Research studies focusing on the fear-avoidance model have expanded considerably since the review by Vlaeyen and Linton (Vlaeyen J. W. S. & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317--332). The fear-avoidance model is a cognitive-behavioral account that explains why a minority of acute low back pain sufferers develop a chronic pain problem. This paper reviews the current state of scientific evidence for the individual components of the model: pain severity, pain catastrophizing, attention to pain, escape/avoidance behavior, disability, disuse, and vulnerabilities. Furthermore, support for the contribution of pain-related fear in the inception of low back pain, the development of chronic low back pain from an acute episode, and the maintenance of enduring pain, will be highlighted. Finally, available evidence on recent clinical applications is provided, and unresolved issues that need further exploration are discussed.

The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.

Quasi-experimentation - design and analysis issues for field settings - cook,td, campbell,dt

Electromyography (EMG) signals can be used for clinical/biomedical applications, Evolvable Hardware Chip (EHW) development, and modern human computer interaction. EMG signals acquired from muscles require advanced methods for detection, decomposition, processing, and classification. The purpose of this paper is to illustrate the various methodologies and algorithms for EMG signal analysis to provide efficient and effective ways of understanding the signal and its nature. We further point up some of the hardware implementations using EMG focusing on applications related to prosthetic hand control, grasp recognition, and human computer interaction. A comparison study is also given to show performance of various EMG signal analysis methods. This paper provides researchers a good understanding of EMG signal and its analysis procedures. This knowledge will help them develop more powerful, flexible, and efficient applications.

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Techniques of EMG signal analysis: detection, processing, classification and applications

Spinal orthoses are common in the treatment of various conditions that affect the spine. They encompass both the spine and pelvis and thus have implications for pelvic and lower-limb motion during walking in addition to a direct effect on spinal motion. The role of the spine in walking is largely ill-defined, and the consequences of restricted spinal motion on walking have yet to be explored. This study investigated the effect of spinal restriction on gait in able-bodied persons. Gait analyses were performed on 10 able-bodied subjects as they walked at five different speeds that were distributed across their comfortable range of speeds. Data were collected during walking with and without spinal restriction by a fiberglass body jacket, which is similar to a thoracolumbosacral orthosis (TLSO). With spinal restriction, peak-to-peak (PP) pelvic obliquity and rotation were significantly reduced across all walking speeds (p < 0.001), while PP pelvic tilt was significantly reduced at only the fastest walking speeds (p = 0.017). PP hip abduction-adduction motion was significantly reduced with spinal restriction across all speeds (p < 0.001), while PP hip flexion-extension significantly increased at only the slow and very slow speeds (p < 0.001 and p = 0.023, respectively). A better understanding of the effects of restricted spinal motion on gait may help clinicians predict and avoid development of additional problems from TLSO use or surgical restriction of spinal motion. An awareness of these issues will enable clinicians to monitor patients for problems that may result from decreased spine and pelvic motion.

/pdf/systematic-review-of-the-effect-of-robot-aided-therapy-on-2s0c9l69dr.pdf

Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke.

Background
Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT.

/pdf/what-is-the-evidence-for-physical-therapy-poststroke-a-9oycnv3dy7.pdf

What is the evidence for physical therapy poststroke? A systematic review and meta-analysis.

Objective: Electrical stimulation can be applied in a variety of ways to the hemiparetic upper extremity following stroke. The aim of this review is to explore the relationship between characteristics of stimulation and the effect of electrical stimulation on the recovery of upper limb motor control following stroke. Methods: A systematic literature search was performed to identify clinical trials evaluating the effect of electrical stimulation on motor control. The reported outcomes were examined to identify a possible relationship between the reported effect and the following characteristics: duration of stimulation, method of stimulation, setting of stimulation parameters, target muscles and stage after stroke. Results: Nineteen clinical trials were included, and the results of 22 patient groups were evaluated. A positive effect of electrical stimulation was reported for 13 patient groups. Positive results were more common when electrical stimulation was triggered by voluntary movement rather than when non-triggered electrical stimulation was used. There was no relation between the effect of electrical stimulation and the other characteristics examined. Conclusion: Triggered electrical stimulation may be more effective than non-triggered electrical stimulation in facilitating upper extremity motor recovery following stroke. It appears that the specific stimulus parameters may not be crucial in determining the effect of electrical stimulation.

/pdf/relation-between-stimulation-characteristics-and-clinical-1nv864dcta.pdf

Relation between stimulation characteristics and clinical outcome in studies using electrical stimulation to improve motor control of the upper extremity in stroke

https://www.archives-pmr.org/article/S0003-9993(03)00949-3/pdf

Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making

Study Design: In a cross-sectional study, surface electromyography
measurements of the upper trapezius
muscles were obtained during different functional tasks in
patients with a chronic whiplash associated disorder
Grade II and healthy control subjects. - 
Objectives: To investigate whether muscle dysfunction
of the upper trapezius muscles, as assessed by surface
electromyography, can be used to distinguish patients
with whiplash associated disorder Grade II from
healthy control subjects. - 
Summary of Background Information: In the whiplash
associated disorder, there is need to improve the diagnostic
tools. Whiplash associated disorder Grade II is
characterized by the presence of “musculoskeletal signs.”
Surface electromyography to assess these musculoskeletal
signs objectively may be a useful tool. - 
Methods: Normalized smoothed rectified electromyography
levels of the upper trapezius muscles of patients
with whiplash associated disorder Grade II (n 5 18) and
healthy control subjects (n 5 19) were compared during
three static postures, during a unilateral dynamic manual
exercise, and during relaxation after the manual exercise.
Coefficients of variation were computed to identify the
measurement condition that discriminated best between
the two groups. - 
Results: The most pronounced differences between
patients with whiplash associated disorder Grade II and
healthy control subjects were found particularly in situations
in which the biomechanical load was low. Patients
showed higher coactivation levels during physical exercise
and a decreased ability to relax muscles after physical
exercise. - 
Conclusions: Patients with whiplash associated disorder
Grade II can be distinguished from healthy control
subjects according to the presence of cervical muscle
dysfunction, as assessed by surface electromyography of
the upper trapezius muscles. Particularly the decreased
ability to relax the trapezius muscles seems to be a promising
feature to identify patients with whiplash associated
disorder Grade II. Assessment of the muscle (dys)function
by surface electromyography offers a refinement of the
whiplash associated disorder classification and provides
an indication to a suitable therapeutic approach. [Key
words: whiplash associated disorder, muscle dysfunction,
surface electromyography, upper trapezius muscle,
static, dynamic, relaxation]

Cervical muscle dysfunction in the chronic whiplash associated disorder grade II (WAD-II).

Electromyography in the biomechanical analysis of human movement and its clinical application.

Study Design. Surface electromyography measurements of the upper trapezius muscles were performed in patients with a chronic whiplash-associated disorder Grade 2 and those with nonspecific neck pain.

Objective. To determine the etiologic relation between acceleration–deceleration trauma and the presence of cervical muscle dysfunction in the chronic stage of whiplash-associated disorder.

Summary of Background Information. From a biopsychosocial perspective, the acceleration–deceleration trauma in patients with whiplash-associated disorder is not regarded as a cause of chronicity of neck pain, but rather as a risk factor triggering response systems that contribute to the maintenance of neck pain. One of the contributing factors is dysfunction of the cervical muscles. Considering the limited etiologic significance of the trauma, it is hypothesized that in patients with neck pain, there are no differences in muscle activation patterns between those with and those without a history of an acceleration–deceleration trauma.

Methods. Muscle activation patterns, expressed in normalized smooth rectified electromyography levels of the upper trapezius muscles, in patients with whiplash-associated disorder Grade 2 were compared with those of patients with nonspecific neck pain. The outcome parameters were the mean level of muscle activity before and after a physical exercise, the muscle reactivity in response to the exercise, and the time-dependent behavior of muscle activity after the exercise.

Results. There were no statistical significant differences in any of the outcome parameters between patients with whiplash-associated disorder Grade 2 and those with nonspecific neck pain. There was only a tendency of higher muscle reactivity in patients with whiplash-associated disorder Grade 2.

Conclusions. It appears that the cervical muscle dysfunction in patients with chronic whiplash-associated disorder Grade 2 is not related to the specific trauma mechanism. Rather, cervical muscle dysfunction appears to be a general sign in diverse chronic neck pain syndromes

G. Zilvold

Papers

Relation between stimulation characteristics and clinical outcome in studies using electrical stimulation to improve motor control of the upper extremity in stroke

Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making

Cervical muscle dysfunction in the chronic whiplash associated disorder grade II (WAD-II).

Electromyography in the biomechanical analysis of human movement and its clinical application.

Cervical muscle dysfunction in chronic whiplash-associated disorder grade 2: the relevance of the trauma.