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Vallance P, Kidgell DJ, Vicenzino B, Frazer AK, Garofolini A, Malliaras P. The Functional Organization of Corticomotor Neurons Within the Motor Cortex Differs Among Basketball and Volleyball Athletes With Patellar Tendinopathy Compared to Asymptomatic Controls. Scand J Med Sci Sports 2024; 34:e14726. [PMID: 39263841 DOI: 10.1111/sms.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/04/2024] [Accepted: 08/24/2024] [Indexed: 09/13/2024]
Abstract
Patellar tendinopathy (PT) typically affects jumping-sport athletes with functional impairments frequently observed. Alterations to the functional organization of corticomotor neurons within the motor cortex that project to working muscles are evident in some musculoskeletal conditions and linked to functional impairments. We aimed to determine if functional organization of corticomotor neuron projections differs between athletes with PT and asymptomatic controls, and if organization is associated with neuromuscular control. We used a cross-sectional design, and the setting was Monash Biomedical Imaging. Basketball and volleyball athletes with (n = 8) and without PT (n = 8) completed knee extension and ankle dorsiflexion force matching tasks while undergoing fMRI. We determined functional organization via identification of the location of peak corticomotor neuron activation during respective tasks (expressed in X, Y, and Z coordinates) and calculated force matching accuracy for both tasks to quantify neuromuscular control. We observed significant interactions between group and coordinate plane for functional organization of corticomotor projections to knee extensors (p < 0.001) and ankle dorsiflexors (p = 0.016). Compared to controls, PT group peak corticomotor activation during the knee extension task was 9.6 mm medial (p < 0.001) and 5.2 mm posterior (p = 0.036), and during the ankle dorsiflexion task 8.2 mm inferior (p = 0.024). In the PT group, more posterior Y coordinate peak activation location during the knee extension task was associated with greater task accuracy (r = 0.749, p = 0.034). Functional organization of corticomotor neurons differed in jumping athletes with PT compared to controls. Links between functional organization and neuromuscular control in the PT group suggest organizational differences may be relevant to knee extension neuromuscular control preservation.
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Affiliation(s)
- Patrick Vallance
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Service and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash Musculoskeletal Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Dawson J Kidgell
- Department of Physiotherapy, Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Ashlyn K Frazer
- Department of Physiotherapy, Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Alessandro Garofolini
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Department of Physiotherapy, Monash Musculoskeletal Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Yang K, Ding Y, Chu L, Cheng C, Yu X, Xu H, Tao Y, Liu T, Yin L, Wu X, Liu B, Jiang L. Altered activation patterns of the sensory-motor cortex in patients with knee osteoarthritis during knee isokinetic movement at different speeds. Front Bioeng Biotechnol 2024; 12:1444731. [PMID: 39234272 PMCID: PMC11371690 DOI: 10.3389/fbioe.2024.1444731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024] Open
Abstract
Background Abnormal brain activation patterns in patients with knee osteoarthritis (KOA) at rest have been revealed, but it is unclear how brain activation patterns change during movement. This study aimed to investigate the alterations in brain activation patterns in KOA patients during knee isokinetic movement, and the correlation between cortical activity changes and pain severity and dysfunction. Methods Eighteen patients with KOA and 18 healthy controls (HC) were recruited, and to performed the knee isokinetic test with three speeds. Functional near-infrared spectroscopy (fNIRS) was used to detect the cerebral cortex hemodynamics changes of primary somatosensory (S1), primary motor (M1) and somatosensory association cortex (SAC) in the region of interest (ROI) during movement. Then, we evaluated potential correlations between M1, S1 and SAC values and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores. Results The results showed that peak torque of knee extension in KOA patients was significantly smaller than that in HC. For HC, unilateral knee movement activated bilateral ROIs. The contralateral activation was dominant, showing the phenomenon of high contralateral activation. For KOA patients, there were no statistical difference in the activation level between the left and right of the cerebral cortex, with both sides showing lower activation levels compared to HC. Further analysis found that the contralateral M1, S1, and SAC of the affected knee in KOA patients were significantly lower than those in HC, while no difference was found on the ipsilateral side. Moreover, during isokinetic movement at 180°/s, VAS score in KOA patients was negatively correlated with the activation level of the contralateral S1 and M1 values, and WOMAC was negatively correlated with the activation level of the contralateral M1 value. Conclusion Contralateral activation of the sensorimotor cortex exists during unilateral knee movement, but in KOA patients, this contralateral cortical activation is suppressed. Furthermore, the clinical pain and dysfunction in KOA patients are associated with activation levels of specific brain regions. These findings can provide a better understanding of KOA brain science and are expected to contribute to the development of central intervention for the disease.
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Affiliation(s)
- Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuwu Ding
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lixi Chu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Changfeng Cheng
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haichen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Tao
- Department of Traditional Chinese Medicine, Shanghai Puxing Community Healthcare Center, Shanghai, China
| | - Tiantian Liu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Yin
- Department of Orthopedics and Traumatology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xubo Wu
- Department of Orthopedics and Traumatology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bingli Liu
- Department of Orthopedics and Traumatology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Shraim MA, Massé-Alarie H, Farrell MJ, Cavaleri R, Loggia ML, Hodges PW. Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: A preliminary proof-of-concept study. Eur J Pain 2024. [PMID: 39007713 DOI: 10.1002/ejp.2313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Chronic pain involves communication between neural and immune systems. Recent data suggest localization of glial (brain immune cells) activation to the sensorimotor regions of the brain cortex (S1/M1) in chronic low back pain (LBP). As glia perform diverse functions that impact neural function, activation might contribute to sensorimotor changes, particularly in LBP maintained by increased nervous system sensitivity (i.e., nociplastic pain). This preliminary proof-of-concept study aimed to: (i) compare evidence of neuroinflammatory activation in S1/M1 between individuals with and without LBP (and between nociceptive and nociplastic LBP phenotypes), and (ii) evaluate relationships between neuroinflammatory activation and sensorimotor function. METHODS Simultaneous PET-fMRI measured neuroinflammatory activation in functionally defined S1/M1 in pain-free individuals (n = 8) and individuals with chronic LBP (n = 9; nociceptive: n = 4, nociplastic: n = 5). Regions of S1/M1 related to the back were identified using fMRI during motor tasks and thermal stimuli. Sensorimotor measures included single and paired-pulse transcranial magnetic stimulation (TMS) and quantitative sensory testing (QST). Sleep, depression, disability and pain questionnaires were administered. RESULTS Neuroinflammatory activation was greater in the lower back cortical representation of S1/M1 of the nociplastic LBP group than both nociceptive LBP and pain-free groups. Neuroinflammatory activation in S1/M1 was positively correlated with sensitivity to hot (r = 0.52) and cold (r = 0.55) pain stimuli, poor sleep, depression, disability and BMI, and negatively correlated with intracortical facilitation (r = -0.41). CONCLUSION This preliminary proof-of-concept study suggests that neuroinflammation in back regions of S1/M1 in individuals with nociplastic LBP could plausibly explain some characteristic features of this LBP phenotype. SIGNIFICANCE STATEMENT Neuroinflammatory activation localized to sensorimotor areas of the brain in individuals with nociplastic pain might contribute to changes in sensory and motor function and aspects of central sensitization. If cause-effect relationships are established in longitudinal studies, this may direct development of therapies that target neuroinflammatory activation.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
- Centre Interdisciplinaire de Recherche en réadaptation et Integration Sociale (CIRRIS), Université Laval, Québec City, Québec, Canada
| | - Michael J Farrell
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation Lab, Western Sydney University, School of Health Sciences, Sydney, New South Wales, Australia
| | - Marco L Loggia
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul W Hodges
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
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Lozano-Meca J, Montilla-Herrador J, Gacto-Sánchez M. The effects of combined transcranial direct Current stimulation with physiotherapy for physical function in subjects with knee osteoarthritis: a systematic review and meta-analysis. Physiother Theory Pract 2024:1-17. [PMID: 38818760 DOI: 10.1080/09593985.2024.2360570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) emerges as a promising therapeutic intervention for knee osteoarthritis (KOA), yet its impact on physical function remains insufficiently explored. OBJECTIVES To evaluate the relative effects of tDCS for physical function in patients with KOA. METHODS Pubmed, Web of Science, Scopus and Cochrane Database were explored as of August 2023 to identify studies to be included in the current systematic review and metaanalysis. Randomized controlled trials in patients with KOA comparing tDCS with placebo were included. The outcomes defined were measures of physical function (questionnaires, gait, or physical performance). The Risk of Bias tool was used to assess bias in the randomized controlled trials, whereas the PEDro scale was applied for methodological quality, and the certainty of evidence for each outcome was assessed through GRADE. Results for each outcome were synthesized using meta-analysis (random-effects model, I2-test for heterogeneity) and a subgroup analysis was performed to improve the sensitivity of the results and to explore potential moderating factors of the effect sizes. RESULTS Ten studies with good to excellent quality were included, analyzing a total of 628 participants. Regarding physical function, tDCS showed a favorable effect (ES: -0.58; 95%CI -0.82, -0.33; I2: 52.1%) with a low risk of bias and low to moderate certainty of evidence. The concurrent application of physiotherapy interventions and tDCS improved the effects on pain and function. Applying physiotherapy interventions, as well as adding peripheral currents, increased the effect sizes (ES: -0.95, k = 3, p = .018; ES: -0.95, k = 4 p = .001, respectively). The pattern of application of the tDCS, either daily or in alternate days, did not moderate the effect size (p = .619). Meta-regression revealed that the number of tDCS sessions did not moderate the effect size either (p = .242). CONCLUSION The tDCS might be a promising therapeutic approach to enhance physical function in subjects affected with KOA. However, further systematic reviews with meta-analyses should be performed with standardized and proven-efficacy physiotherapy programs, as well as with long-term results, to ascertain whether the improvement may be sustained over time. This study provides valuable insights into optimizing tDCS interventions for enhanced outcomes in the management of KOA.Protocol available via PROSPERO [CRD42023440676].
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Affiliation(s)
- José Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
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Hemmerling KJ, Hoggarth MA, Sandhu MS, Parrish TB, Bright MG. Spatial distribution of hand-grasp motor task activity in spinal cord functional magnetic resonance imaging. Hum Brain Mapp 2023; 44:5567-5581. [PMID: 37608682 PMCID: PMC10619382 DOI: 10.1002/hbm.26458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/17/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023] Open
Abstract
Upper extremity motor paradigms during spinal cord functional magnetic resonance imaging (fMRI) can provide insight into the functional organization of the cord. Hand-grasping is an important daily function with clinical significance, but previous studies of similar squeezing movements have not reported consistent areas of activity and are limited by sample size and simplistic analysis methods. Here, we study spinal cord fMRI activation using a unimanual isometric hand-grasping task that is calibrated to participant maximum voluntary contraction (MVC). Two task modeling methods were considered: (1) a task regressor derived from an idealized block design (Ideal) and (2) a task regressor based on the recorded force trace normalized to individual MVC (%MVC). Across these two methods, group motor activity was highly lateralized to the hemicord ipsilateral to the side of the task. Activation spanned C5-C8 and was primarily localized to the C7 spinal cord segment. Specific differences in spatial distribution are also observed, such as an increase in C8 and dorsal cord activity when using the %MVC regressor. Furthermore, we explored the impact of data quantity and spatial smoothing on sensitivity to hand-grasp motor task activation. This analysis shows a large increase in number of active voxels associated with the number of fMRI runs, sample size, and spatial smoothing, demonstrating the impact of experimental design choices on motor activation.
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Affiliation(s)
- Kimberly J. Hemmerling
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Department of Biomedical Engineering, McCormick School of EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Mark A. Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Department of Physical TherapyNorth Central CollegeNapervilleIllinoisUSA
| | - Milap S. Sandhu
- Shirley Ryan Ability LabChicagoIllinoisUSA
- Department of Physical Medicine and Rehabilitation, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Todd B. Parrish
- Department of Biomedical Engineering, McCormick School of EngineeringNorthwestern UniversityEvanstonIllinoisUSA
- Department of Radiology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Molly G. Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Department of Biomedical Engineering, McCormick School of EngineeringNorthwestern UniversityEvanstonIllinoisUSA
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Lee S, Neogi T, Costello KE, Senderling B, Stefanik JJ, Frey-Law L, Kumar D. Association of mechanical temporal summation of pain with muscle co-contraction during walking in people with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2023; 110:106105. [PMID: 37778085 PMCID: PMC10841902 DOI: 10.1016/j.clinbiomech.2023.106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND People with knee osteoarthritis walk with excessive muscle co-contraction that can accelerate disease progression. Central pain sensitization is common in people with knee osteoarthritis and may be related to walking patterns. The objective of this study was to examine the relation of central pain sensitization with muscle co-contraction during walking in people with knee osteoarthritis. METHODS This study reports secondary analysis from baseline data of two clinical trials (n = 90 participants with knee osteoarthritis). The presence of central pain sensitization was measured by mechanical temporal summation at the patella and the wrist. Quadriceps and hamstrings activation was assessed using surface electromyography during walking at self-selected and fast paces. Muscle co-contraction indices for vastus medialis-medial hamstrings and vastus lateralis-lateral hamstrings muscle pairs were calculated during stance phases. Co-contraction outcomes were compared between people with and without mechanical temporal summation at each site, adjusting for age, sex, and body mass index. FINDINGS People with mechanical temporal summation at the knee had greater vastus lateralis-lateral hamstrings co-contraction while walking at a fast pace (P = 0.04). None of the other differences was statistically significant, but the overall trends and effect sizes indicated greater co-contraction in people with temporal summation at the knee irrespective of gait phase, walking speed, or muscle pairs. INTERPRETATION Central pain sensitization, assessed as mechanical temporal summation at the knee, is related to greater knee muscle co-contraction during fast walking in people with knee osteoarthritis. Thus, mitigating central sensitization may be an interventional target to reduce muscle co-contraction for people with knee osteoarthritis.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kerry E Costello
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | | | - Joshua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Laura Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Deepak Kumar
- Department of Physical Therapy, Boston University, Boston, MA, USA; Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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7
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Le Rossignol S, Fraser E, Grant A, Doma K, Wilkinson M, Morse L, McEwen P, Hazratwala K, Connor J. Patients with knee osteoarthritis have altered gait and gaze patterns compared to age-matched controls: A pilot study. PLoS One 2023; 18:e0283451. [PMID: 38011143 PMCID: PMC10681189 DOI: 10.1371/journal.pone.0283451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/07/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Although knee Osteoarthritis (KOA) sufferers are at an increased risk of falls, possibly due to impaired gait function, the associated gaze behaviour in patients with KOA are largely unknown. Thus, we compared gait and gaze behaviours characteristics between KOA patients and asymptomatic age-matched controls. RESULTS For Timed Up and Go (TUG) and stair climb tasks, the KOA group demonstrated longer periods of gaze fixations with less frequency of fixations compared to the control group. Conversely, for the Timed up and Go Agility (TUGA) test shorter fixation and frequency patterns were observed. The KOA group presented a shorter final stride length prior to the initiation of the first step in the Stair climb assessment. In addition, for the 30m walk and dual task assessments, the average step length was significantly shorter in the KOA group compared to controls. CONCLUSION Overall, we found altered gait and gaze behaviours are evident in KOA patients which could relate to their increased falls risk.
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Affiliation(s)
- Scott Le Rossignol
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Ewen Fraser
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kenji Doma
- School of Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Peter McEwen
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Jonathan Connor
- School of Exercise Science, James Cook University, Townsville, Queensland, Australia
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Schnittjer AJ, Kim H, Lepley AS, Onate JA, Criss CR, Simon JE, Grooms DR. Organization of sensorimotor activity in anterior cruciate ligament reconstructed individuals: an fMRI conjunction analysis. Front Hum Neurosci 2023; 17:1263292. [PMID: 38077185 PMCID: PMC10704895 DOI: 10.3389/fnhum.2023.1263292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is characterized by persistent involved limb functional deficits that persist for years despite rehabilitation. Previous research provides evidence of both peripheral and central nervous system adaptations following ACLR. However, no study has compared functional organization of the brain for involved limb motor control relative to the uninvolved limb and healthy controls. The purpose of this study was to examine sensorimotor cortex and cerebellar functional activity overlap and non-overlap during a knee motor control task between groups (ACLR and control), and to determine cortical organization of involved and uninvolved limb movement between groups. Methods Eighteen participants with left knee ACLR and 18 control participants performed a knee flexion/extension motor control task during functional magnetic resonance imaging (fMRI). A conjunction analysis was conducted to determine the degree of overlap in brain activity for involved and uninvolved limb knee motor control between groups. Results The ACLR group had a statistically higher mean percent signal change in the sensorimotor cortex for the involved > uninvolved contrast compared to the control group. Brain activity between groups statistically overlapped in sensorimotor regions of the cortex and cerebellum for both group contrasts: involved > uninvolved and uninvolved > involved. Relative to the control group, the ACLR group uniquely activated superior parietal regions (precuneus, lateral occipital cortex) for involved limb motor control. Additionally, for involved limb motor control, the ACLR group displayed a medial and superior shift in peak voxel location in frontal regions; for parietal regions, the ACLR group had a more posterior and superior peak voxel location relative to the control group. Conclusion ACLR may result in unique activation of the sensorimotor cortex via a cortically driven sensory integration strategy to maintain involved limb motor control. The ACLR group's unique brain activity was independent of strength, self-reported knee function, and time from surgery.
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Affiliation(s)
- Amber J. Schnittjer
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, United States
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
| | - HoWon Kim
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, United States
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
| | - Adam S. Lepley
- School of Kinesiology, Exercise and Sports Science Initiative, University of Michigan, Ann Arbor, MI, United States
| | - James A. Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Cody R. Criss
- OhioHealth Riverside Methodist Hospital, Columbus, OH, United States
| | - Janet E. Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, United States
| | - Dustin R. Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, United States
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, United States
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Hemmerling KJ, Hoggarth MA, Sandhu MS, Parrish TB, Bright MG. Spatial distribution of hand-grasp motor task activity in spinal cord functional magnetic resonance imaging. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.25.537883. [PMID: 37503173 PMCID: PMC10370018 DOI: 10.1101/2023.04.25.537883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Upper extremity motor paradigms during spinal cord functional magnetic resonance imaging (fMRI) can provide insight into the functional organization of the cord. Hand-grasping is an important daily function with clinical significance, but previous studies of similar squeezing movements have not reported consistent areas of activity and are limited by sample size and simplistic analysis methods. Here, we study spinal cord fMRI activation using a unimanual isometric hand-grasping task that is calibrated to participant maximum voluntary contraction (MVC). Two task modeling methods were considered: (1) a task regressor derived from an idealized block design (Ideal) and (2) a task regressor based on the recorded force trace normalized to individual MVC (%MVC). Across these two methods, group motor activity was highly lateralized to the hemicord ipsilateral to the side of the task. Activation spanned C5-C8 and was primarily localized to the C7 spinal cord segment. Specific differences in spatial distribution are also observed, such as an increase in C8 and dorsal cord activity when using the %MVC regressor. Furthermore, we explored the impact of data quantity and spatial smoothing on sensitivity to hand-grasp motor task activation. This analysis shows a large increase in number of active voxels associated with the number of fMRI runs, sample size, and spatial smoothing, demonstrating the impact of experimental design choices on motor activation.
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Affiliation(s)
- Kimberly J. Hemmerling
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Mark A. Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Physical Therapy, North Central College, Naperville, IL, United States
| | - Milap S. Sandhu
- Shirley Ryan Ability Lab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Todd B. Parrish
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Molly G. Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
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Du J, Li A, Shi D, Chen X, Wang Q, Liu Z, Sun K, Guo T. Association of APOE-ε4, Osteoarthritis, β-Amyloid, and Tau Accumulation in Primary Motor and Somatosensory Regions in Alzheimer Disease. Neurology 2023; 101:e40-e49. [PMID: 37188537 PMCID: PMC10351313 DOI: 10.1212/wnl.0000000000207369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES One of the most prevalent chronic diseases, osteoarthritis (OA), may work in conjunction with APOE-ε4 to accelerate Alzheimer disease (AD) alterations, particularly in the primary motor (precentral) and somatosensory (postcentral) cortices. To understand the reasoning behind this, we investigated how OA and APOE-ε4 influence the accumulation of β-amyloid (Aβ) and tau accumulation in primary motor and somatosensory regions in Aβ-positive (Aβ+) older individuals. METHODS We selected Aβ+ Alzheimer Disease Neuroimaging Initiative participants, defined by baseline 18F-florbetapir (FBP) Aβ PET standardized uptake value ratio (SUVR) of AD summary cortical regions, who had longitudinal Aβ PET, the records of OA medical history, and APOE-ε4 genotyping. We examined how OA and APOE-ε4 relate to baseline and longitudinal Aβ accumulation and tau deposition measured at follow-up in precentral and postcentral cortical areas and how they modulate Aβ-associated future higher tau levels, adjusting for age, sex, and diagnosis and using multiple comparison corrections. RESULTS A total of 374 individuals (mean age 75 years, 49.2% female, 62.8% APOE-ε4 carriers) who underwent longitudinal FBP PET with a median follow-up of 3.3 years (interquartile range [IQR] 3.4, range 1.6-9.4) were analyzed, and 96 people had 18F-flortaucipir (FTP) tau PET measured at a median of 5.4 (IQR 1.9, range 4.0-9.3) years postbaseline FBP PET. Neither OA nor APOE-ε4 was related to baseline FBP SUVR in precentral and postcentral regions. At follow-up, OA rather than APOE-ε4 was associated with faster Aβ accumulation in postcentral region (β = 0.005, 95% CI 0.001-0.008) over time. In addition, OA but not the APOE-ε4 allele was strongly linked to higher follow-up FTP tau levels in precentral (β = 0.098, 95% CI 0.034-0.162) and postcentral (β = 0.105, 95% CI 0.040-0.169) cortices. OA and APOE-ε4 were also interactively associated with higher follow-up FTP tau deposition in precentral (β = 0.128, 95% CI 0.030-0.226) and postcentral (β = 0.124, 95% CI 0.027-0.223) regions. DISCUSSION This study suggests that OA was associated with faster Aβ accumulation and higher Aβ-dependent future tau deposition in primary motor and somatosensory regions, providing novel insights into how OA increases the risk of AD.
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Affiliation(s)
- Jing Du
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China.
| | - Anqi Li
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China
| | - Dai Shi
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China
| | - Xuhui Chen
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China
| | - Qingyong Wang
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China
| | - Zhen Liu
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China
| | - Kun Sun
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China
| | - Tengfei Guo
- From the Institute of Biomedical Engineering (J.D., A.L., Z.L., T.G.), Shenzhen Bay Laboratory; Neurology Medicine Center (D.S.), The Seventh Affiliated Hospital, Sun Yat-sen University; Department of Neurology (X.C.), Peking University Shenzhen Hospital; Department of Neurology (Q.W.), University of Chinese Academy of Sciences-Shenzhen Hospital; Institute of Cancer Research (K.S.), Shenzhen Bay Laboratory; and Institute of Biomedical Engineering (T.G.), Peking University Shenzhen Graduate School, China.
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11
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Ulrich B, Erhart-Hledik JC, Asay JL, Omoumi P, Andriacchi TP, Jolles BM, Favre J. Diverse parameters of ambulatory knee moments differ with medial knee osteoarthritis severity and are combinable into a severity index. Front Bioeng Biotechnol 2023; 11:1176471. [PMID: 37383522 PMCID: PMC10293674 DOI: 10.3389/fbioe.2023.1176471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Objective: To characterize ambulatory knee moments with respect to medial knee osteoarthritis (OA) severity comprehensively and to assess the possibility of developing a severity index combining knee moment parameters. Methods: Nine parameters (peak amplitudes) commonly used to quantify three-dimensional knee moments during walking were analyzed for 98 individuals (58.7 ± 9.2 years old, 1.69 ± 0.09 m, 76.9 ± 14.5 kg, 56% female), corresponding to three medial knee osteoarthritis severity groups: non-osteoarthritis (n = 22), mild osteoarthritis (n = 38) and severe osteoarthritis (n = 38). Multinomial logistic regression was used to create a severity index. Comparison and regression analyses were performed with respect to disease severity. Results: Six of the nine moment parameters differed statistically significantly among severity groups (p ≤ 0.039) and five reported statistically significant correlation with disease severity (0.23 ≤ |r| ≤ 0.59). The proposed severity index was highly reliable (ICC = 0.96) and statistically significantly different between the three groups (p < 0.001) as well as correlated with disease severity (r = 0.70). Conclusion: While medial knee osteoarthritis research has mostly focused on a few knee moment parameters, this study showed that other parameters differ with disease severity. In particular, it shed light on three parameters frequently disregarded in prior works. Another important finding is the possibility of combining the parameters into a severity index, which opens promising perspectives based on a single figure assessing the knee moments in their entirety. Although the proposed index was shown to be reliable and associated with disease severity, further research will be necessary particularly to assess its validity.
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Affiliation(s)
- Baptiste Ulrich
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Jennifer C. Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Jessica L. Asay
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Thomas P. Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne, Switzerland
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12
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Culiver A, Grooms D, Edwards N, Schmitt L, Oñate J. A Preliminary Investigation into the Neural Correlates of Knee Loading during a Change of Direction Task in Individuals after Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2023; 18:70-80. [PMID: 36793571 PMCID: PMC9897027 DOI: 10.26603/001c.57782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/03/2022] [Indexed: 02/04/2023] Open
Abstract
Background Central nervous system (CNS) function after ACLR, quantified by the blood oxygen level dependent (BOLD) response, is altered in regions of sensory function during knee movement after ACLR. However, it is unknown how this altered neural response may manifest in knee loading and response to sensory perturbations during sport specific movements. Purpose To investigate the relationship among CNS function and lower extremity kinetics, under multiple visual conditions, during 180° change of direction task in individuals with a history of ACLR. Methods Eight participants, 39.3 ± 37.1 months after primary, left ACLR performed repetitive active knee flexion and extension of their involved knee during fMRI scanning. Participants separately performed 3D motion capture analysis of a 180° change of direction task under full vision (FV) and stroboscopic vision (SV) conditions. A neural correlate analysis was performed to associate BOLD signal to knee loading of the left lower extremity. Results Involved limb peak internal knee extension moment (pKEM) was significantly lower in the SV condition (1.89 ± 0.37 N*m/Kg) compared to the FV condition (2.0 ± 0.34 N*m/Kg) (p = .018). Involved limb pKEM during the SV condition was positively correlated with BOLD signal in the contralateral precuneus and superior parietal lobe (Voxels: 53; p = .017; z-stat max: 6.47; MNI peak: 6, -50, 66). Conclusion There is a positive association between involved limb pKEM in the SV condition and BOLD response in areas of visual-sensory integration. Activation of contralateral precuneus and superior parietal lobe brain regions may be a strategy to maintain joint loading when vision is perturbed. Level of Evidence Level 3.
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Affiliation(s)
- Adam Culiver
- School of Health and Rehabilitation Sciences Ohio State University
- Jameson Crane Sports Medicine Research Institute Ohio State University
| | - Dustin Grooms
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions Ohio University
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions Ohio University
- 5. Ohio Musculoskeletal and Neurological Institute Ohio University
| | - Nathan Edwards
- School of Health and Rehabilitation Sciences Ohio State University
- Jameson Crane Sports Medicine Research Institute Ohio State University
| | - Laura Schmitt
- Jameson Crane Sports Medicine Research Institute Ohio State University
- Division of Physical Therapy, School of Health and Rehabilitation Sciences Ohio State University
| | - James Oñate
- Jameson Crane Sports Medicine Research Institute Ohio State University
- Division of Athletic Training, School of Health and Rehabilitation Sciences Ohio State University
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13
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Criss CR, Lepley AS, Onate JA, Simon JE, France CR, Clark BC, Grooms DR. Neural Correlates of Self-Reported Knee Function in Individuals After Anterior Cruciate Ligament Reconstruction. Sports Health 2023; 15:52-60. [PMID: 35321615 PMCID: PMC9808834 DOI: 10.1177/19417381221079339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a common knee injury among athletes and physically active adults. Despite surgical reconstruction and extensive rehabilitation, reinjuries are common and disability levels are high, even years after therapy and return to activity. Prolonged knee dysfunction may result in part from unresolved neuromuscular deficits of the surrounding joint musculature in response to injury. Indeed, "upstream" neurological adaptations occurring after injury may explain these persistent functional deficits. Despite evidence for injury consequences extending beyond the joint to the nervous system, the link between neurophysiological impairments and patient-reported measures of knee function remains unclear. HYPOTHESIS Patterns of brain activation for knee control are related to measures of patient-reported knee function in individuals after ACL reconstruction (ACL-R). STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS In this multicenter, cross-sectional study, participants with unilateral ACL-R (n = 25; 10 men, 15 women) underwent task-based functional magnetic resonance imaging testing. Participants performed repeated cycles of open-chain knee flexion/extension. Neural activation patterns during the movement task were quantified using blood oxygen level-dependent (BOLD) signals. Regions of interest were generated using the Juelich Histological Brain Atlas. Pearson product-moment correlations were used to determine the relationship between mean BOLD signal within each brain region and self-reported knee function level, as measured by the International Knee Documentation Committee index. Partial correlations were also calculated after controlling for time from surgery and sex. RESULTS Patient-reported knee function was positively and moderately correlated with the ipsilateral secondary somatosensory cortex (r = 0.57, P = 0.005) and the ipsilateral supplementary motor area (r = 0.51, P = 0.01). CONCLUSION Increased ipsilateral secondary sensorimotor cortical activity is related to higher perceived knee function. CLINICAL RELEVANCE Central nervous system mechanisms for knee control are related to subjective levels of knee function after ACL-R. Increased neural activity may reflect central neuroplastic strategies to preserve knee functionality after traumatic injury.
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Affiliation(s)
- Cody R. Criss
- Translational Biomedical Sciences,
Graduate College, Ohio University, Athens, Ohio
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Cody R Criss, W283 Grover
Center, 1 Ohio University, Athens, OH 45701 (
) (Twitter: @criss_cody)
| | - Adam S. Lepley
- Exercise and Sport Science Initiative,
School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - James A. Onate
- School of Health and Rehabilitation
Sciences, The Ohio State University, Columbus, Ohio
| | - Janet E. Simon
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Division of Athletic Training, School
of Applied Health Sciences and Wellness, College of Health Sciences and Professions,
Ohio University, Athens, Ohio
| | - Christopher R. France
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Department of Psychology, College of
Arts and Sciences, Ohio University, Athens, Ohio
| | - Brian C. Clark
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Department of Biomedical Sciences,
Ohio University, Athens, Ohio
- Department of Geriatric Medicine, Ohio
University, Athens, Ohio
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Division of Athletic Training, School
of Applied Health Sciences and Wellness, College of Health Sciences and Professions,
Ohio University, Athens, Ohio
- Division of Physical Therapy, School
of Rehabilitation and Communication Sciences, College of Health Sciences and
Professions, Ohio University, Athens, Ohio
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14
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Lopes TDS, Ballas SK, Santana JERS, de Melo-Carneiro P, de Oliveira LB, Sá KN, Lopes LCD, Silva WDS, Lucena R, Baptista AF. Sickle cell disease chronic joint pain: Clinical assessment based on maladaptive central nervous system plasticity. Front Med (Lausanne) 2022; 9:679053. [PMID: 36203767 PMCID: PMC9530388 DOI: 10.3389/fmed.2022.679053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.
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Affiliation(s)
- Tiago da Silva Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
| | - Samir K. Ballas
- Department of Medicine, Jefferson Medical College, Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jamille Evelyn Rodrigues Souza Santana
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Pedro de Melo-Carneiro
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Lilian Becerra de Oliveira
- Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | - Katia Nunes Sá
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | | | | | - Rita Lucena
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Abrahão Fontes Baptista
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
- Laboratory of Medical Investigations 54 (LIM-54), Universidade de São Paulo, São Paulo, SP, Brazil
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15
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Mansfield CJ, Culiver A, Briggs M, Schmitt LC, Grooms DR, Oñate J. The effects of knee osteoarthritis on neural activity during a motor task: A scoping systematic review. Gait Posture 2022; 96:221-235. [PMID: 35700640 DOI: 10.1016/j.gaitpost.2022.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 05/11/2022] [Accepted: 05/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the evidence of neural activation with functional magnetic resonance imaging (fMRI), corticospinal excitability, and other central nervous system measurement differences during motor tasks between those with and without knee osteoarthritis (KOA). METHODS A scoping review strategy was systematically performed. We searched PubMed, CINAHL, Embase, PsychInfo, SportDiscus, SCOPUS and Web of Science from database inception to April 2021. Any study investigating central nervous system measures during a motor task for individuals with KOA with or without a healthy control group for comparison was included. Two reviewers independently screened all studies in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses extension for scoping reviews. RESULTS Thirteen studies met the inclusion criteria. KOA had reduced activation of the premotor cortex during a gait imagery task when examining the brain using fMRI. This hypoactivation was not significant when the task was combined with ankle movement. Individuals with KOA had decreased motor cortex activation during a force matching motor task. KOA was associated with gamma loop dysfunction of the quadriceps and increased responsiveness of the triceps surae muscles. Also, there was an increased soleus Hoffmann reflex during heel strike of gait cycle. The flexor withdrawal reflex was heighted for individuals with KOA with a lower threshold of the reflex occurring with increased joint compression, but this reflex was modulated with joint mobilizations. CONCLUSION Individuals with KOA have motor deficits associated with decreased neural activation, central nervous system sensitization, decreased quadriceps muscle spindle responsiveness, and increased triceps surae muscle activity.
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Affiliation(s)
- Cody J Mansfield
- School of Health & Rehabilitation Sciences, The Ohio State University, 453 W. 10th Avenue, Columbus, OH 43210, USA; Ohio State Sports Medicine, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Columbus, OH 43202, USA.
| | - Adam Culiver
- School of Health & Rehabilitation Sciences, The Ohio State University, 453 W. 10th Avenue, Columbus, OH 43210, USA; Ohio State Sports Medicine, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Columbus, OH 43202, USA
| | - Matthew Briggs
- Ohio State Sports Medicine, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Columbus, OH 43202, USA; Department of Orthopaedics, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Columbus, OH 43202, USA
| | - Laura C Schmitt
- School of Health & Rehabilitation Sciences, The Ohio State University, 453 W. 10th Avenue, Columbus, OH 43210, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Columbus, OH 43202, USA
| | - Dustin R Grooms
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH 45701, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH 45701, USA; Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, USA
| | - James Oñate
- School of Health & Rehabilitation Sciences, The Ohio State University, 453 W. 10th Avenue, Columbus, OH 43210, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Columbus, OH 43202, USA
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Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev 2022; 139:104735. [PMID: 35705110 DOI: 10.1016/j.neubiorev.2022.104735] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.
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Affiliation(s)
- Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom; Department of Psychology, Oslo New University College, Oslo, Norway.
| | - Monika Halicka
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Gavin Buckingham
- Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom
| | - Michael J Proulx
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Centre for Real and Virtual Environments Augmentation Labs, Department of Computer Science, University of Bath, Bath, Somerset, United Kingdom
| | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
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17
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Ho KY, Liang JN, Budge S, Madriaga A, Meske K, Nguyenton D. Brain and Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review and Meta-Analysis. Front Integr Neurosci 2022; 16:791719. [PMID: 35197832 PMCID: PMC8859985 DOI: 10.3389/fnint.2022.791719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the evidence for altered cortical and spinal cord functions in individuals with patellofemoral pain (PFP). Methods We conducted a comprehensive search of databases to appraise and analyze the studies published prior to December 10, 2021 that examined spinal reflex excitability measured using Hoffmann reflex (H-reflex) amplitudes, corticospinal excitability measured using transcranial magnetic stimulation (TMS)-elicited motor evoked potential (MEP) amplitudes, motor threshold (MT), or stimulus-response (SR) curves, cortical reorganization assessed using TMS cortical mapping or structural magnetic resonance imaging (MRI), or functional changes of the brain assessed using functional MRI (fMRI) in individuals with PFP. Results Eight studies were eligible for analyses. While an earlier study showed that pain had no effect on the H-reflex amplitude of the quadriceps muscle, more recent evidence reported a decrease in vastus medialis (VM) H-reflex amplitude in participants with PFP. VM H-reflex amplitude was correlated with pain, chronicity, physical function, and isometric knee extensor torque production in participants with PFP. Altered corticospinal excitability was reported in participants with PFP, observed as increased MT in the VM and vastus lateralis (VL) muscles. In addition, cortical reorganization has been observed, where decreased number of cortical peaks, shifts and reduced volumes, and increased overlap of motor cortex representations for the VM, VL, and rectus femoris (RF) muscles were reported in participants with PFP. Conclusion There is emerging evidence on altered cortical and spinal cord functions in individuals with PFP, however, solid conclusions cannot be drawn due to limited literature available. Further research is needed to better understand the adaptations of the brain and spinal cord in this population. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42020212128.
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18
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Kang BX, Ma J, Shen J, Xu H, Wang HQ, Zhao C, Xie J, Zhong S, Gao CX, Xu XR, A XY, Gu XL, Xiao L, Xu J. Altered brain activity in end-stage knee osteoarthritis revealed by resting-state functional magnetic resonance imaging. Brain Behav 2022; 12:e2479. [PMID: 34967156 PMCID: PMC8785636 DOI: 10.1002/brb3.2479] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is characterized by a degenerative change of knee cartilage and secondary bone hyperplasia, resulting in pain, stiffness, and abnormal walking gait. Long-term chronic pain causes considerable cortical plasticity alternations in patients. However, the brain structural and functional alterations associated with the pathological changes in knee joints of end-stage KOA patients remain unclear. This study aimed to analyze the structural and functional connectivity alterations in end-stage KOA to comprehensively understand the main brain-associated mechanisms underlying its development and progression. METHODS In this study, 37 patients with KOA and 37 demographically matched healthy controls (HCs) were enrolled. Alternations in gray matter (GM) volume in patients with KOA were determined using voxel-based morphometry. The region with the largest GM volume alteration was selected as the region of interest to calculate the voxel-wise resting-state functional connectivity (rs-FC) in the two groups. Pearson's correlation coefficient was used to analyze the correlation between clinical measures and GM volume alternations in patients with KOA. RESULTS Compared with HCs, patients with KOAs exhibited significantly decreased GM volumes in the left middle temporal gyrus (left-MTG) and the left inferior temporal gyrus. Results of the voxel-wise rs-FC analysis revealed that compared with HCs, patients with KOA had decreased left-MTG rs-FC to the right dorsolateral superior frontal gyrus, left middle frontal gyrus, and left medial superior frontal gyrus. GM volume in the left-MTG was negatively correlated with the Western Ontario and McMaster Universities Arthritis Index in patients with KOA (r = -0.393, p = .016). CONCLUSION Structural remodeling and functional connectivity alterations may be one of the central brain mechanisms associated with end-stage KOA.
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Affiliation(s)
- Bing-Xin Kang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jie Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Shen
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Xu
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Hai-Qi Wang
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chi Zhao
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Xie
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Zhong
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen-Xin Gao
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xi-Rui Xu
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin-Yu A
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Li Gu
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lianbo Xiao
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianguang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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19
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Magni NE, McNair PJ, Rice DA. Impairments in grip and pinch force accuracy and steadiness in people with osteoarthritis of the hand: A case-control comparison. Musculoskelet Sci Pract 2021; 55:102432. [PMID: 34333399 DOI: 10.1016/j.msksp.2021.102432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Symptomatic hand osteoarthritis (OA) is severely disabling condition. Limited evidence has focused on force control measures in this population. OBJECTIVES It was the aim of the present study to determine whether force matching accuracy and steadiness are impaired in people with hand OA. In addition, the relationship between force control measures (accuracy and steadiness) and measures of hand function and pain in people with symptomatic hand OA was explored. DESIGN Case-control study. METHOD Sixty-two participants with symptomatic hand OA and 26 healthy pain-free controls undertook an isometric grip and pinch force matching task at 50 % of their maximum voluntary contraction. Average pain hand pain was recorded. In addition, the Disability of the Arm Shoulder and Hand Questionnaire (DASH), and the Functional Index of Hand Osteoarthritis were collected. RESULTS Grip force-matching accuracy and steadiness were significantly impaired in the hand OA group compared to controls (P < 0.05). Pinch force-matching error was greater in people with hand OA (P < 0.05), however, pinch force steadiness was not different between groups. There was a learning effect in people with hand OA, with resolution of force matching impairments with task repetition. A small positive correlation was identified between grip force control and the DASH. No association was found between other measures of force control and self-reported measures of function or pain. CONCLUSIONS People with hand OA presented with greater impairments in measures of submaximal force control. These were correlated with self-reported hand function but not pain. Future studies may wish to examine whether objective measures of functional performance are related to force-matching error and steadiness.
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Affiliation(s)
- Nicoló Edoardo Magni
- Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
| | - Peter John McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
| | - David Andrew Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand; Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Waitemata DHB, 124 Shakespeare Road, Takapuna, Westlake, Auckland, 0622, New Zealand.
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20
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Neuropathic Pain in Hand Osteoarthritis: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10194439. [PMID: 34640455 PMCID: PMC8509392 DOI: 10.3390/jcm10194439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 01/13/2023] Open
Abstract
Symptomatic hand osteoarthritis (OA) is a severely debilitating condition. Neuropathic pain (NP) has been shown to be a factor affecting pain severity, hand function, psychological wellbeing, body schema, and the number of pain medications in people with OA of other joints. The aim of this study was to assess the prevalence of NP in symptomatic hand OA and assess its association with pain, hand function, measures of psychological wellbeing, sleep, body schema disturbances, and number of pain medications. Participants with symptomatic hand OA diagnosed through the American College of Rheumatology criteria, were recruited and completed a series of online questionnaires. These included the Douleur Neuropathique 4 interview (DN4-interview), Short Form Brief Pain Inventory (SF-BPI), Neglect-like Symptoms questionnaire, Functional Index of Hand Osteoarthritis (FIHOA), Centre for Epidemiologic Studies Depression Scale (CES-D), Pain Catastrophising Scale (PCS), and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression with age, body mass index, and sex as covariates were utilised to assess differences between participants with and without NP as identified through the DN4-interview. Correlation analysis assessed the relationship between pain intensity, body schema alterations, and number of pain medications. A total of 121 participants were included in the present study. Forty-two percent of participants presented with NP. Participants with NP reported higher levels of worst pain (OR: 10.2 95% CI: 2.2 to 48.5; p = 0.007). Worst pain intensity correlated with the number of pain medications (rho = 0.2; p = 0.04), and neglect-like symptoms (rho = 0.4; p < 0.0001). No difference between phenotypes was shown for catastrophising, function, depression, neglect-like symptoms, pain interference, or sleep. A large proportion of people with symptomatic hand OA present with NP. This phenotype is characterised by greater levels of pain intensity. Pain intensity is associated with number of pain relief medications and body schema alteration. Psychological factors, hand function, and sleep do not appear to be affected by the presence of NP.
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21
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Rahimi F, Nejati V, Nassadj G, Ziaei B, Mohammadi HK. The effect of transcranial direct stimulation as an add-on treatment to conventional physical therapy on pain intensity and functional ability in individuals with knee osteoarthritis: A randomized controlled trial. Neurophysiol Clin 2021; 51:507-516. [PMID: 34518098 DOI: 10.1016/j.neucli.2021.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the effect of adding transcranial direct current stimulation (tDCS) to conventional physiotherapy treatment (PT) on pain and performance of individuals with knee osteoarthritis (KOA). METHODS Eighty people suffering from chronic KOA participated in this study. They were randomly divided into four treatment groups, including PT combined with tDCS over the primary motor cortex (M1), PT combined with tDCS over the primary sensory cortex (S1), PT combined with tDCS over the dorsolateral prefrontal cortex (DLPFC), and PT combined with sham tDCS. A visual analog scale (VAS) for pain intensity, the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire for knee-related disability, and several performance tests (stepping 15 s, chair stand test in 30 s, and walking 4 × 10 m) were used for assessment following 10 sessions of tDCS (T1), and one month after the last session of tDCS (T2). RESULTS Differential effects on pain intensity, knee-related disability, and performance were found between groups. Compared to sham tDCS: (i) tDCS over M1 improved VAS pain score, KOOS disability score, and performance tests at T1 and T2; (ii) tDCS over S1 improved VAS pain score at T1 and T2 and KOOS disability score and performance tests at T2; (iii) tDCS over the DLPFC improved VAS pain score at T1 and performance tests at T1 and T2. CONCLUSION tDCS could be a beneficial add-on treatment to conventional PT for pain relief, disability reduction and functional improvement in patients with KOA.
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Affiliation(s)
- Fatemeh Rahimi
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Rehabilitation School, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vahid Nejati
- Cognitive Neurosciences, Shahid Beheshti University, Tehran, Iran
| | - Gholamhossein Nassadj
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Rehabilitation School, Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Bahare Ziaei
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Rehabilitation School, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Kouhzad Mohammadi
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Rehabilitation School, Jundishapur University of Medical Sciences, Ahvaz, Iran
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22
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Self-Perception of the Knee Is Associated with Joint Motion during the Loading Response in Individuals with Knee Osteoarthritis: A Pilot Cross-Sectional Study. SENSORS 2021; 21:s21124009. [PMID: 34200714 PMCID: PMC8229136 DOI: 10.3390/s21124009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022]
Abstract
Small knee flexion motion is a characteristic of gait in individuals with knee osteoarthritis. This study examined the relationship between knee flexion excursion in loading response and knee self-perception in individuals with knee osteoarthritis. Twenty-one individuals with knee osteoarthritis participated in this study. Knee flexion excursions in loading response while walking at a comfortable and a fast-walking speed were measured using an inertial measurement unit-based motion capture system. The degree of knee perceptual impairment was evaluated using the Fremantle Knee Awareness Questionnaire (FreKAQ). The relationships between the FreKAQ score and gait variables and knee function were evaluated by calculating the correlation coefficient. The unique contributions of knee self-perception and muscle strength to knee flexion excursion in loading response were analyzed using hierarchical linear regression. Knee self-perception was significantly correlated with pain during walking, muscle strength and knee flexion excursion at fast speed. In the fast speed condition only, impaired knee self-perception was inversely proportional to knee flexion excursion and accounted for 21.8% of the variance in knee flexion excursion. This result suggests that impaired self-perception of the knee may help to explain the decrease in the knee flexion excursion in the loading response in individuals with knee osteoarthritis.
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23
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Brain gray matter abnormalities in osteoarthritis pain: a cross-sectional evaluation. Pain 2021; 161:2167-2178. [PMID: 32379222 DOI: 10.1097/j.pain.0000000000001904] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
ABSTRACT The interaction between osteoarthritis (OA) pain and brain properties remains minimally understood, although anatomical and functional neuroimaging studies suggest that OA, similar to other chronic pain conditions, may impact as well as partly be determined by brain properties. Here, we studied brain gray matter (GM) properties in OA patients scheduled to undergo total joint replacement surgery. We tested the hypothesis that brain regional GM volume is distinct between hip OA (HOA) and knee OA (KOA) patients, relative to healthy controls and moreover, that these properties are related to OA pain. Voxel-based morphometry group contrasts showed lower anterior cingulate GM volume only in HOA. When we reoriented the brains (flipped) to examine the hemisphere contralateral to OA pain, precentral GM volume was lower in KOA and HOA, and 5 additional brain regions showed distortions between groups. These GM changes, however, did not reflect clinical parameters. Next, we subdivided the brain into larger regions, approximating Brodmann areas, and performed univariable and machine learning-based multivariable contrasts. The univariable analyses approximated voxel-based morphometry results. Our multivariable model distinguished between KOA and controls, was validated in a KOA hold-out sample, and generalized to HOA. The multivariable model in KOA, but not HOA, was related to neuropathic OA pain. These results were mapped into term space (using Neurosynth), providing a meta-analytic summary of brain anatomical distortions in OA. Our results indicate more subtle cortical anatomical differences in OA than previously reported and also emphasize the interaction between OA pain, namely its neuropathic component, and OA brain anatomy.
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24
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Kinetics, kinematics, and knee muscle activation during sit to stand transition in unilateral and bilateral knee osteoarthritis. Gait Posture 2021; 86:38-44. [PMID: 33677177 DOI: 10.1016/j.gaitpost.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 01/09/2021] [Accepted: 02/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The sit to stand transition (STS) is a task performed by those with knee osteoarthritis (KOA) with biomechanical modifications that may influence the lower limb load distribution. As a weight bearing task mainly performed in the sagittal plane, the presence of unilateral or bilateral KOA may lead to asymmetry during its performance. RESEARCH QUESTION Are the biomechanical and neuromuscular aspects of the sit to stand transition (STS) different between participants with unilateral and bilateral KOA? METHODS Twenty-eight participants were allocated as follows: unilateral KOA (OAUNI; n = 12) and bilateral KOA (OABI; n = 16). All participants were evaluated by means of kinematics (Qualisys Motion Capture System, Qualisys Medical AB, SUE), kinetics (Bertec Corporation's model 4060-08 Mod., USA), and electromyography (TrignoTM Wireless System, DelSys Inc., USA) during the STS. The variables calculated were the symmetry indices of the total support moment (TSM) and ground reaction force (ISGRF and ISTSM, respectively), magnitude of the TSM, individual joint contribution to the TSM, peak trunk flexion, hip, knee, and ankle range of motion, duration in seconds, the magnitudes of activation of the extensor and flexor muscles, knee extensors: flexor co-contraction indices and isometric knee extensor peak torques. Participants also answered the WOMAC questionnaire and performed the 30-second STS test (STS30). RESULTS The OABI got up from a chair with a lower TSM magnitude in the most affected limb (p = 0.040), used greater trunk flexion amplitude (p ≤ 0.034), and presented lower isometric KET (p = 0.039) and worse self-reported pain (p = 0.011) and physical function (p = 0.015). SIGNIFICANCE Participants with unilateral and bilateral KOA differ regarding lower limb kinetics and trunk kinematics while getting up from a chair, without modification in the lower limb intersegmental coordination or symmetry regarding ground reaction force or TSM distribution.
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25
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Wohl TR, Criss CR, Grooms DR. Visual Perturbation to Enhance Return to Sport Rehabilitation after Anterior Cruciate Ligament Injury: A Clinical Commentary. Int J Sports Phys Ther 2021; 16:552-564. [PMID: 33842051 PMCID: PMC8016421 DOI: 10.26603/001c.21251] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/10/2020] [Indexed: 01/13/2023] Open
Abstract
Anterior cruciate ligament (ACL) tears are common traumatic knee injuries causing joint instability, quadriceps muscle weakness and impaired motor coordination. The neuromuscular consequences of injury are not limited to the joint and surrounding musculature, but may modulate central nervous system reorganization. Neuroimaging data suggest patients with ACL injuries may require greater levels of visual-motor and neurocognitive processing activity to sustain lower limb control relative to healthy matched counterparts. Therapy currently fails to adequately address these nuanced consequences of ACL injury, which likely contributes to impaired neuromuscular control when visually or cognitively challenged and high rates of re-injury. This gap in rehabilitation may be filled by visual perturbation training, which may reweight sensory neural processing toward proprioception and reduce the dependency on vision to perform lower extremity motor tasks and/or increase visuomotor processing efficiency. This clinical commentary details a novel approach to supplement the current standard of care for ACL injury by incorporating stroboscopic glasses with key motor learning principles customized to target visual and cognitive dependence for motor control after ACL injury. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Timothy R Wohl
- Honors Tutorial College, Ohio University, Athens, OH, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Cody R Criss
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Grover Center, Athens, OH, USA; Translational Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Grover Center, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, USA; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, USA
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26
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Öztürk Ö, Bombacı H, Keçeci T, Algun ZC. Effects of additional action observation to an exercise program in patients with chronic pain due to knee osteoarthritis: A randomized-controlled trial. Musculoskelet Sci Pract 2021; 52:102334. [PMID: 33582621 DOI: 10.1016/j.msksp.2021.102334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/30/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) leads to pain, stiffness, and functional impairment and eventually decreased level of the quality of life. Although several treatment methods have been used to achieve pain relief, patients still complain of pain. OBJECTIVE The aim of this study was to investigate the effects of the addition of action observation therapy to an exercise program on pain severity, pressure pain threshold, kinesiphobia functionality, and pain catastrophization in knee OA patients with chronic pain. METHODS This prospective, randomized-controlled, superiority trial included a total of 36 patients with knee OA. The patients were randomly divided into two groups as the treatment group (n = 18) receiving action observation therapy in addition to exercise and control group (n = 18) receiving exercise alone. The interventions were performed three times weekly for six weeks. The primary outcomes were pain and pressure pain threshold. Secondary outcomes were kinesiphobia, functionality, and pain catastrophization. All participants were assessed at baseline (pre-intervention) and after the six-week treatment (post-intervention). RESULTS There was no significant difference in the primary and secondary outcome measures before and after the intervention between the groups (p > 0.05). Both groups showed a significant improvement in all outcome measures after the intervention (p < 0.01). CONCLUSION Our study results suggest that action observation therapy in addition to an exercise program does not contribute any additional benefits to pain, pressure pain threshold, kinesiophobia, pain catastrophization, and functionality in knee OA patients with chronic pain. Nonetheless, further large-scale, long-term, prospective studies are needed to gain a better understanding on this subject.
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Affiliation(s)
- Özgül Öztürk
- Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Hasan Bombacı
- University of Health Sciences, Haydarpaşa Numune Research and Training Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Tolga Keçeci
- Ordu University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ordu, Turkey
| | - Zeliha Candan Algun
- Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
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27
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Strik M, Shanahan CJ, van der Walt A, Boonstra FMC, Glarin R, Galea MP, Kilpatrick TJ, Geurts JJG, Cleary JO, Schoonheim MM, Kolbe SC. Functional correlates of motor control impairments in multiple sclerosis: A 7 Tesla task functional MRI study. Hum Brain Mapp 2021; 42:2569-2582. [PMID: 33666314 PMCID: PMC8090767 DOI: 10.1002/hbm.25389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 02/01/2023] Open
Abstract
Upper and lower limb impairments are common in people with multiple sclerosis (pwMS), yet difficult to clinically identify in early stages of disease progression. Tasks involving complex motor control can potentially reveal more subtle deficits in early stages, and can be performed during functional MRI (fMRI) acquisition, to investigate underlying neural mechanisms, providing markers for early motor progression. We investigated brain activation during visually guided force matching of hand or foot in 28 minimally disabled pwMS (Expanded Disability Status Scale (EDSS) < 4 and pyramidal and cerebellar Kurtzke Functional Systems Scores ≤ 2) and 17 healthy controls (HC) using ultra‐high field 7‐Tesla fMRI, allowing us to visualise sensorimotor network activity in high detail. Task activations and performance (tracking lag and error) were compared between groups, and correlations were performed. PwMS showed delayed (+124 s, p = .002) and more erroneous (+0.15 N, p = .001) lower limb tracking, together with lower cerebellar, occipital and superior parietal cortical activation compared to HC. Lower activity within these regions correlated with worse EDSS (p = .034), lower force error (p = .006) and higher lesion load (p < .05). Despite no differences in upper limb task performance, pwMS displayed lower inferior occipital cortical activation. These results demonstrate that ultra‐high field fMRI during complex hand and foot tracking can identify subtle impairments in lower limb movements and upper and lower limb brain activity, and differentiates upper and lower limb impairments in minimally disabled pwMS.
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Affiliation(s)
- Myrte Strik
- Department of Medicine and Radiology, University of Melbourne, Parkville, Australia.,Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Camille J Shanahan
- Department of Medicine and Radiology, University of Melbourne, Parkville, Australia
| | - Anneke van der Walt
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Frederique M C Boonstra
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Rebecca Glarin
- Department of Medicine and Radiology, University of Melbourne, Parkville, Australia
| | - Mary P Galea
- Department of Medicine and Radiology, University of Melbourne, Parkville, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jon O Cleary
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Scott C Kolbe
- Department of Medicine and Radiology, University of Melbourne, Parkville, Australia.,Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
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28
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Teixeira PEP, Pacheco-Barrios K, Gunduz ME, Gianlorenço AC, Castelo-Branco L, Fregni F. Understanding intracortical excitability in phantom limb pain: A multivariate analysis from a multicenter randomized clinical trial. Neurophysiol Clin 2021; 51:161-173. [PMID: 33648819 DOI: 10.1016/j.neucli.2020.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore associations of intracortical excitability with clinical characteristics in a large sample of subjects with phantom limb pain (PLP). METHODS Ancillary study using baseline and longitudinal data from a large multicenter randomized trial that investigated the effects of non-invasive brain stimulation combined with sensorimotor training on PLP. Multivariate regression modeling analyses were used to investigate the association of intracortical excitability, measured by percentages of intracortical inhibition (ICI) and facilitation (ICF) with clinical variables. RESULTS Ninety-eight subjects were included. Phantom sensation of itching was positively associated with ICI changes and at baseline in the affected hemisphere (contralateral to PLP). However, in the non-affected hemisphere (ipsilateral to PLP), the phantom sensation of warmth and PLP intensity were negatively associated with ICI (both models). For the ICF, PLP intensity (baseline model only) and age (longitudinal model) were negatively associated, while time since amputation and amputation level (both for longitudinal model only) were positively associated in the affected hemisphere. Additionally, use of antidepressants led to lower ICF in the non-affected hemisphere for the baseline model while higher amputation level also led to less changes in the ICF. CONCLUSION Results revealed clear associations of clinical variables and cortical excitability in a large chronic pain sample. ICI and ICF changes appear not to be mainly explained by PLP intensity. Instead, other variables associated with duration of neuroplasticity changes (such as age and duration of amputation) and compensatory mechanisms (such as itching and phantom limb sensation) seem to be more important in explaining these variables.
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Affiliation(s)
- Paulo E P Teixeira
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; MGH Institute of Health Professions, Boston, MA, USA; Instituto Wilson Mello, Campinas, SP, Brazil.
| | - Kevin Pacheco-Barrios
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Muhammed Enes Gunduz
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Gianlorenço
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Laboratory of neuroscience, Department of Physical Therapy, Federal University of Sao Carlos, SP, Brazil
| | - Luis Castelo-Branco
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Grooms DR, Criss CR, Simon JE, Haggerty AL, Wohl TR. Neural Correlates of Knee Extension and Flexion Force Control: A Kinetically-Instrumented Neuroimaging Study. Front Hum Neurosci 2021; 14:622637. [PMID: 33613205 PMCID: PMC7890238 DOI: 10.3389/fnhum.2020.622637] [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: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The regulation of muscle force is a vital aspect of sensorimotor control, requiring intricate neural processes. While neural activity associated with upper extremity force control has been documented, extrapolation to lower extremity force control is limited. Knowledge of how the brain regulates force control for knee extension and flexion may provide insights as to how pathology or intervention impacts central control of movement. Objectives: To develop and implement a neuroimaging-compatible force control paradigm for knee extension and flexion. Methods: A magnetic resonance imaging (MRI) safe load cell was used in a customized apparatus to quantify force (N) during neuroimaging (Philips Achieva 3T). Visual biofeedback and a target sinusoidal wave that fluctuated between 0 and 5 N was provided via an MRI-safe virtual reality display. Fifteen right leg dominant female participants (age = 20.3 ± 1.2 years, height = 1.6 ± 0.10 m, weight = 64.8 ± 6.4 kg) completed a knee extension and flexion force matching paradigm during neuroimaging. The force-matching error was calculated based on the difference between the visual target and actual performance. Brain activation patterns were calculated and associated with force-matching error and the difference between quadriceps and hamstring force-matching tasks were evaluated with a mixed-effects model (z > 3.1, p < 0.05, cluster corrected). Results: Knee extension and flexion force-matching tasks increased BOLD signal among cerebellar, sensorimotor, and visual-processing regions. Increased knee extension force-matching error was associated with greater right frontal cortex and left parietal cortex activity and reduced left lingual gyrus activity. Increased knee flexion force-matching error was associated with reduced left frontal and right parietal region activity. Knee flexion force control increased bilateral premotor, secondary somatosensory, and right anterior temporal activity relative to knee extension. The force-matching error was not statistically different between tasks. Conclusion: Lower extremity force control results in unique activation strategies depending on if engaging knee extension or flexion, with knee flexion requiring increased neural activity (BOLD signal) for the same level of force and no difference in relative error. These fMRI compatible force control paradigms allow precise behavioral quantification of motor performance concurrent with brain activity for lower extremity sensorimotor function and may serve as a method for future research to investigate how pathologies affect lower extremity neuromuscular function.
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Affiliation(s)
- Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Translational Biomedical Sciences Program, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Adam L Haggerty
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Timothy R Wohl
- Honors Tutorial College, Ohio University, Athens, OH, United States.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
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VALIDITY OF AN MRI-COMPATIBLE MOTION CAPTURE SYSTEM FOR USE WITH LOWER EXTREMITY NEUROIMAGING PARADIGMS. Int J Sports Phys Ther 2020; 15:936-946. [PMID: 33344010 DOI: 10.26603/ijspt20200936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Emergent linkages between musculoskeletal injury and the nervous system have increased interest to evaluate brain activity during functional movements associated with injury risk. Functional magnetic resonance imaging (fMRI) is a sophisticated modality that can be used to study brain activity during functional sensorimotor control tasks. However, technical limitations have precluded the precise quantification of lower-extremity joint kinematics during active brain scanning. The purpose of this study was to determine the validity of a new, MRI-compatible motion tracking system relative to a traditional multi-camera 3D motion capture system for measuring lower extremity joint kinematics. Methods Fifteen subjects (9 females, 6 males) performed knee flexion-extension and leg press movements against guided resistance while laying supine. Motion tracking data were collected simultaneously using the MRI-compatible and traditional multi-camera 3D motion systems. Participants' sagittal and frontal plane knee angles were calculated from data acquired by both multi-camera systems. Resultant range of angular movement in both measurement planes were compared between both systems. Instrument agreement was assessed using Bland-Altman plots and intraclass correlation coefficients (ICC). Results The system demonstrated excellent validity in the sagittal plane (ICCs>0.99) and good to excellent validity in the frontal plane (0.84 < ICCs < 0.92). Mean differences between corresponding range of angular movement measurements ranged from 0.186 ° to 0.295 °. Conclusions The present data indicate that this new, MRI-compatible system is valid for measuring lower extremity movements when compared to the gold standard 3D motion analysis system. As there is growing interest regarding the neural substrates of lower extremity movement, particularly in relation to injury and pathology, this system can now be integrated into neuroimaging paradigms to investigate movement biomechanics and its relation to brain activity. Level of Evidence 3.
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Breckenridge JD, McAuley JH, Ginn KA. Motor Imagery Performance and Tactile Spatial Acuity: Are They Altered in People with Frozen Shoulder? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207464. [PMID: 33066655 PMCID: PMC7602509 DOI: 10.3390/ijerph17207464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/24/2022]
Abstract
Frozen shoulder (adhesive capsulitis) is a severe chronic pain condition that is not well understood and current treatment is suboptimal. In several other chronic pain conditions motor imagery and tactile acuity deficits are present, which are thought to represent associated neuroplastic changes. The aims of this study were to determine if motor imagery performance assessed by the left/right judgement task, and tactile acuity assessed by two-point discrimination, are altered in people with unilateral frozen shoulder. In this cross-sectional, prospective study eighteen adults diagnosed with frozen shoulder in a physiotherapy clinic setting completed a left/right judgement task, response times (RT) and accuracy for the left/right judgement task were determined. Next, tactile acuity over both shoulders was assessed with a novel, force-standardised two-point discrimination test. Results corresponding to the affected side were compared to the pain free shoulder; Left/right judgement task: mean RT (SD) corresponding to the affected shoulder was significantly slower than RT for the healthy shoulder (p = 0.031). There was no side-to-side difference in accuracy (p > 0.05). Neither RT nor accuracy was related to pain/disability scores or duration of symptoms (p > 0.05). Two-point discrimination: mean two-point discrimination threshold of the affected shoulder was significantly larger than the contralateral healthy shoulder (p < 0.001). Two-point discrimination threshold was not related to pain/disability scores or pain duration (p > 0.05); One explanation for these findings is altered sensorimotor processing and/or disrupted sensorimotor cortex representations of the affected shoulder. A case then exists for the use of treatments aimed at reversing these changes, training the brain to reduce chronic shoulder pain.
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Affiliation(s)
- John D. Breckenridge
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
- The Clinical Research Institute, Sydney 2145, Australia
- Correspondence: ; Tel.: +61-2-9672-3511
| | - James H. McAuley
- Neuroscience Research Australia (NeuRA), Hospital Rd, Randwick 2013, Australia;
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney 2033, Australia
| | - Karen A. Ginn
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
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Davies JL. Using transcranial magnetic stimulation to map the cortical representation of lower-limb muscles. Clin Neurophysiol Pract 2020; 5:87-99. [PMID: 32455179 PMCID: PMC7235616 DOI: 10.1016/j.cnp.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/30/2020] [Accepted: 04/18/2020] [Indexed: 01/25/2023] Open
Abstract
Objective To evaluate the extent to which transcranial magnetic stimulation (TMS) can identify discrete cortical representation of lower-limb muscles in healthy individuals. Methods Motor evoked potentials were recorded from resting vastus medialis, rectus femoris, vastus lateralis, medial and lateral hamstring, and medial and lateral gastrocnemius muscles on the right leg of 16 young healthy adults using bipolar surface electrodes. TMS was delivered through a 110-mm double-cone coil at 63 sites over the left hemisphere. Location and size of cortical representation and number of discrete peaks were quantified. Results Within the quadriceps group there was a main effect of muscle on anterior-posterior centre of gravity (p = 0.010), but the magnitude of the difference was small. There was also a main effect of muscle on medial-lateral hotspot (p = 0.027) and map volume (p = 0.047), but no post-hoc tests were significant. The topography of each lower-limb muscle was complex and variable across individuals. Conclusions TMS delivered with a 110-mm double-cone coil could not reliably identify discrete cortical representations of resting lower-limb muscles when responses were measured using bipolar surface electromyography. Significance The characteristics of the cortical representation provide a basis against which to evaluate cortical reorganisation in clinical populations.
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Affiliation(s)
- Jennifer L Davies
- School of Healthcare Sciences, Cardiff University, United Kingdom.,Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, United Kingdom.,Cardiff University Brain Research Imaging Centre, Cardiff University, United Kingdom
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McDougall JJ. Osteoarthritis is a neurological disease – an hypothesis. OSTEOARTHRITIS AND CARTILAGE OPEN 2019; 1:100005. [DOI: 10.1016/j.ocarto.2019.100005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022] Open
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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Elgueta-Cancino E, Marinovic W, Jull G, Hodges PW. Motor cortex representation of deep and superficial neck flexor muscles in individuals with and without neck pain. Hum Brain Mapp 2019; 40:2759-2770. [PMID: 30835902 DOI: 10.1002/hbm.24558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/04/2019] [Accepted: 02/20/2019] [Indexed: 01/07/2023] Open
Abstract
Sensorimotor control of neck muscles differs between individuals with and without pain. Differences in the primary motor cortex (M1) maps of these muscles may be involved. This study compared M1 representations of deep (DNF) and superficial (SNF) neck flexor muscles between 10 individuals with neck pain (NP) and 10 painfree controls. M1 organisation was studied using transcranial magnetic stimulation (TMS) applied to a grid over the skull and surface electromyography of DNF (pharyngeal electrode) and SNF. Three-dimensional maps of M1 representation of each muscle were generated. Peaks in the SNF map that represented the sternocleidomastoid (SCM) and platysma muscles were identified. Unique centre of gravity (CoG)/map peaks were identified for the three muscles. In comparison to painfree controls, NP participants had more medial location of the CoG/peak of DNF, SCM, and platysma, greater mediolateral variation in DNF CoG (p = 0.02), fewer SNF and DNF map peaks (p = 0.01). These data show that neck flexor muscle M1 maps relate to trunk, neck, and face areas of the motor homunculus. Differences in M1 representation in NP have some similarities and some differences with observations for other musculoskeletal pain conditions. Despite the small sample size, our data did reveal differences and is comparable to other similar studies. The results of this study should be interpreted with consideration of methodological issues.
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Affiliation(s)
- Edith Elgueta-Cancino
- Centre of Clinical Excellence Research in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Welber Marinovic
- Centre of Clinical Excellence Research in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Gwendolen Jull
- Centre of Clinical Excellence Research in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul W Hodges
- Centre of Clinical Excellence Research in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Pelletier R, Bourbonnais D, Higgins J, Mireault M, Danino MA, Harris PG. Left Right Judgement Task and Sensory, Motor, and Cognitive Assessment in Participants with Wrist/Hand Pain. Rehabil Res Pract 2018; 2018:1530245. [PMID: 30225144 PMCID: PMC6129336 DOI: 10.1155/2018/1530245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/20/2018] [Accepted: 08/02/2018] [Indexed: 01/01/2023] Open
Abstract
The Left Right Judgement Task (LRJT) involves determining if an image of the body part is of the left or right side. The LRJT has been utilized as part of rehabilitation treatment programs for persons with pain associated with musculoskeletal injuries and conditions. Although studies often attribute changes and improvement in LRJT performance to an altered body schema, imaging studies suggest that the LRJT implicates other cortical regions. We hypothesized that cognitive factors would be related to LRJT performance of hands and feet and that sensory, motor, and pain related factors would be related to LRJT in the affected hand of participants with wrist/hand pain. In an observational cross-sectional study, sixty-one participants with wrist/hand pain participated in a study assessing motor imagery ability, cognitive (Stroop test), sensory (Two-Point Orientation Discrimination, pressure pain thresholds), motor (grip strength, Purdue Pegboard Test), and pain related measures (West Haven Yale Multidimensional Pain Inventory) as well as disability (Disability of the Arm, Shoulder and Hand). Multiple linear regression found Stroop test time and motor imagery ability to be related to LRJT performance. Tactile acuity, motor performance, participation in general activities, and the taking of pain medications were predictors of LRJT accuracy in the affected hand. Participants who took pain medications performed poorly in both LRJT accuracy (p=0.001) and reaction time of the affected hand (p=0.009). These participants had poorer cognitive (p=0.013) and motor function (p=0.002), and higher pain severity scores (p=0.010). The results suggest that the LRJT is a complex mental task that involves cognitive, sensory, motor, and behavioural processes. Differences between persons with and without pain and improvement in LRJT performance may be attributed to any of these factors and should be considered in rehabilitation research and practice utilizing this task.
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Affiliation(s)
- René Pelletier
- Sciences de la Réadaptation, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montréal (Québec), Canada H3C 3J7
| | - Daniel Bourbonnais
- École de Réadaptation, Faculté de Médecine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal (Québec), Canada H3C 3J7
- Researcher, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada
| | - Johanne Higgins
- École de Réadaptation, Faculté de Médecine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal (Québec), Canada H3C 3J7
- Researcher, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada
| | - Maxime Mireault
- Sciences de la Réadaptation, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montréal (Québec), Canada H3C 3J7
| | - Michel Alain Danino
- Professeur Agrégé Université de Montréal, Chef du Service de Chirurgie Plastique du Centre Hospitalier Université de Montréal (CHUM), 850 rue St-Denis Pav. S-Local S02-128 Montréal (Québec), Canada H2X 0A9
| | - Patrick G. Harris
- Service de Chirurgie Plastique, Département de Chirurgie du Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis (Québec), Canada H2X 0C1
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Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM. Quadriceps Neuromuscular Function in Patients With Anterior Cruciate Ligament Reconstruction With or Without Knee Osteoarthritis: A Cross-Sectional Study. J Athl Train 2018; 53:475-485. [PMID: 29893603 DOI: 10.4085/1062-6050-102-17] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Central and peripheral neural adaptations have been identified after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) and are hypothesized to contribute to posttraumatic muscle dysfunction. Limited evidence exists about the temporal nature of neuromuscular adaptations during early and late-term phases of recovery after ACLR, and no researchers have studied patients with posttraumatic osteoarthritis. OBJECTIVE To compare quadriceps neuromuscular function less than 2 years ( early) and more than 2 years ( late) after ACLR, including in patients who experienced posttraumatic knee osteoarthritis. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 72 patients after ACLR, consisting of 34 early (9.0 ± 4.3 months postsurgery), 30 late (70.5 ± 41.6 months postsurgery), and 8 with osteoarthritis (115.9 ± 110.0 months postsurgery), and 30 healthy control volunteers. MAIN OUTCOME MEASURE(S) Quadriceps function was measured bilaterally during a single visit to determine normalized Hoffmann reflex (H : M ratio), knee-extension maximal voluntary isometric contraction torque (Nm/kg), central activation ratio (%), fatigue index (% decline), and active motor threshold (%). Comparisons were made using 2-way analyses of variance to identify the effect of limb and group on each outcome measure. We calculated Cohen d effect sizes to assess the magnitude of difference between ACLR and matched control limbs for each group. RESULTS Compared with healthy control limbs, involved-limb maximal voluntary isometric contraction was lower among all patients after ACLR ( P < .001, Cohen d values = -1.00 to -1.75). The central activation ratio ( P < .001, Cohen d = -1.74) and fatigue index ( P = .003, Cohen d = -0.95) were lower among patients only early after ACLR. The active motor threshold was higher among all patients after ACLR ( P < .001, Cohen d values = -0.42 to -1.56). CONCLUSIONS Neuromuscular impairments were present in patients early and late after ACLR, regardless of osteoarthritis status. Quadriceps strength and corticospinal excitability were impaired at each time point compared with values in healthy control individuals, suggesting the need to address cortical function early after ACLR.
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Affiliation(s)
- Grant E Norte
- School of Exercise and Rehabilitation Sciences, Athletic Training Program, University of Toledo, OH
| | - Jay Hertel
- Department of Kinesiology, Sports Medicine Program and.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, Sports Medicine Program and.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, Sports Medicine Program and.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
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Harms A, Heredia-Rizo AM, Moseley GL, Hau R, Stanton TR. A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care. Physiother Theory Pract 2018; 36:142-156. [PMID: 29889597 DOI: 10.1080/09593985.2018.1482391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. Methods: Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. Results: A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout, p = 0.007; BT vs. washout, p = 0.029) and left/right judgment accuracy (usual care vs. washout; p = 0.006). Conclusions: Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.
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Affiliation(s)
- Anton Harms
- Department of Physiotherapy, Northern Hospital, Epping, Victoria, Australia
| | - Alberto M Heredia-Rizo
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Sevilla, Spain.,School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - G Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Raphael Hau
- Northern Clinical School of Melbourne Medical School, Northern Hospital, Epping, Victoria, Australia
| | - Tasha R Stanton
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
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Chang WJ, O'Connell NE, Beckenkamp PR, Alhassani G, Liston MB, Schabrun SM. Altered Primary Motor Cortex Structure, Organization, and Function in Chronic Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2018; 19:341-359. [DOI: 10.1016/j.jpain.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023]
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40
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Pelletier R, Bourbonnais D, Higgins J. Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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41
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Luz-Santos C, Ribeiro Camatti J, Barbosa Paixão A, Nunes Sá K, Montoya P, Lee M, Fontes Baptista A. Additive effect of tDCS combined with Peripheral Electrical Stimulation to an exercise program in pain control in knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2017; 18:609. [PMID: 29268764 PMCID: PMC5740917 DOI: 10.1186/s13063-017-2332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/08/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA. METHODS Patients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention. DISCUSSION The motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. TRIAL REGISTRATION Brazilian Registry on Clinical Trials (ReBEC) - Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B. TRIAL REGISTRATION ID: RBR-9D7C7B . Registered on 29 February 2016.
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Affiliation(s)
- Cleber Luz-Santos
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Janine Ribeiro Camatti
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Alaí Barbosa Paixão
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Katia Nunes Sá
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Bahian School of Medicine and Public Health, Salvador, Brazil
| | - Pedro Montoya
- Research Institute on Health Sciences, University of Balearic Islands, Palma de Majorca, Spain
| | - Michael Lee
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, NSW Australia
| | - Abrahão Fontes Baptista
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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Magni NE, McNair PJ, Rice DA. Sensorimotor performance and function in people with osteoarthritis of the hand: A case-control comparison. Semin Arthritis Rheum 2017; 47:676-682. [PMID: 29153332 DOI: 10.1016/j.semarthrit.2017.09.008] [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: 04/21/2017] [Revised: 08/22/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine whether hand left/right judgements, tactile acuity, and body perception are impaired in people with hand OA. To examine the relationships between left right judgements, tactile acuity and hand pain. To explore the relationships between sensorimotor measures (left/right judgements and tactile acuity) and measures of hand function in people with hand OA. METHODS Twenty patients with symptomatic hand OA and 19 healthy pain-free controls undertook a hand left/right judgment task, a control left/right judgement task, two-point discrimination (TPD) threshold testing (assessing tactile acuity), a neglect-like symptoms questionnaire (assessing body perception) and several established measures of hand function. RESULTS Neglect-like symptoms were experienced more frequently in the hand OA group (P < 0.05). People with hand OA were slower (P < 0.05) and less accurate (P < 0.05) in the hand left/right judgement task when compared to healthy controls, with no significant difference in the control task. Significant associations were found between hand left/right judgement reaction time and pain intensity (P < 0.05) and accuracy and pain intensity (P < 0.05). TPD was not different between groups, and no correlation was found between TPD and left/right judgement performance. No association was found between left/right judgement performance and measures of hand function (all P > 0.05). However, TPD (tactile acuity) was related to several measures of hand function (all P < 0.05). CONCLUSION People with hand OA had more frequent neglect-like symptoms and were slower and less accurate compared to healthy controls at hand left/right judgments, which was indicative of disrupted working body schema. Future studies may wish to examine whether interventions targeting sensorimotor dysfunction are effective at reducing pain and improving hand function and dexterity in people with hand OA.
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Affiliation(s)
- Nicoló Edoardo Magni
- Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
| | - Peter John McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - David Andrew Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand; Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Waitemata Pain Service, Waitemata DHB, Takapuna, Westlake, Auckland, New Zealand
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Silfies SP, Vendemia JM, Beattie PF, Stewart JC, Jordon M. Changes in Brain Structure and Activation May Augment Abnormal Movement Patterns: An Emerging Challenge in Musculoskeletal Rehabilitation. PAIN MEDICINE 2017; 18:2051-2054. [DOI: 10.1093/pm/pnx190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nishigami T, Mibu A, Tanaka K, Yamashita Y, Yamada E, Wand BM, Catley MJ, Stanton TR, Moseley GL. Development and psychometric properties of knee-specific body-perception questionnaire in people with knee osteoarthritis: The Fremantle Knee Awareness Questionnaire. PLoS One 2017. [PMID: 28650969 PMCID: PMC5484477 DOI: 10.1371/journal.pone.0179225] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Recent systematic reviews have demonstrated that pain associated with knee osteoarthritis (OA) is a complex phenomenon that involves various contributors. People with knee OA exhibit symptoms of impaired body-perception, including reduced tactile acuity, impairments in limb laterality recognition, and degraded proprioceptive acuity. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body-perception specific to the back in people with chronic low back pain. The aim of this study was to develop and assess the psychometric properties of a knee-specific version of the FreBAQ-J (FreKAQ-J), determine whether people with knee pain experience perceptual impairments and investigate the relationship between disturbed self-perception and clinical status. Methods Sixty-five people with knee OA completed the FreKAQ-J. A subset of the participants completed the FreKAQ-J again two-weeks later. Rasch analysis was used to assess item order, targeting, category ordering, unidimensionality, person fit, internal consistency, and differential item functioning. Validity was investigated by examining the relationship between the FreKAQ-J and clinical valuables. Results The FreKAQ-J had acceptable internal consistency, unidimensionality, good test-retest reliability, and was functional on the category rating scale. The FreKAQ-J was significantly correlated with pain in motion, disability, pain-related catastrophizing, fear of movement, and anxiety symptomatology. Conclusions We developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA. Altered body perception may be worth evaluating when managing people with knee OA.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Nursing and Physical Therapy, Konan Woman’s University, Kobe, Hyogo, Japan
- * E-mail:
| | - Akira Mibu
- Department of Rehabilitation, Tanabe Orthopaedics, Osaka, Osaka, Japan
| | - Katsuyoshi Tanaka
- Department of Rehabilitation, Tanabe Orthopaedics, Osaka, Osaka, Japan
| | - Yuh Yamashita
- Department of Rehabilitation, Morinaga Orthopedic Clinic, Saga, Saga, Japan
| | - Eiji Yamada
- Joint Surgery Centre, Kaisei Hospital, Sakaide, Kagawa, Japan
| | - Benedict M. Wand
- The School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Mark J. Catley
- Sansom Institute for Health Research, University of South Australia, SA, Australia
| | - Tasha R. Stanton
- Sansom Institute for Health Research, University of South Australia, SA, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - G. Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, SA, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
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Nyland J, Gamble C, Franklin T, Caborn DNM. Permanent knee sensorimotor system changes following ACL injury and surgery. Knee Surg Sports Traumatol Arthrosc 2017; 25:1461-1474. [PMID: 28154888 DOI: 10.1007/s00167-017-4432-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/12/2017] [Indexed: 01/14/2023]
Abstract
The cruciate ligaments are components of the knee capsuloligamentous system providing vital neurosensory and biomechanical function. Since most historical primary ACL repair attempts were unsuccessful, reconstruction has become the preferred surgery. However, an increased understanding of the efficacy of lesion-site scaffolding, innovative suturing methods and materials, and evolving use of biological healing mediators such as platelet-rich plasma and stem cells has prompted reconsideration of what was once believed to be impossible. A growing number of in vivo animal studies and prospective clinical studies are providing increasing support for this intervention. The significance of ACL repair rather than reconstruction is that it more likely preserves the native neurosensory system, entheses, and ACL footprints. Tissue preservation combined with restored biomechanical function increases the likelihood for premorbid neuromuscular control system and dynamic knee stability recovery. This recovery should increase the potential for more patients to safely return to sports at their desired intensity and frequency. This current concepts paper revisits cruciate ligament neurosensory and neurovascular anatomy from the perspective of knee capsuloligamentous system function. Peripheral and central nerve pathways and central cortical representation mapping are also discussed. Surgical restoration of a more physiologically sound knee joint may be essential to solving the osteoarthritis dilemma. Innovative rehabilitative strategies and outcome measurement methodologies using more holistic and clinically relevant measurements that closely link biomechanical and neurosensory characteristics of physiological ACL function are discussed. Greater consideration of task-specific patient physical function and psychobehavioral links should better delineate the true efficacy of all ACL surgical and non-surgical interventions. Level of evidence IV.
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Affiliation(s)
- John Nyland
- Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA.
| | - Collin Gamble
- School of Medicine, University of Louisville, 323 East Chestnut Street, Louisville, KY, 40202, USA
| | - Tiffany Franklin
- Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA
| | - David N M Caborn
- Shea Orthopedic Group, KentuckyOne Health, 201 Abraham Flexner Way, Ste. 100, Louisville, KY, 40202, USA
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Pelletier R, Higgins J, Bourbonnais D. The relationship of corticospinal excitability with pain, motor performance and disability in subjects with chronic wrist/hand pain. J Electromyogr Kinesiol 2017; 34:65-71. [PMID: 28411487 DOI: 10.1016/j.jelekin.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 03/25/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022] Open
Abstract
There is a growing body of evidence of changes in corticospinal excitability associated with musculoskeletal disorders, however there is a lack of knowledge of how these changes relate to measures of pain, motor performance and disability. An exploratory study was performed utilizing Transcranial Magnetic Stimulation to investigate differences in corticospinal excitability in the Abductor Pollicis Brevis (APB) between 15 pain-free subjects and 15 subjects with chronic wrist/hand pain and to determine how corticospinal excitability was associated with measures of pain (visual analog scale, AUSCAN™), hand motor performance (isometric and key pinch strength, Purdue Pegboard Test), disability (AUSCAN™), and spinal motoneuronal excitability. Input-output curves demonstrated increased corticospinal excitability of the APB in the affected hand of subjects with chronic pain (p<0.01). Changes in corticospinal excitability were significantly correlated with pain intensity (r=0.77), disability (r=0.58), and negatively correlated with motoneuronal excitability (r=-0.57). Corticospinal excitability in subjects with heterogeneous injuries of the wrist/hand was associated with disability and pain.
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Affiliation(s)
- René Pelletier
- Sciences de la réadaptation, École de réadaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec H3C 3J7, Canada.
| | - Johanne Higgins
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec H3C 3J7, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada.
| | - Daniel Bourbonnais
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec H3C 3J7, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Canada.
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Te M, Baptista AF, Chipchase LS, Schabrun SM. Primary Motor Cortex Organization Is Altered in Persistent Patellofemoral Pain. PAIN MEDICINE 2017; 18:2224-2234. [DOI: 10.1093/pm/pnx036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Anterior cruciate ligament (ACL) reconstruction is a common and predominantly successful surgical intervention. But are there specific preoperative patient characteristics or intraoperative surgeon decisions that lead to better or worse outcomes? And can understanding brain function changes of patients after ACL reconstruction reveal insights into the ways that postsurgical rehabilitation can be improved to further enhance outcomes? These intriguing and clinically applicable questions are addressed in this webinar titled "Improving ACL Reconstruction Outcomes," hosted jointly by JOSPT and JBJS. The webinar is based on 2 published research articles-one from JBJS and the other from JOSPT. Participants in this continuing education activity are asked to read both articles carefully before watching the webinar. JBJS co-author Kurt Spindler, MD, discusses findings from a longitudinal analysis that identified certain baseline patient characteristics and intraoperative choices that predicted higher and lower SF-36 Physical Component scores after ACL reconstruction. JOSPT co-author Dustin Grooms, PhD, ATC, shares recently published results of a controlled laboratory study that employed functional MRI to investigate brain-activation differences between patients who did and did not undergo ACL reconstruction. Moderated by Kevin Wilk, PT, DPT, FAPTA, a leading authority on rehabilitation of sports injuries, the webinar includes additional insights from expert commentators Eric McCarty, MD, and Karin Grävare Silbernagel, PT, PhD, ATC.
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Abstract
Study Design Controlled laboratory study. Background Anterior cruciate ligament (ACL) injury may result in neuroplastic changes due to lost mechanoreceptors of the ACL and compensations in neuromuscular control. These alterations are not completely understood. Assessing brain function after ACL injury and anterior cruciate ligament reconstruction (ACLR) with functional magnetic resonance imaging provides a means to address this gap in knowledge. Objective To compare differences in brain activation during knee flexion/extension in persons who have undergone ACLR and in matched controls. Methods Fifteen participants who had undergone left ACLR (38.13 ± 27.16 months postsurgery) and 15 healthy controls matched on age, sex, height, mass, extremity dominance, education level, sport participation, and physical activity level participated. Functional magnetic resonance imaging data were obtained during a unilateral knee motor task consisting of repeated cycles of knee flexion and extension. Results Participants who had undergone ACLR had increased activation in the contralateral motor cortex, lingual gyrus, and ipsilateral secondary somatosensory area and diminished activation in the ipsilateral motor cortex and cerebellum when compared to healthy matched controls. Conclusion Brain activation for knee flexion/extension motion may be altered following ACLR. The ACLR brain activation profile may indicate a shift toward a visual-motor strategy as opposed to a sensory-motor strategy to engage in knee movement. Level of Evidence Cohort, level 3. J Orthop Sports Phys Ther 2017;47(3):180-189. Epub 5 Nov 2016. doi:10.2519/jospt.2017.7003.
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Elliott JM, Owen M, Bishop MD, Sparks C, Tsao H, Walton DM, Weber KA, Wideman TH. Measuring Pain for Patients Seeking Physical Therapy: Can Functional Magnetic Resonance Imaging (fMRI) Help? Phys Ther 2017; 97:145-155. [PMID: 27470977 DOI: 10.2522/ptj.20160089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022]
Abstract
In the multidisciplinary fields of pain medicine and rehabilitation, advancing techniques such as functional magnetic resonance imaging (fMRI) are used to enhance our understanding of the pain experience. Given that such measures, in some circles, are expected to help us understand the brain in pain, future research in pain measurement is undeniably rich with possibility. However, pain remains intensely personal and represents a multifaceted experience, unique to each individual; no single measure in isolation, fMRI included, can prove or quantify its magnitude beyond the patient self-report. Physical therapists should be aware of cutting-edge advances in measuring the patient's pain experience, and they should work closely with professionals in other disciplines (eg, magnetic resonance physicists, biomedical engineers, radiologists, psychologists) to guide the exploration and development of multimodal pain measurement and management on a patient-by-patient basis. The primary purpose of this perspective article is to provide a brief overview of fMRI and inform physical therapist clinicians of the pros and cons when utilized as a measure of the patient's perception of pain. A secondary purpose is to describe current known factors that influence the quality of fMRI data and its analyses, as well as the potential for future clinical applications relevant to physical therapist practice. Lastly, the interested reader is introduced and referred to existing guidelines and recommendations for reporting fMRI research.
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