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Efstathiou MA, Giannaki CD, Roupa Z, Hadjisavvas S, Stefanakis M. Evidence of distorted proprioception and postural control in studies of experimentally induced pain: a critical review of the literature. Scand J Pain 2022; 22:445-456. [PMID: 35470647 DOI: 10.1515/sjpain-2021-0205] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Deficits in proprioception and postural control are common in patients with different musculoskeletal pain syndromes. It has been proposed that pain can negatively affect proprioception and postural control at a peripheral level, however research is limited to animal studies. Human studies have shown that it is more likely, that the link between pain and proprioceptive deficits, lies within changes in the central nervous system where noxious and non-noxious stimuli may overlap. In clinical studies, causality cannot be determined due to other factors which could confound the assessment such as pathophysiological features of the underlying musculoskeletal disorder and different psycho-social influences especially in patients with chronic pain. On the other hand, experimentally induced pain in healthy participants is able to control most of these confounding factors and perhaps offers an assessment of the effects of pain on proprioception and postural control. The aim of this paper is to critically appraise the literature related to the effect of experimentally induced pain on proprioception and postural control. Results from these studies are discussed and limitations are highlighted for future research. METHODS A search of databases (Medline, Scopus, PubMed) was conducted as well as reference check from relevant articles published since 2000. Fifteen studies which explored the effect of experimentally induced pain on postural control and ten studies which explored the effect of experimentally induced pain on proprioception were included. RESULTS We found that in the majority of the studies, postural control was negatively affected by experimentally induced pain. Results for proprioception were mixed depending on the body region and the way the painful stimuli were delivered. Kinesthesia was negatively affected in two studies, while in one study kinesthesia was enhanced. Joint position sense was not affected in four out of five studies. Finally, force sense was affected in three out of four studies. CONCLUSIONS From a clinical point of view, findings from the available literature suggest that experimentally induced pain impairs postural control and could potentially increases the risk for falls in patients. Interventions aiming to reduce pain in these patients could lead to preservation or improvement of their balance. On the other hand, the same conclusion cannot be drawn for the effect of experimentally induced pain on kinesthesia and joint position sense due to the limited number of studies showing such an effect.
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Affiliation(s)
| | | | - Zoe Roupa
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Stelios Hadjisavvas
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Manos Stefanakis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Lima CR, Sozio RS, Law AC, Nelson AJ, Singh H, Hurt CP, Li P, Reed WR. Effects of Thrust Magnitude and Duration on Immediate Postspinal Manipulation Trunk Muscle Spindle Responses. J Manipulative Physiol Ther 2021; 44:363-371. [PMID: 34103172 DOI: 10.1016/j.jmpt.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/29/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize trunk muscle spindle responses immediately after high-velocity, low-amplitude spinal manipulation (HVLA-SM) delivered at various thrust magnitudes and thrust durations. METHODS Secondary analysis from multiple studies involving anesthetized adult cats (N = 70; 2.3-6.0 kg) receiving L6 HVLA-SM. Muscle spindle afferent recordings were obtained from L6 dorsal rootlets before, during, and immediately after HVLA-SM. L6 HVLA-SM was delivered posteriorly-to-anteriorly using a feedback motor with peak thrust magnitudes of 25%, 55%, and 85% of cat body weight (BW) and thrust durations of 25, 50, 75, 100, 150, 200, and 250 ms. Time to the first action potential and muscle spindle discharge frequency at 1 and 2 seconds post-HVLA-SM were determined. RESULTS A significant association between HVLA-SM thrust magnitude and immediate (≤2 s) muscle spindle response was found (P < .001). For non-control thrust magnitude, pairwise comparisons (25%, 55%, 85% BW), 55% BW thrust magnitude had the most consistent effect on immediate post-HVLA-SM discharge outcomes (false discovery rate < 0.05). No significant association was found between thrust duration and immediate post-HVLA-SM muscle spindle response (P > .05). CONCLUSION The present study found that HVLA-SM thrust magnitudes delivered at 55% BW were more likely to affect immediate (≤2 s) post-HVLA-SM muscle spindle response.
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Affiliation(s)
- Carla R Lima
- Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Randall S Sozio
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - AaMarryah C Law
- CORD Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alicia J Nelson
- CORD Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harshvardhan Singh
- Physical Therapy Department, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher P Hurt
- Physical Therapy Department, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - William R Reed
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa; Physical Therapy Department, University of Alabama at Birmingham, Birmingham, Alabama.
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Macefield VG. The roles of mechanoreceptors in muscle and skin in human proprioception. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Burke D. Crosstalk opposing view: Independent fusimotor control of muscle spindles in humans: there is little to gain. J Physiol 2021; 599:2505-2508. [PMID: 33749872 DOI: 10.1113/jp281337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- David Burke
- Department of Neurology, Royal Prince Alfred Hospital and The University of Sydney, New South Wales 2006, Australia
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Lima CR, Sahu PK, Martins DF, Reed WR. The Neurophysiological Impact of Experimentally-Induced Pain on Direct Muscle Spindle Afferent Response: A Scoping Review. Front Cell Neurosci 2021; 15:649529. [PMID: 33679333 PMCID: PMC7933477 DOI: 10.3389/fncel.2021.649529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Musculoskeletal pain disorders are among the leading causes of years lived with disability worldwide representing a significant burden to society. Studies investigating a “nociceptive-fusimotor” relationship using experimentally-induced pain/noxious stimuli and muscle spindle afferent (MSA) response have been published over several decades. The purpose of this scoping review was to systematically identify and summarize research findings related to the impact of experimentally-induced pain or noxious stimulation on direct MSA discharge/response. Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane and Embase were searched from database inception to August 2020. Eligible studies were: (a) published in English; (b) clinical or pre-clinical studies; (c) original data studies; (d) included the investigation of MSA response to experimentally-induced pain or noxious stimulation; (e) included quantification of at least one direct physiological measure associated with MSA activity/response. Two-phase screening procedures were conducted by a pair of independent reviewers and data extracted from eligible studies. Results: The literature search resulted in 195 articles of which 23 met inclusion criteria. Six studies (26%) were classified as clinical and 17 (74%) as pre-clinical. Two clinical studies investigated the effects of sacral dermatome pin-pricking on MSA response, while the remaining 4 studies investigated the effects of tonic muscle and/or skin pain induced by injection/infusion of hypertonic saline into the tibialis anterior muscle or subdermal tissues. In pre-clinical studies, muscle pain was induced by injection of noxious substances or the surgical removal of the meniscus at the knee joint. Conclusion: Clinical studies in awake humans reported that experimentally-induced pain did not affect, or else slightly decreased MSA spontaneous discharge and/or response during weak dorsiflexor muscle contraction, thus failing to support an excitatory nociceptive-fusimotor relationship. However, a majority of pre-clinical studies indicated that ipsilateral and contralateral muscle injection of noxious substances altered MSA resting discharge and/or response to stretch predominately through static fusimotor reflex mechanisms. Methodological differences (use of anesthesia, stretch methodology, etc.) may ultimately be responsible for the discrepancies between clinical and pre-clinical findings. Additional investigative efforts are needed to reconcile these discrepancies and to clearly establish or refute the existence of nociceptive-fusimotor relationship in muscular pain.
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Affiliation(s)
- Carla R Lima
- Rehabilitation Science, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pradeep K Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Daniel F Martins
- Postgraduate Program in Health Sciences, Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Brazil
| | - William R Reed
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Effect of sustained experimental muscle pain on joint position sense. Pain Rep 2019; 4:e737. [PMID: 31583352 PMCID: PMC6749891 DOI: 10.1097/pr9.0000000000000737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Joint position sense (JPS) is impaired in clinical musculoskeletal pain conditions, but when this impairment develops in the transition from initial to prolonged pain is not known. Objectives: This study assessed whether progressively developing sustained experimentally induced muscle pain impacts JPS in healthy individuals. Methods: Twenty-eight healthy individuals received injection of nerve growth factor (NGF) into the right extensor carpi radialis brevis muscle on days 0 and 2 to induce sustained pain and hyperalgesia. Wrist JPS was assessed 2 days before day 0 (day −2), before the injection on days 0 and 2, and on days 4 and 14. Joint position sense was quantified as the ability to return the wrist to a neutral position following movements in the direction of radial and ulnar deviation. A 3-dimensional motion analysis system was used to calculate absolute, relative, and joint-angle repositioning errors. Numerical rating scale scores of pain intensity, body chart pain drawings, and pressure pain thresholds (PPTs) were recorded on each day. Results: Compared with baseline, pressure pain thresholds decreased while pain intensity and area increased at day 2 (P < 0.001) and day 4 (P < 0.001) before returning to baseline on day 14 (P > 0.13). Relative to day 0, there was no change in wrist JPS at day 2, 4, and 14 following movements in either target direction (P > 0.05). Conclusion: Despite the presence of sustained muscle pain and hyperalgesia for 4 days at the elbow, no statistical change in wrist joint position error was observed. These findings suggest that pain and hyperalgesia lasting as long as 4 days does not impair JPS.
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Smith LJ, Macefield VG, Birznieks I, Burton AR. Effects of tonic muscle pain on fusimotor control of human muscle spindles during isometric ankle dorsiflexion. J Neurophysiol 2019; 121:1143-1149. [DOI: 10.1152/jn.00862.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Studies on anesthetized animals have revealed that nociceptors can excite fusimotor neurons and thereby change the sensitivity of muscle spindles to stretch; such nociceptive reflexes have been suggested to underlie the mechanisms that lead to chronic musculoskeletal pain syndromes. However, the validity of the “vicious cycle” hypothesis in humans has yielded results contrasting with those found in animals. Given that spindle firing rates are much lower in humans than in animals, it is possible that some of the discrepancies between human experimental data and those obtained in animals could be explained by differences in background fusimotor drive when the leg muscles are relaxed. We examined the effects of tonic muscle pain during voluntary contractions of the ankle dorsiflexors. Unitary recordings were obtained from 10 fusimotor-driven muscle spindle afferents (6 primary, 4 secondary) supplying the ankle dorsiflexors via a microelectrode inserted percutaneously into the common peroneal nerve. A series of 1-min weak contractions was performed at rest and during 1 h of muscle pain induced by intramuscular infusion of 5% hypertonic saline into the tibialis anterior muscle. We did not observe any statistically significant increases in muscle spindle firing rates of six afferents followed during tonic muscle pain, although discharge variability increased slightly. Furthermore, a participant’s capacity to maintain a constant level of force, while relying on proprioceptive feedback in the absence of visual feedback, was not compromised during pain. We conclude that nociceptive inputs from contracting muscle do not excite fusimotor neurons during voluntary isometric contractions in humans. NEW & NOTEWORTHY Data obtained in the cat have shown that muscle pain causes a marked increase in the firing of muscle spindles, attributed to a nociceptor-driven fusimotor reflex. However, our studies of muscle spindles in relaxed leg muscles failed to find any effect on spindle discharge. Here we showed that experimental muscle pain failed to increase the firing of muscle spindle afferents during weak voluntary contractions, when fusimotor drive sufficient to increase their firing is present.
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Affiliation(s)
- Lyndon J. Smith
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Vaughan G. Macefield
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ingvars Birznieks
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Alexander R. Burton
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
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Macefield VG, Knellwolf TP. Functional properties of human muscle spindles. J Neurophysiol 2018; 120:452-467. [DOI: 10.1152/jn.00071.2018] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Muscle spindles are ubiquitous encapsulated mechanoreceptors found in most mammalian muscles. There are two types of endings, primary and secondary, and both are sensitive to changes in muscle length and velocity, with the primary endings having a greater dynamic sensitivity. Unlike other mechanoreceptors in the somatosensory system, muscle spindles are unique in possessing motor innervation, via γ-motoneurons (fusimotor neurons), that control their sensitivity to stretch. Much of what we know about human muscles spindles comes from studying the behavior of their afferents via intraneural microelectrodes (microneurography) inserted into accessible peripheral nerves. We review the functional properties of human muscle spindles, comparing and contrasting with what we know about the functions of muscle spindles studied in experimental animals. As in the cat, many human muscle spindles possess a background discharge that is related to the degree of muscle stretch, but mean firing rates are much lower (~10 Hz). They can faithfully encode changes in muscle fascicle length in passive conditions, but higher level extraction of information is required by the central nervous system to measure changes in muscle length during muscle contraction. Moreover, although there is some evidence supporting independent control of human muscle spindles via fusimotor neurons, any effects are modest compared with the clearly independent control of fusimotor neurons observed in the cat.
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Affiliation(s)
- Vaughan G. Macefield
- School of Medicine, Western Sydney University, Sydney, Australia
- Neuroscience Research Institute, Sydney, Australia
- Baker Heart & Diabetes Institute, Melbourne, Australia
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Tsay AJ, Giummarra MJ. Position Sense in Chronic Pain: Separating Peripheral and Central Mechanisms in Proprioception in Unilateral Limb Pain. THE JOURNAL OF PAIN 2016; 17:815-23. [DOI: 10.1016/j.jpain.2016.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/19/2016] [Accepted: 03/09/2016] [Indexed: 11/25/2022]
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Tsay A, Allen T, Proske U, Giummarra M. Sensing the body in chronic pain: A review of psychophysical studies implicating altered body representation. Neurosci Biobehav Rev 2015; 52:221-32. [DOI: 10.1016/j.neubiorev.2015.03.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/11/2014] [Accepted: 03/06/2015] [Indexed: 01/29/2023]
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Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford) 2014; 54:392-9. [PMID: 25477053 DOI: 10.1093/rheumatology/keu471] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore, the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced.
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Affiliation(s)
- John L Quintner
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Geoffrey M Bove
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Milton L Cohen
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
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Marshall PWM, Siegler JC. Lower hamstring extensibility in men compared to women is explained by differences in stretch tolerance. BMC Musculoskelet Disord 2014; 15:223. [PMID: 25000977 PMCID: PMC4105123 DOI: 10.1186/1471-2474-15-223] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examined whether passive hamstring tissue stiffness and/or stretch tolerance explain the relationship between sex and hamstring extensibility. METHODS Ninety healthy participants, 45 men and 45 women (mean ± SD; age 24.6 ± 5.9 years, height 1.72 ± 0.09 m, weight 74.6 ± 14.1 kg) volunteered for this study. The instrumented straight leg raise was used to determine hamstring extensibility and allow measurement of stiffness and stretch tolerance (visual analog pain score, VAS). RESULTS Hamstring extensibility was 9.9° greater in women compared to men (p = 0.003). VAS scores were 16 mm lower in women (p = 0.001). Maximal stiffness (maximal applied torque) was not different between men and women (p = 0.42). Passive stiffness (slope from 20-50° hip flexion) was 0.09 Nm.°(-1) lower in women (p = 0.025). For women, linear and stepwise regression showed that no predictor variables were associated with hamstring extensibility (adjusted r(2) = -0.03, p = 0.61). For men, 44% of the variance in hamstring extensibility was explained by VAS and maximal applied torque (adjusted r(2) = 0.44, p < 0.001), with 41% of the model accounted for by the relationship between higher VAS scores and lower extensibility (standardized β coefficient = -0.64, p < 0.001). CONCLUSIONS The results of this study suggest that stretch tolerance and not passive stiffness explains hamstring extensibility, but this relationship is only manifest in men.
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Affiliation(s)
- Paul W M Marshall
- School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith South, NSW 2751, Australia.
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Consistent interindividual increases or decreases in muscle sympathetic nerve activity during experimental muscle pain. Exp Brain Res 2014; 232:1309-15. [DOI: 10.1007/s00221-014-3847-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/16/2014] [Indexed: 12/18/2022]
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