSMC changes over time in individuals with chronic idiopathic neck pain and whether neck pain characteristics are associated with CSMC.

DESIGN

A longitudinal observational study was performed.

METHODS

A total 50 participants with chronic idiopathic neck pain and 50 matched participants who were healthy (controls) completed 7 CSMC tests (including 14 test conditions): joint position error, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Neck pain characteristics included pain intensity (visual analog scale), pain duration, and neck disability (Neck Disability Index). Linear mixed models were used to investigate whether any factors were associated with changes in CSMC.

RESULTS

Neck pain intensity was associated with 1 of 14 CSMC test conditions (balance with torsion and eyes open), and neck disability was associated with balance with eyes open and high-load head steadiness. Other factors, including sex, age, body mass index, physical activity levels, and neck pain duration, showed no association with CSMC.

LIMITATIONS

Although all other tests involved computerized data collection, the joint position error test was administered manually, introducing the risk of researcher bias.

CONCLUSIONS

The few associations between test conditions and neck pain characteristics were at best weak; hence, these are likely to be chance findings. These results suggest that CSMC may not be associated with improvement/worsening of chronic idiopathic neck pain, spawning debate on the clinical usefulness of CSMC tests.

Perception of verticality is altered in people with severe chronic low back pain compared to healthy controls: A cross-sectional study

BACKGROUND

People with chronic low back pain (CLBP) have abnormal lumbar proprioception, which increases their reliance on visual input to maintain body verticality. Maintaining verticality is important for spatial orientation, balance and movement coordination. It is unknown if these patients also have altered perception of verticality.

OBJECTIVE

To compare whether the perception of verticality is different between people with and without CLBP.

DESIGN

Cross-sectional.

METHODS

Two comparisons of perception of verticality were done between a group of people with CLBP (n = 25) and healthy people (n = 25); and between a subgroup of people with severe CLBP (n = 14) and healthy people (n = 25). In a dark room, the subjective visual vertical test was performed under 3 conditions: rod, rod-and-frame, and rod-and-disc. In each condition, the rod was tilted 40° clockwise and counterclockwise, and the participants were asked to bring it back to vertical 0° position. The rod deviation from verticality was recorded in degrees.

RESULTS

When considering the CLBP group, analysis of variance showed that deviation from verticality had no significant group interaction with condition (p = 0.2), or group main effect (p = 0.2). However, deviation from verticality was significantly different between the conditions (p < 0.001). When considering the severe CLBP subgroup, the interaction effect was significant (p = 0.046). Simple main effects showed that the severe CLBP subgroup had larger deviations from verticality (7.5 ± 0.9 deg) compared to the healthy group (4.2 ± 0.7 deg) specifically on the rod-and-frame condition (p = 0.007).

CONCLUSION

People with severe CLBP appear to have larger deviations in judging verticality compared to the healthy group.

No Differences Between Individuals With Chronic Idiopathic Neck Pain and Asymptomatic Individuals on 7 Cervical Sensorimotor Control Tests: A Cross-sectional Study

OBJECTIVE

Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. We aimed to compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability.

DESIGN

Case-control study.

METHODS

Fifty participants with chronic idiopathic neck pain and 50 age- and sex-matched asymptomatic controls completed 7 cervical sensorimotor control tests: joint position error (including joint position error torsion), postural balance, subjective visual vertical, head-tilt response, "the Fly," smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with the Mann-Whitney U test. Correlations between tests and levels of neck pain and disability were investigated using the Spearman rho.

RESULTS

There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (P = .203-.981). For each test, "poor performers" consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r = 0.010-0.294) and neck disability (r = 0.007-0.316).

CONCLUSION

These findings suggest that sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther 2020;50(1):33-43. Epub 23 Aug 2019. doi:10.2519/jospt.2020.8846.

Clinical assessment of cervical movement sense in those with neck pain compared to asymptomatic individuals

BACKGROUND

A simple clinical test involving subject tracing zigzag (ZZ) and figure of eight (F8) patterns with a head mounted laser device in determining cervical movement sense has proven reliability and feasibility. However, its validity in comparing individuals with and without neck pain (NP) has not been examined.

METHODS

Seventy-six subjects (38 NP and 38 asymptomatic subjects) performed both patterns while motion of their laser point was videoed. Independent examiners subsequently rated the videos (real-time) to record the time needed and the number of errors when completing each task. Sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for various cut-offs to optimise clinical interpretation were determined. Comparisons between 25 subjects with idiopathic neck pain versus 13 with whiplash-associated disorders were also undertaken.

RESULTS

All outcome variables except ZZ time were significantly different between individuals with NP and controls. Optimal cut-offs of 9 and 10 errors yielded LR+/LR- of 3.67/0.17 (F8) and 3.00/0.38 (ZZ). Whiplash patients performed the ZZ task faster with similar errors to those with idiopathic neck pain.

CONCLUSION

The clinical utility of this inexpensive measure to assess cervical movement sense in people with NP is supported. Moderate LRs+ were demonstrated for number of errors for both patterns. Individuals with NP generated significantly more errors while tracing each pattern. Optimal cut offs of 9 errors for ZZ and 10 errors for F8 were established. Overall, these tests appear to be clinically suitable to determine altered cervical movement sense in those with NP.

No Differences Between Individuals With Chronic Idiopathic Neck Pain and Asymptomatic Individuals on Seven Cervical Sensorimotor Control Tests: A Cross-Sectional Study

STUDY DESIGN

Case-control study.

BACKGROUND

Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value.

OBJECTIVES

To compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability.

METHODS

Fifty participants with chronic idiopathic neck pain and 50 age and sex-matched asymptomatic controls completed seven cervical sensorimotor control tests: joint position error, joint position error torsion, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with Mann-Whitney U tests. Correlations between tests and levels of neck pain and disability were investigated using Spearman's rho.

RESULTS

There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (p-values ranged from p=0.203 to p=0.981). For each test, 'poor performers' consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r values ranged from 0.010 to 0.294) and neck disability (0.007 to 0.316).

DISCUSSION

These findings suggest sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2019.8846.

Higher variability in cervical force perception in people with neck pain

BACKGROUND

A reduced capacity to generate and sustain cervical muscle force over a range of contraction intensities is a feature of some participants with neck pain. To date there have been no studies comparing the accuracy of force perception in participants with and without neck pain.

DESIGN

Cross-sectional observational study.

METHODS

Participants with (n = 25) and without (n = 25) neck pain performed isometric muscle contractions at three progressive self-perceived (no feedback provided) intensities (10, 25, 50) % of their maximal voluntary contraction (MVC) in cervical: flexion, extension, right and left lateral flexion. Absolute error (AE), constant error (CE), and variable error (VE) between actual and targeted force values were calculated.

RESULTS

The neck pain group had: (1) AE-combined direction -significantly higher at 10% and lower at 50% (p < 0.05); (2) significantly lower CE in most measures (p < 0.05); (3) higher mean VE in all measures, with 10, 25, and 50% combined direction and overall combined % extension significantly higher (p < 0.05).

CONCLUSIONS

Findings indicate higher variability in force generation perception across all directions and intensities in participants with neck pain compared to healthy controls. Potentially this greater variability might suggest impaired force sense, a construct of proprioception in participants with neck pain. Reduced force sense may have implications for participants with neck pain during functional activities requiring precision and may need to be trained. Further research is required.

Seven cervical sensorimotor control tests measure different skills in individuals with chronic idiopathic neck pain

BACKGROUND

Sensorimotor control is commonly reported in neck pain research and rapidly gaining interest in clinical practice. Joint position error (conventional and torsion), postural balance, subjective visual vertical, head tilt response, The Fly®, smooth pursuit neck torsion and head steadiness are tests that have been reported to assess cervical sensorimotor control. However, it is unknown whether clinicians could use one test, or a test battery, to appropriately assess cervical sensorimotor control and improve efficiency. Our main research question is: Do seven cervical sensorimotor control tests measure unique or similar characteristics of sensorimotor control in individuals with chronic idiopathic neck pain?

METHODS

Principle components factor analysis. Data from seven cervical sensorimotor control tests of 50 participants with chronic idiopathic neck pain were included. Individual factors, potentially related to sensorimotor control, were determined by Eigen values >1.00 and inspection of a loading plot. Items with loadings ≥0.40 were considered satisfactory for inclusion in a factor.

RESULTS

All cervical sensorimotor control tests were found to measure unique skills. Four factors were isolated with two, postural balance and head steadiness, accounting for most of the variance across tests. The remaining two factors, continuous movement accuracy and perceived verticality, contributed less to the observed variance.

CONCLUSION

Postural balance and head steadiness were the major underlying factors explaining cervical sensorimotor control in the current sample. However, our results imply that all seven tests are independent and measure different skills. It is not possible to recommend a test battery for clinical practice, as all tests measure unique skills which appear to be independent of each other.

[Pilot study: Determination of the subjective trunk vertical in upright head position]

BACKGROUND

Consensus has been established that the subjective vertical (SV) is a result of multimodal sensory integration. In order to be able to calculate the vestibulocervical sensory competence for the SV, the isolated subjective trunk vertical axis (STV) was measured under conditions of vertical head fixation.

MATERIALS AND METHODS

Young, healthy volunteers (n = 49) were compared to older, healthy volunteers (n = 50) on a three-dimensionally deflectable (tilt, torsion, pitch) trunk excursion chair in which the volunteer's head remains in an upright position. Another young, healthy group was divided into a placebo (n = 27) and a monophasic cervical transcutaneous electrical nerve stimulation (C-TENS; n = 22) group to examine verticality perception.

RESULTS

In the STV after trunk pitch, age was a significant variable (p = 0.021). The older, healthy group of subjects missed the physical vertical by an average of 1.8° more than the younger group. Only the placebo group showed an average improvement in STV of 4.3° after torsion.

CONCLUSION

Apart from the macular organs the vestibulocervical sensory afference is involved in finding the trunk vertical. A difference in age to the disadvantage of the older healthy subjects was observed, as well as a lack of learning success after applied C‑TENS. The presented pilot study was able to confirm that a correct vertical trunk sensation is caused by vestibulocervical sensory afference in upright head position.

Subjective Visual Vertical in Idiopathic Bilateral Vestibular Hypofunction: Enhanced Role of Vision, Neck, and Body Proprioception

INTRODUCTION

We aimed to study the participation of proprioceptive and visual inputs in subjective visual vertical (SVV) in bilateral vestibular hypofunction and in normal subjects.

STUDY DESIGN

Prospective case-control study.

SETTING

Tertiary referral center.

MATERIALS AND METHODS

SVV (six replicates) was measured on a tiltable rehabilitation seat in 26 adult patients with idiopathic bilateral vestibular hypofunction (IBVH) and 33 adult controls. Subjects were asked to place vertically a 45 degrees-tilted red line on a screen (three replicates to left and three to right alternatively) using a remote control in total darkness and in seven body positions: vertical, head, and body left- and right-tilts to 12 and 24 degrees, and then body left- and right-tilt to 24 degrees with the head upright.

RESULTS

In the vertical position, SVV did not differ between IBVH and controls. Patients with IBVH were more sensitive to body tilt than controls (SVV: -8.1 ± 4.66 degrees for IBVH versus -0.2 ± 3.23 for control at 24 degrees body and head left-tilt, p < 0.0001, unpaired t test). The visual attraction effect defined by a deviation of the SVV to the side of the initial line presentation appeared to be higher in the IBVH than in controls suggesting higher visual dependence in IBVH. Placing the head upright while the body was still tilted significantly reduced this difference. Similar results were observed for the right-tilts.

CONCLUSION

Not only otolithic function but also visual plus body and neck proprioceptive entries participate in SVV. The influence of vision and proprioception appears to be enhanced in case of IBVH.

Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain

Synopsis There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms. However, there are other possible causes for these symptoms, and secondary adaptive changes should also be considered in differential diagnosis. Understanding the nature of these symptoms and differential diagnosis of their potential origin is important for rehabilitation. In addition to symptoms, the evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits. Once adequately assessed, appropriate tailored management should be implemented. Research to further assist differential diagnosis and to understand the most important contributing factors associated with abnormal cervical afferent input and subsequent disturbances to the sensorimotor control system, as well as the most efficacious management of such symptoms and impairments, is important for the future. J Orthop Sports Phys Ther 2017;47(7):492-502. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7052.

The effect of shoulder muscle fatigue on active repositioning acuity and scapulothoracic resting alignment: A systematic review with meta-analysis

OBJECTIVES

The purpose was to synthesize the current evidence for the impact of muscle fatigue on measures for active repositioning task of the glenohumeral or scapulothoracic movements including the absolute error and/or scapulothoracic resting alignment.

METHODS

We searched the PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, SportDiscuss and the Cochrane library databases. We included papers using a fatiguing task as part of their experimental design. Meta-analyses were undertaken for the active repositioning acuity of the glenohumeral outer/inner range of external rotation, glenohumeral inner range of internal rotation and scapulothoracic resting alignment in the scapular upward/downward rotation, anterior/posterior tilt and protraction/retraction planes. Qualitative data synthesis with standardized mean difference (SMD) was also conducted.

RESULTS

There was a significantly pooled SMD, -2.10 (95% confidence interval -2.57 to -1.63), P < 0.001) in active repositioning acuity of the glenohumeral outer range of external rotation before and after a fatiguing task. However, the pooled SMD in active repositioning acuity for other glenohumeral movements and scapulothoracic resting positions were not significant (P > 0.05).

CONCLUSION

Shoulder muscle fatigue impairs active repositioning acuity of the glenohumeral outer range of external rotation. Conversely, the current evidence does not support such impairment for the remaining glenohumeral movements and scapulothoracic resting alignments..

Head repositioning accuracy in patients with neck pain and asymptomatic subjects: concurrent validity, influence of motion speed, motion direction and target distance

BACKGROUND

Cervicocephalic kinesthetic deficiencies have been demonstrated in patients with chronic neck pain (NP). On the other hand, authors emphasized the use of different motion speeds for assessing functional impairment of the cervical spine.

PURPOSE

The objectives of this study were (1) to investigate the head repositioning accuracy in NP patients and control subjects and (2) to assess the influence of target distance, motion speed, motion direction and pain.

MATERIALS AND METHODS

Seventy-one subjects (36 healthy subjects and 35 NP patients; age 30-55 years) performed the head repositioning test (HRT) at two different speeds for horizontal and vertical movements and at two different distances. For each condition, six consecutive trials were sampled.

RESULTS

The study showed the validity and reproducibility of the HRT, confirming a dysfunctional threshold of 4.5°. Normative values of head repositioning error up to 3.6° and 7.1° were identified for healthy and NP subjects, respectively. A distance of 180 cm from the target and a natural motion speed increased HRT accuracy. Repositioning after extension movement showed a significantly larger error in both groups. Intensity, duration of pain as well as pain level did not significantly alter head repositioning error.

CONCLUSIONS

The assessment of proprioceptive performance in healthy and NP subjects allowed the validation of the HRT. The HRT is a simple, not expensive and fast test, easily implementable in daily practice to assess and monitor treatment and evolution of proprioceptive cervical deficits.