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Tieppo Francio V, Westerhaus BD, Carayannopoulos AG, Sayed D. Multifidus dysfunction and restorative neurostimulation: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1341-1354. [PMID: 37439698 PMCID: PMC10690869 DOI: 10.1093/pm/pnad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation. METHODS A scoping review of the literature. RESULTS In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action. CONCLUSIONS Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine & Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, United States
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Benjamin D Westerhaus
- Cantor Spine Institute at the Paley Orthopedic & Spine Institute, West Palm Beach, FL 33407, United States
| | - Alexios G Carayannopoulos
- Department of Neurosurgery and Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
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Pourahmadi M, Negahban H, Koes BW, Fernández-de-Las-Peñas C, Ebrahimi Takamjani I, Bahramian M. The effect of dual-task conditions on postural control in adults with low back pain: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:555. [PMID: 37528400 PMCID: PMC10391969 DOI: 10.1186/s13018-023-04035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Dual-task conditions, which involve performing two tasks simultaneously, may exacerbate pain and further impair daily functioning in individuals with low back pain (LBP). Understanding the effects of dual-task conditions on postural control in patients with LBP is crucial for the development of effective rehabilitation programs. Our objective was to investigate the impact of dual-task conditions on postural control in individuals with LBP compared to those without LBP. METHODS We conducted a comprehensive search of Medline via PubMed, Scopus, the Cochrane Central Register of Controlled Trials, Web of Science, and EMBASE databases, with no language restrictions, from inception to January 1, 2023. The primary outcome measures of the study were velocity, area, amplitude, phase plane portrait, and path/sway length of the center of pressure (CoP). Standardized mean difference (SMD) effect sizes were calculated, and the quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS From 196 studies, five involving 242 adults (≥ 18 years) met the inclusion criteria. Three studies were rated as high quality, while two were deemed moderate. In the included studies, 140 participants had non-specific LBP, while 102 participants did not report any symptoms, with mean ages of 36.68 (± 14.21) and 36.35 (± 15.39) years, respectively. Three studies had both genders, one exclusively included females, and one did not specify gender. Meta-analyses of primary outcomes revealed no significant differences in postural control between patients with LBP and pain-free controls during both easy and difficult postural tasks and cognitive load for velocity (easy: SMD - 0.09, 95% CI - 0.91 to 0.74; difficult: SMD 0.12, 95% CI - 0.67 to 0.91), area (easy: SMD 0.82, 95% CI - 2.99 to 4.62; difficult: SMD 0.14, 95% CI - 2.62 to 2.89), phase plane (easy: SMD - 0.59, 95% CI - 1.19 to 0.02; difficult: SMD - 0.18, 95% CI - 0.77 to 0.42), path/sway length (easy: SMD - 0.18, 95% CI - 0.77 to 0.42; difficult: SMD - 0.14, 95% CI - 0.84 to 0.55), and amplitude (easy: SMD 0.89, 95% CI - 1.62 to 3.39; difficult: SMD 1.31, 95% CI - 1.48 to 4.10). CONCLUSIONS The current evidence suggests that there are no significant differences in postural control parameters during dual-task conditions between individuals with non-specific LBP and pain-free subjects. However, due to the limited number of available studies, significant publication bias, and considerable statistical heterogeneity, definitive conclusions cannot be drawn. Therefore, further research comprising high-quality studies with larger sample sizes is necessary to obtain conclusive results. Trial registration PROSPERO CRD42022359263.
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Affiliation(s)
- Mohammadreza Pourahmadi
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Bart Willem Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Research Unit of General Practice, Department of Public Health and the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
| | - Ismail Ebrahimi Takamjani
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Bahramian
- Department of Physical Therapy, College of Health Science & Professions, University of North Georgia, Dahlonega, USA
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Effect of Cognitive Load on Anticipatory Postural Adjustment Latency and its Relationship with Pain-Related Dysfunction in Non-specific Chronic Low Back Pain: A Cross-Sectional Study. Pain Ther 2023; 12:723-735. [PMID: 36932302 PMCID: PMC10199985 DOI: 10.1007/s40122-023-00495-0] [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: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the effect of cognitive load on anticipatory postural adjustment (APA) latency in patients with non-specific chronic low back pain (NCLBP) and its relationship with pain-related functional changes. METHODS A cross-sectional study was conducted from December 15, 2022 to January 25, 2023. Participants were divided into a healthy control group (n = 29) and an NCLBP group (n = 29). Each group was assigned a single task of rapid arm raising and a dual task of rapid arm raising combined with a cognitive load. The cognitive load task was conducted using visual conflict. The APA latency for bilateral trunk muscles was observed using electromyography. The duration of electromyography recording in each task cycle was 28 s. Pain related-functional changes were evaluated using Roland-Morris Disability Questionnaire (RMDQ) before all tasks. RESULTS The APA latency for the right multifidus was significantly delayed in the NCLBP group [25.38, 95% confidence interval (CI) 13.41-37.35] than in the healthy control group (- 5.80, 95% CI - 19.28 to 7.68) during dual task (p = 0.0416). The APA latency for the right multifidus (25.38, 95% CI 13.41-37.35) and transverse abdominis/internal oblique (29.15, 95% CI 18.81-39.50) were significantly delayed compared with on the left side in the NCLBP group during dual task (- 3.03, 95% CI - 15.18-9.13, p = 0.0220; 3.69, 95% CI - 6.81 to 14.18, p = 0.0363). The latency delay of the right and left multifidus APA in the NCLBP group under the dual-task was positively correlated with RMDQ scores (r = 0.5560, p = 0.0017; r = 0.4010, p = 0.0311). CONCLUSIONS Cognitive load could induce APA delay in the right trunk muscles and co-activation pattern changes in bilateral trunk muscle APA in patients with NCLBP. The APA onset delay in multifidus is positively related to pain-related daily dysfunction. Trial Registration ChiCTR2300068580 (retrospectively registered in February 23, 2023).
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Xiao W, Yang H, Wang Z, Mao H, Wang H, Hao Z, Zu Y, Wang C. Postural Control of Patients with Low Back Pain Under Dual-Task Conditions. J Pain Res 2023; 16:71-82. [PMID: 36647432 PMCID: PMC9840397 DOI: 10.2147/jpr.s392868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Low back pain is a major global public health problem, but the current intervention effect is not ideal. A large body of previous literature suggests that patients with chronic low back pain may have abnormal postural control, which is more evident in the dual task situation. In recent years, research on postural control in patients with low back pain under dual-task conditions has gradually become a hot topic. However, the results obtained from these studies were not entirely consistent. In this review, we summarized relevant studies on the performance of postural control in patients with low back pain under dual-task conditions, analyze it from the perspective of the theoretical model of dual-task interaction, the specific research paradigm of dual task, the performance of postural control, and the related factors affecting postural control performance, etc. It was reasonable to assume that patients with low back pain might have a certain degree of abnormal postural control, and this abnormality was affected by comprehensive factors such as age, cognitive resource capacity, attention needs, complex sensorimotor integration, external environment, etc. Furthermore, postural control performance in low back pain patients under dual-task conditions was further influenced by the nature and complexity of the different tasks. In general, the more attention resources were needed, the external environmental conditions were worse, and the age-related functions were degenerate, etc., the weaker posture control ability was. In short, a deeper understanding of postural control in patients with low back pain under dual-task conditions may shed light on more references for the rehabilitation and management of low back pain, as well as some new ideas for scientific research on cognition and postural control.
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Affiliation(s)
- Wenwu Xiao
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Huaichun Yang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Zhuangfu Wang
- Faculty of Population Health Sciences, Institute of Child Health I, University College London, London, UK
| | - Haian Mao
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Hongjiang Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Zengming Hao
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Yao Zu
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China,Correspondence: Chuhuai Wang, Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou, 510080, People’s Republic of China, Tel +86 13316191023, Email
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Yamane M, Aoki M, Sasaki Y, Hayashi T, Okino K. Activity of deep trunk muscles for postural control to predictable and unpredictable sagittal plane perturbations: Electromyographic analysis. J Back Musculoskelet Rehabil 2023; 36:1411-1420. [PMID: 37482983 DOI: 10.3233/bmr-220416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND The activity of deep trunk muscles (psoas major; PM, quadratus lumborum; QL, transverse abdominis; TrA, and lumbar multifidus; MF) in response to external perturbation is not clearly known. OBJECTIVE This study aimed to record the onset and amount of activity of the deep trunk muscles during sagittal plane perturbations. METHODS Fourteen healthy males participated in this study. The activity of the right deep trunk muscles was recorded using wire electrodes. In standing, the participants performed three tasks: a pendulum impacted from anterior with predictable and unpredictable and posterior with unpredictable. RESULTS In predictable anterior perturbation, the TrA and PM demonstrated feedforward activation, while all deep trunk muscles demonstrated feedback activation in unpredictable anterior and posterior perturbations. In the anticipatory postural adjustment phase, the activity of the TrA was large in predictable anterior perturbation, while that of all deep trunk muscles was slight in other perturbations. In the compensatory postural adjustment phase, the activity of the PM, QL, and TrA in unpredictable anterior perturbation and those of the PM, QL, and MF in unpredictable posterior perturbation were large. CONCLUSIONS These results showed that the onset and magnitude of deep trunk muscle activity changed depending on both predictable or unpredictable perturbation and the direction of perturbation.
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Affiliation(s)
- Masahiro Yamane
- Department of Rehabilitation, Health Sciences University of Hokkaido Hospital, Sapporo, Japan
| | - Mitsuhiro Aoki
- Department of PhysicalTherapy, Faculty of Rehabilitation Science, Health Sciences University of Hokkaido, Ishikari, Japan
| | - Yuji Sasaki
- Department of PhysicalTherapy, Faculty of Rehabilitation Science, Health Sciences University of Hokkaido, Ishikari, Japan
| | - Tomoya Hayashi
- Department of Rehabilitation, Do-nan Royal Hospital, Kuon, Japan
| | - Kumiko Okino
- Department of Clinical Laboratory, Health Sciences University of Hokkaido Hospital, Sapporo, Japan
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Postural Adjustments in HTLV-1 Infected Patients during a Self-Initiated Perturbation. Viruses 2022; 14:v14112389. [PMID: 36366487 PMCID: PMC9695886 DOI: 10.3390/v14112389] [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: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Human T-cell lymphotropic virus type 1 (HTLV-1) infection can be associated with tropical spastic paraparesis (TSP/HAM), which causes neurological myelopathy and sensory and muscle tone alterations, leading to gait and balance impairments. Once trunk perturbation is predicted, the motor control system uses anticipatory and compensatory mechanisms to maintain balance by recruiting postural muscles and displacement of the body's center of mass. METHODS Twenty-six participants (control or infected) had lower limb muscle onset and center of pressure (COP) displacements assessed prior to perturbation and throughout the entire movement. RESULTS Semitendinosus (ST) showed delayed onset in the infected group compared to the control group. The percentage of trials with detectable anticipatory postural adjustment was also lower in infected groups in the tibialis anterior and ST. In addition, COP displacement in the infected group was delayed, had a smaller amplitude, and took longer to reach the maximum displacement. CONCLUSIONS HTLV-1 infected patients have less efficient anticipatory adjustments and greater difficulty recovering their postural control during the compensatory phase. Clinical assessment of this population should consider postural stability during rehabilitation programs.
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Sung PS, Park MS. Ankle reaction times with tray usage following a slip perturbation between subjects with and without chronic low back pain. Gait Posture 2022; 97:196-202. [PMID: 35988435 DOI: 10.1016/j.gaitpost.2022.07.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/29/2022] [Accepted: 07/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormal stepping strategies have been associated with handheld tasks in subjects with chronic low back pain (LBP). However, the dominant ankle reactions of subjects with LBP remain unclear following a perturbation during handheld tasks. RESEARCH QUESTION Are there differences in the reaction times of the ankle muscles during handheld tasks between subjects with and without LBP following a treadmill-induced slip perturbation? METHODS Thirty-seven right limb dominant subjects with LBP and 37 subjects without LBP participated in the study. Each subject was introduced to a slip perturbation (1.37 m/sec velocity for 8.22 cm) with and without a handheld tray in random order. Subjects were allowed to recover by stepping forward for a 0.12 s duration while bilateral tibialis anterior (TA) and gastrocnemius (GA) muscle reaction times were measured by electromyography (EMG). RESULTS The EMG results indicated that the groups demonstrated significant interactions on the limb sides and muscles (F = 4.86, p = 0.03). The dominant TA reaction time was significantly faster in the LBP group (t = 2.14, p = 0.03) while holding a tray. SIGNIFICANCE The LBP group demonstrated faster reaction times on the dominant TA muscles during perturbations. Clinicians need to consider dominance-dependent compensatory ankle dorsiflexion strategies in LBP patients to help enhance dynamic balance and control.
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Affiliation(s)
- Paul S Sung
- Doctor of Physical Therapy Program, Indiana Wesleyan University, USA.
| | - Moon Soo Park
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Republic of Korea
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Impact of pathological conditions on postural reflex latency and adaptability following unpredictable perturbations: A systematic review and meta-analysis. Gait Posture 2022; 95:149-159. [PMID: 35500364 DOI: 10.1016/j.gaitpost.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pathological conditions can impair responses to postural perturbations and increase risk of falls. RESEARCH QUESTION To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes? METHODS MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861). RESULTS Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3). CONCLUSIONS This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms); pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.
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Saadat Z, Pirouzi S, Nami M, Rojhani-Shirazi Z. Quantitative Electroencephalography and Surface Electromyography Correlations upon Predictable and Unpredictable Perturbation in Older Adults. J Biomed Phys Eng 2022; 12:257-266. [PMID: 35698538 PMCID: PMC9175129 DOI: 10.31661/jbpe.v0i0.2004-1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/15/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Quantitative Electroencephalography (qEEG) is a non-invasive method used to quantify electrical activity over the cortex. QEEG provides an accurate temporal resolution of the brain activity, making it a useful tool for assessing cortical function during challenging tasks. OBJECTIVE This study aimed to investigate postural adjustments in older adults in response to an external perturbation. MATERIAL AND METHODS In this observational study, nineteen healthy older adults were involved. A 32-channel qEEG was employed to track alterations in beta power on the electrodes over the two sensory-motor areas. Integrated electromyographic activity (IntEMG) of the leg muscles was evaluated in response to perturbations under predictable and unpredictable conditions. RESULTS The results indicated higher beta power during late-phase in the Cz electrode in both conditions. IntEMG was significantly greater in the tibialis anterior muscle during both conditions in the CPA epoch. In predictable condition, a positive correlation was found between the beta power over C4 (r = 0.560, p = 0.013) and C3 (r = 0.458, p = 0.048) electrodes and tibialis anterior muscle amplitude, and between beta power in C4 and gastrocnemius amplitude (r = 0.525, p = 0.021). In unpredictable condition, there was a positive correlation between beta power over the C4 and the tibialis anterior amplitude (r = 0.580, p = 0.009) and also it over the C3 and the tibialis anterior amplitude (r = 0.452, p = 0.049). CONCLUSION Our findings demonstrate that sensorimotor processing occurs in the brain during response to perturbation. Furthermore, cortical activity appeared to be greatest during the recruitment of the muscles upon late-phase in older adults.
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Affiliation(s)
- Zahra Saadat
- PhD Candidate, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soraya Pirouzi
- PhD, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nami
- MD, PhD, Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- MD, PhD, Neuroscience Center, Instituto De Investigaciones Científicasy Servicios De Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, Republic of Panama
| | - Zahra Rojhani-Shirazi
- PhD, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- PhD, Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Monaghan AS, Johansson H, Torres A, Brewer GA, Peterson DS. The impact of divided attention on automatic postural responses: A systematic review and meta-analysis. Exp Gerontol 2022; 162:111759. [PMID: 35245641 DOI: 10.1016/j.exger.2022.111759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/28/2022]
Abstract
Quick responses to a loss of balance or "automatic postural responses" (APRs) are critical for fall prevention. The addition of a distracting task- dual-tasking (DT), typically worsens performance on mobility tasks. However, the effect of DT on APRs is unclear. We conducted a systematic review and meta-analyses to examine the effects of DT on spatial, temporal, and neuromuscular components of APRs and the effect of DT on cognitive performance. A Meta-analysis of 19 cohorts (n = 329) showed significant worsening in spatial kinematic features of APRs under DT conditions (P = 0.01), and a meta-analysis of 9 cohorts (n = 123) demonstrated later muscle onset during DT (P = 0.003). No significant DT effect was observed for temporal kinematic outcomes in 18 cohorts (n = 328; P = 0.47). Finally, significant declines in cognitive performance were evident in 20 cohorts (n = 400; P = 0.002). These results indicate that, despite the somewhat reactive nature of APRs, the addition of a secondary task negatively impacts some aspects of the response. These findings underscore the importance of cortical structures in APR generation. Given the importance of APRs for falls, identifying aspects of APRs that are altered under DT may inform fall-prevention treatment approaches.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, N 5th St. Phoenix, AZ 85282, USA.
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.
| | - Alexis Torres
- Department of Psychology, Arizona State University, 950 S McAllister Ave, Tempe, AZ, USA.
| | - Gene A Brewer
- Department of Psychology, Arizona State University, 950 S McAllister Ave, Tempe, AZ, USA.
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, N 5th St. Phoenix, AZ 85282, USA; Phoenix VA Health Care Center, 650 E Indian School Rd, Phoenix, AZ, USA.
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Lin S, Zhu B, Zheng Y, Liu S, Wang C. Effect of RUSI-based core stability exercise on chronic non-specific low back pain patients: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e047317. [PMID: 34907039 PMCID: PMC8671944 DOI: 10.1136/bmjopen-2020-047317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is one of the most highly prevalent pain both in developed countries and low-income and middle-income countries. Despite increasing healthcare resources and numerous treatment methods for LBP, the efficacy of these therapeutic strategies is still uncertain. Recently, core stability exercise (CSE) is popularly applied as a preventive or rehabilitative method in the treatment of LBP. However, the adequate activation of the local muscle systems of CSE needs further optimisation and quantification. This trial aims to investigate the feasibility and efficacy of CSE monitored by real-time ultrasound image (RUSI) on LBP individuals. METHODS AND ANALYSIS Forty subjects with chronic non-specific LBP (CNLBP), aged from 20 to 50 years, will be randomly allocated into two groups using sealed, consecutively numbered opaque envelopes: (1) study group (SG): CSE monitored by RUSI and (2) control group (CG): identical CSE without monitoring. Interventions will last 30 mins, two times a week for 8 weeks. The primary outcomes include pain intensity, disability and quality of life, and the secondary outcomes will be the postural control static stability, onset timing of trunk muscles activation, ultrasound images of muscle thickness and surface electromyography (sEMG) signal of muscle activities. Outcome measures will be collected at baseline, 4 and 8 weeks during training, and at 6 months follow-up. Data will be collected and analysed by an assessor blinded to group allocation. Effect sizes and mixed-model repeated measures analysis of variance (2 groups×4 time points) will be calculated. ETHICS AND DISSEMINATION This protocol and informed consent has been approved by the Institutional Research Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University (Approval number: [2020] 254-1). The findings of this study will be disseminated to participants through social networks and will be submitted to peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2000034498).
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Affiliation(s)
- Shanshan Lin
- Department of Rehabilitation Medicine, Jiangmen Central Hospital, Jiangmen, Guangdong, China
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Bo Zhu
- Department of Hepatobiliary Surgery, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Yiyi Zheng
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Shufeng Liu
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
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A Study on the Relationship between Postural Control and Pain-Related Clinical Outcomes in Patients with Chronic Nonspecific Low Back Pain. Pain Res Manag 2021; 2021:9054152. [PMID: 34765050 PMCID: PMC8577937 DOI: 10.1155/2021/9054152] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/22/2021] [Accepted: 10/16/2021] [Indexed: 11/17/2022]
Abstract
Objectives To explore the relationship between postural control and pain-related clinical outcomes in patients with chronic nonspecific low back pain (cNLBP). Methods Participants with cNLBP and healthy individuals were recruited. Muscle activities were recorded during internal and external perturbation tasks. Postural control capacity was assessed by muscle onset time and integrals of electromyography (iEMGs) of postural muscles during the phases of anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs). Correlation analysis was employed to investigate the relationship between postural control capacity, pain, and disability. Results Twenty-seven patients with cNLBP and 27 healthy participants were recruited. Gastrocnemius (GA) muscle onset time was earlier in the cNLBP group than in the control group in the internal perturbation task. The onset time of GA and erector spinae (ES) of the cNLBP group was later than that of the controls in the external perturbation task. Disability level moderately correlated with the iEMGs of rectus abdominis (RA), GA, and external oblique (EO) during APAs. Pain score moderately correlated with the iEMGs of RA, EO, and ES during CPAs of perturbation tasks. Conclusion cNLBP participants had altered muscle activation strategy to maintain postural stability in response to perturbation. This study further discovered that pain-related disabilities of cNLBP participants were likely related to the APAs capacity, whereas the pain intensity may relate to the CPAs capacity. Pain and disability may therefore be related to the control process of the posture-related muscles.
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Amici C, Ragni F, Piovanelli B, Buraschi R, Faglia R, Negrini S, Pollet J. Quantitative analysis of voluntary movement and anticipatory postural adjustments: a functional approach. Comput Methods Biomech Biomed Engin 2021; 24:1660-1669. [PMID: 33797980 DOI: 10.1080/10255842.2021.1906866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Daily living activities and tasks like standing forward reaching present complex Anticipatory Postural Adjustments (APAs), and an objective, repeatable, subject- and task-dependent procedure to detect Voluntary Movements (VM) and APAs onsets is still missing. This paper proposes a new approach to the VMs study, based on a functional mechanical interpretation of the movement performing, which allows defining kinematic and dynamic APAs. A protocol for the identification of VMs and APAs onsets in the reaching movement is presented. Acquired data on 9 healthy young subjects enable a preliminary validation of this method suitability as support for an objective quantification of APAs.
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Affiliation(s)
- Cinzia Amici
- Mechanical and Industrial Engineering Department, University of Brescia, Brescia, Italy
| | - Federica Ragni
- Mechanical and Industrial Engineering Department, University of Brescia, Brescia, Italy
| | | | | | - Rodolfo Faglia
- Mechanical and Industrial Engineering Department, University of Brescia, Brescia, Italy
| | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,University of Milan "La Statale," Milan, Italy
| | - Joel Pollet
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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Postural adjustments impairments in elderly people with chronic low back pain. Sci Rep 2021; 11:4783. [PMID: 33637810 PMCID: PMC7910566 DOI: 10.1038/s41598-021-83837-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/09/2021] [Indexed: 11/08/2022] Open
Abstract
Chronic low back pain (CLBP) is associated with postural control impairments and is highly prevalent in elderly people. The objective of this study is to verify whether anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) are affected by CLBP in elderly people by assessing their postural control during a self-initiated perturbation paradigm induced by rapid upper arm movement when pointing to a target. The participants’ lower limb muscle onset and center of pressure (COP) displacements were assessed prior to perturbation and throughout the entire movement. T0 moment (i.e., the beginning of the movement) was defined as the anterior deltoid (DEL) onset, and all parameters were calculated with respect to it. The rectus femoris (RT), semitendinosus (ST), and soleous (SOL) showed delayed onset in the CLBP group compared with the control group: RF (control: − 0.094 ± 0.017 s; CLBP: − 0.026 ± 0.012 s, t = 12, p < 0.0001); ST (control: − 0.093 ± 0.013 s; CLBP: − 0.018 ± 0.019 s, t = 12, p < 0.0001); and SOL (control: − 0.086 ± 0.018 s; CLBP: − 0.029 ± 0.015 s, t = 8.98, p < 0.0001). In addition, COP displacement was delayed in the CLBP group (control: − 0.035 ± 0.021 s; CLBP: − 0.015 ± 0.009 s, t = 3; p = 0.003) and presented a smaller amplitude during APA COPAPA [control: 0.444 cm (0.187; 0.648); CLBP: 0.228 cm (0.096; 0.310), U = 53, p = 0.012]. The CLBP group required a longer time to reach the maximum displacement after the perturbation (control: 0.211 ± 0.047 s; CLBP 0.296 ± 0.078 s, t = 3.582, p = 0.0013). This indicates that CLBP elderly patients have impairments to recover their postural control and less efficient anticipatory adjustments. Our results suggest that people with CLBP have altered feedforward hip and ankle muscle control, as shown from the SOL, ST, and RT muscle onset. This study is the first study in the field of aging that investigates the postural adjustments of an elderly population with CLBP. Clinical assessment of this population should consider postural stability as part of a rehabilitation program.
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Peterson DS, Barajas JS, Denney L, Mehta SH. Backward Protective Stepping During Dual-Task Scenarios in People With Parkinson's Disease: A Pilot Study. Neurorehabil Neural Repair 2020; 34:702-710. [PMID: 32633614 DOI: 10.1177/1545968320935814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction. Reactive movements in response to a loss of balance are altered in people with Parkinson's disease (PD) and are critical for fall prevention. Further, falls are more common while attention is divided. Although divided attention has been shown to impact postural responses in healthy older adults, the impact of dividing attention on reactive balance, and the natural prioritization across postural and cognitive tasks in people with PD is largely unknown. Objectives. To characterize (1) the impact of a secondary cognitive task on reactive postural control and (2) the prioritization across stepping and cognitive tasks in people with PD. Methods. Sixteen people with PD and 14 age-matched controls underwent step-inducing, support-surface perturbations from stance, with and without an auditory Stroop secondary cognitive task. Cognitive, neuromuscular, and protective stepping performance were calculated for single and dual task scenarios. Results. In PD and control participants, cognitive reaction times (P = .001) and muscle onset latency (P = .007), but not protective step outcomes (P > .12 for all) were worse during dual tasking compared with single-task scenarios. Both PD and control groups prioritized the protective stepping task over the cognitive task. Overall, people with PD exhibited worse first-step margin of stability (a measure of protective step performance) than controls (P = .044). Conclusion. This study provides preliminary evidence that people with PD, like age-matched controls, exhibit cognitive and neuromuscular, but not protective step, dual-task interference. The lack of dual-task interference on step performance indicates a postural prioritization for PD and healthy older adults during dual-task protective stepping.
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Affiliation(s)
- Daniel S Peterson
- Arizona State University, Phoenix, AZ, USA.,Phoenix VA Health Care Center, Phoenix, AZ, USA
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Burcal CJ, Needle AR, Custer L, Rosen AB. The Effects of Cognitive Loading on Motor Behavior in Injured Individuals: A Systematic Review. Sports Med 2020; 49:1233-1253. [PMID: 31066022 DOI: 10.1007/s40279-019-01116-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Research suggests that individuals with musculoskeletal injury may have difficulty negotiating physical tasks when they are combined with cognitive loads. OBJECTIVE Our objective was to conduct a systematic review to understand the effects of increased cognitive demand on movement patterns among individuals with musculoskeletal injuries. METHODS A comprehensive search of PubMed, MEDLINE, the Cumulative Index for Nursing and Allied Health Literature (CINAHL), and SPORTDiscus was conducted to find research reports that included a population that had previously experienced an ankle, knee, or low back injury, included an uninjured control group, and assessed a dual-task paradigm. RESULTS Forty-five full-text research reports were assessed, of which 28 studies (six ankle injury, nine knee injury, and 13 low back pain studies) were included in the review. Included studies were assessed for methodological quality and the study design extracted for analysis including the participants, cognitive and physical tasks performed, as well as outcome measures (e.g., three-dimensional kinematics, center of pressure, etc.). All studies included were cross-sectional or case-control with methodological quality scores of 17.8 ± 2.2 out of a possible 22. Twenty-five of the 28 studies found changes in motor performance with dual-task conditions compared with single tasks. Furthermore, 54% of studies reported a significant group by task interaction effect, reporting at least one alteration in injured groups' motor performance under dual-task conditions when compared with an uninjured group. CONCLUSION The results of this systematic review indicate that motor performance is further impaired by placing a cognitive load on individuals in populations with musculoskeletal injury. More demanding tasks such as gait appear to be more affected in injured individuals than simple balance tasks. Future investigators may want to consider the difficulty of the tasks included as well as the impact of dual-task paradigms on rehabilitation programs.
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Affiliation(s)
| | - Alan R Needle
- Department of Health and Exercise Science, Appalachian State University, ASU Box 32071, Boone, NC, 28608, USA.
| | - Lisa Custer
- Department of Kinesiology, Towson University, Towson, MD, USA
| | - Adam B Rosen
- School of Health and Kinesiology, University of Nebraska-Omaha, Omaha, NE, USA
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Nikzad S, Pirouzi S, Taghizadeh S, Hemmati L. Relationship Between Hamstring Flexibility and Extensor Muscle Activity During a Trunk Flexion Task. J Chiropr Med 2020; 19:21-27. [PMID: 33192188 PMCID: PMC7646136 DOI: 10.1016/j.jcm.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 12/26/2019] [Accepted: 02/14/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between hamstring flexibility and electromyography (EMG) muscle parameters in back and lower limb extensor muscles during a trunk flexion task. METHODS Thirty healthy women aged 18 to 30 years with normal hip movement were recruited for this study. Hamstring muscle flexibility was measured with the 90-90 active straight leg raise test. Surface EMG activities were simultaneously recorded from the lumbar erector spinae, gluteus maximus, biceps femoris, semitendinosus, lateral gastrocnemius, and medial gastrocnemius muscles during forward bending. Muscle activity onset and offset, amplitude, and duration were calculated with technical computer software (MATLAB, version 1.6.0). Linear regression analysis was used to investigate the relationships between hamstring flexibility test results and EMG parameters during trunk flexion. In addition, the Friedman test was used to determine the recruitment activity pattern in women with low versus normal hamstring flexibility. RESULTS During flexion, the back extensor muscles in individuals with lower hamstring flexibility test scores were activated and deactivated later, which can lead to delayed flexion-relaxation. Regression analysis did not disclose any significant correlations between hamstring flexibility and other EMG parameters (duration and amplitude) in back extensor muscles. Activation and deactivation recruitment patterns differed between the groups with normal and low hamstring flexibility. CONCLUSION The findings of this study suggest that hamstring flexibility plays an important role in the patterns of trunk and lower limb muscle activity onset, offset, and recruitment.
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Affiliation(s)
- Sousan Nikzad
- Physiotherapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soraya Pirouzi
- Physiotherapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Taghizadeh
- Physiotherapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ladan Hemmati
- Physiotherapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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