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Journal ArticleDOI

Changes in coordination of postural control during dynamic stance in chronic low back pain patients.

01 Nov 2006-Gait & Posture (Elsevier)-Vol. 24, Iss: 3, pp 349-355
TL;DR: In CLBP patients, postural stability under challenging conditions is maintained by an increased sway in AP direction, which may underlie a dysfunction of the peripheral proprioceptive system or the central integration of proprioception information.
About: This article is published in Gait & Posture.The article was published on 2006-11-01. It has received 221 citations till now. The article focuses on the topics: Balance (ability) & Posturography.
Citations
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Journal ArticleDOI
TL;DR: Patients with NSLBP exhibit greater postural instability than healthy controls, signified by greater COP excursions and a higher mean velocity, and the decreased postural stability in NSL BP sufferers seems unrelated to the exact location and pain duration.
Abstract: Over the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While many studies investigated COP excursions in low back pain patients and healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists. Six online databases were systematically searched followed by a manual search of the retrieved papers. The selection criteria comprised papers comparing COP measures derived from bipedal static task conditions on a force-plate of non-specific low back pain (NSLBP) sufferers to those of healthy controls. Sixteen papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data so only a qualitative data analysis was conducted. The majority of the papers (14/16, 88%) concluded that NSLBP patients have increased COP mean velocity and overall excursion as compared to healthy individuals. This was statistically significant in the majority of studies (11/14, 79%). An increased sway in anteroposterior direction was also observed in NSLBP patients. Patients with NSLBP exhibit greater postural instability than healthy controls, signified by greater COP excursions and a higher mean velocity. While the decreased postural stability in NSLBP sufferers further appears to be associated with the presence of pain, it seems unrelated to the exact location and pain duration. No correlation between the pain intensity and the magnitude of COP excursions could be identified.

281 citations


Cites background or methods from "Changes in coordination of postural..."

  • ...[2] Normal stance, EO/F 20 3 mVel (AP)...

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  • ...A minority used three or more trial repetitions [2, 19, 21, 26, 29, 33]....

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  • ...Experimentally induced pain into the biceps muscle, for example, did not exhibit any significant effect on postural sway [2], while a similar injection of levo-ascorbic acid (L-AS) into the feet elicited the same basic COP pattern found in chronic LBP sufferers....

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  • ...With few exceptions [2, 20, 23, 31], most of the studies conducted the trials under visual deprivation while only four [24, 28, 32, 38] applied a sampling duration that has shown sufficient reliability [36]....

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  • ...[2] Unclear Unclear 0 ? 0 ? ?? Popa et al....

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Journal ArticleDOI
TL;DR: It is concluded that young persons with recurrent LBP seem to use the same proprioceptive postural control strategy even in conditions when this ankle strategy is not the most appropriate such as standing on an unstable support surface.
Abstract: Persons with recurrent low back pain (LBP) have been observed to have altered proprioceptive postural control. These patients seem to adopt a body and trunk stiffening strategy and rely more on ankle proprioception to control their posture during quiet upright standing. The aim of this study is to determine the effect of changing postural condition (stable and unstable support surface) on postural stability and proprioceptive postural control strategy in persons with recurrent LBP. Postural sway characteristics of 21 persons with recurrent LBP and 24 healthy individuals were evaluated in upright posture with or without standing on “foam” for the conditions as follows: (1) control (no vibration); (2) vibration of the triceps surae muscles; (3) paraspinal muscle vibration; (4) vibration of the tibialis anterior muscles. Vision was occluded in all conditions except for one control trial. All trials lasted 60 s. Vibration (60 Hz, 0.5 mm), as a potent stimulus for muscle spindles, was initiated 15 s after the start of the trial for a duration of 15 s. Persons with recurrent LBP showed significantly different postural control strategies favoring ankle muscle proprioceptive control (ratio closer to 1) instead of paraspinal muscle proprioceptive control (ratio closer to 0) for both standing without foam (ratio ankle muscle/paraspinal muscle control = 0.83) (P < 0.0001) and on foam (ratio ankle muscle/paraspinal muscle control = 0.87; P < 0.0001) compared to healthy individuals (0.67 and 0.46, respectively). It is concluded that young persons with recurrent LBP seem to use the same proprioceptive postural control strategy even in conditions when this ankle strategy is not the most appropriate such as standing on an unstable support surface. The adopted proprioceptive postural control strategy might be effective in simple conditions, however, when used in all postural conditions this could be a mechanism to undue spinal loading, pain and recurrences.

251 citations


Cites background or result from "Changes in coordination of postural..."

  • ...These results are in agreement with previous studies where no significant differences in postural sways could be found between persons with and without LBP during quiet standing conditions [13, 30]....

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  • ...Assessment in several postural conditions with different degrees of complexity will be necessary as simple postural conditions would not be sufficient to detect differences [13, 23, 30]....

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Journal ArticleDOI
TL;DR: This article re-examines the original findings and the principles of core stability/spinal stabilisation approaches and how well they fare within the wider knowledge of motor control, prevention of injury and rehabilitation of neuromuscular and musculoskeletal systems following injury.

178 citations

Journal ArticleDOI
TL;DR: The results suggest that young persons with recurrent LBP have an altered body inclination that might be caused by anticipation of postural instability, and the adopted forward inclined posture may potentially be a factor in the recurrence of LBP.

157 citations

Journal ArticleDOI
TL;DR: The factors and challenges in the automated recognition of such expressions and behaviour are described and potential avenues for development of such systems are discussed by discussing potential avenues in the context of these findings.
Abstract: Pain-related emotions are a major barrier to effective self rehabilitation in chronic pain. Automated coaching systems capable of detecting these emotions are a potential solution. This paper lays the foundation for the development of such systems by making three contributions. First, through literature reviews, an overview of how pain is expressed in chronic pain and the motivation for detecting it in physical rehabilitation is provided. Second, a fully labelled multimodal dataset (named ‘EmoPain’ ) containing high resolution multiple-view face videos, head mounted and room audio signals, full body 3D motion capture and electromyographic signals from back muscles is supplied. Natural unconstrained pain related facial expressions and body movement behaviours were elicited from people with chronic pain carrying out physical exercises. Both instructed and non-instructed exercises were considered to reflect traditional scenarios of physiotherapist directed therapy and home-based self-directed therapy. Two sets of labels were assigned: level of pain from facial expressions annotated by eight raters and the occurrence of six pain-related body behaviours segmented by four experts. Third, through exploratory experiments grounded in the data, the factors and challenges in the automated recognition of such expressions and behaviour are described, the paper concludes by discussing potential avenues in the context of these findings also highlighting differences for the two exercise scenarios addressed.

144 citations


Cites background from "Changes in coordination of postural..."

  • ...This could even lead to impairment in motor control where there is proprioceptive dysfunction [14]....

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References
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Journal Article
TL;DR: Soms is het moeilijk om tussen twee vakjes te kiezen, kruis dan het vakje aan dat uw huidig probleem het best beschrijft.

4,022 citations


"Changes in coordination of postural..." refers methods in this paper

  • ...Selfreported disability was assessed with the Oswestry Low Back Pain Disability Questionnaire [33]....

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Journal ArticleDOI
TL;DR: Exposing subjects to horizontal surface perturbations while standing on support surfaces intermediate in length between the shortest and longest elicited more complex postural movements and associated muscle activation patterns that resembled ankle and hip strategies combined in different temporal relations.
Abstract: We studied the extent to which automatic postural actions in standing human subjects are organized by a limited repertoire of central motor programs. Subjects stood on support surfaces of various lengths, which forced them to adopt different postural movement strategies to compensate for the same external perturbations. We assessed whether a continuum or a limited set of muscle activation patterns was used to produce different movement patterns and the extent to which movement patterns were influenced by prior experience. Exposing subjects standing on a normal support surface to brief forward and backward horizontal surface perturbations elicited relatively stereotyped patterns of leg and trunk muscle activation with 73- to 110-ms latencies. Activity began in the ankle joint muscles and then radiated in sequence to thigh and then trunk muscles on the same dorsal or ventral aspect of the body. This activation pattern exerted compensatory torques about the ankle joints, which restored equilibrium by moving the body center of mass forward or backward. This pattern has been termed the ankle strategy because it restores equilibrium by moving the body primarily around the ankle joints. To successfully maintain balance while standing on a support surface short in relation to foot length, subjects activated leg and trunk muscles at similar latencies but organized the activity differently. The trunk and thigh muscles antagonistic to those used in the ankle strategy were activated in the opposite proximal-to-distal sequence, whereas the ankle muscles were generally unresponsive. This activation pattern produced a compensatory horizontal shear force against the support surface but little, if any, ankle torque. This pattern has been termed the hip strategy, because the resulting motion is focused primarily about the hip joints. Exposing subjects to horizontal surface perturbations while standing on support surfaces intermediate in length between the shortest and longest elicited more complex postural movements and associated muscle activation patterns that resembled ankle and hip strategies combined in different temporal relations. These complex postural movements were executed with combinations of torque and horizontal shear forces and motions of ankle and hip joints. During the first 5-20 practice trials immediately following changes from one support surface length to another, response latencies were unchanged. The activation patterns, however, were complex and resembled the patterns observed during well-practiced stance on surfaces of intermediate lengths.(ABSTRACT TRUNCATED AT 400 WORDS)

2,212 citations


"Changes in coordination of postural..." refers background in this paper

  • ...In normal adults, postural adjustments during quiet standing are generally achieved using an ‘‘ankle strategy’’ [23], in which the ankle torque maintains the center of force over the base of support....

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Journal ArticleDOI
TL;DR: This chapter discusses anticipatory postural adjustments associated with equilibrium maintenance in the context of dual-modular approach to posture versus global approach to equilibrium.

1,510 citations


"Changes in coordination of postural..." refers background in this paper

  • ...This information, which allows to assess the position and motion of the body in space, is constantly reweighted so as to generate the appropriate forces to control and maintain balance in a wide range of situations [6]....

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  • ...009 The human postural system operates on the basis of the integrated information from three independent sensory sources: somatosensory, vestibular and visual inputs [6]....

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Journal ArticleDOI
TL;DR: The intent of this study was to discover the stabilizing role of stretch reflexes acting upon the ankle musculature while human subjects performed stance tasks requiring several different postural “sets”.
Abstract: Doubt about the role of stretch reflexes in movement and posture control has remained in part because the questions of reflex “usefulness” and the postural “set” have not been adequately considered in the design of experimental paradigms. The intent of this study was to discover the stabilizing role of stretch reflexes acting upon the ankle musculature while human subjects performed stance tasks requiring several different postural “sets”. Task specific differences of reflex function were investigated by experiments in which the role of stretch reflexes to stabilize sway during stance could be altered to be useful, of no use, or inappropriate. Because the system has available a number of alternate inputs to posture (e.g., vestibular and visual), stretch reflex responses were in themselves not necessary to prevent a loss of balance. Nevertheless, 5 out of 12 subjects in this study used long-latency (120 msec) stretch reflexes to help reduce postural sway. Following an unexpected change in the usefulness of stretch reflexes, the 5 subjects progressively altered reflex gain during the succeeding 3–5 trials. Adaptive changes in gain were always in the sense to reduce sway, and therefore could be attenuating or facilitating the reflex response. Comparing subjects using the reflex with those not doing so, stretch reflex control resulted in less swaying when the task conditions were unchanging. However, the 5 subjects using reflex controls oftentimes swayed more during the first 3–5 trials after a change, when inappropriate responses were elicited. Four patients with clinically diagnosed cerebellar deficits were studied briefly. Among the stance tasks, their performance was similar to normal in some and significantly poorer in others. Their most significant deficit appeared to be the inability to adapt long-latency reflex gain following changes in the stance task. The study concludes with a discussion of the role of stretch reflexes within a hierarchy of controls ranging from muscle stiffness up to centrally initiated responses.

997 citations


"Changes in coordination of postural..." refers background in this paper

  • ...However, there is evidence that standing, rather than rely on mechano-reflex mechanisms [2,3], may require activity of higher order structures [4,5]....

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Journal ArticleDOI
TL;DR: The hypothesis that cutaneous and joint somatosensory information from the feet and ankles may play an important role in assuring that the form of postural movements are appropriate for the current biomechanical constraints of the surface and/or foot is supported.
Abstract: This study examines the roles of somatosensory and vestibular information in the coordination of postural responses. The role of somatosensory information was examined by comparing postural responses of healthy control subjects prior to and following somatosensory loss due to hypoxic anesthesia of the feet and ankles. The role of vestibular information was evaluated by comparing the postural responses of control subjects and patients with bilateral vestibular loss. Postural responses were quantified by measuring 1) spatial and temporal characteristics of leg and trunk EMG activation; 2) ankle, knee, and hip joint kinematics, and 3) surface forces in response to anterior and posterior surface translations under different visual and surface conditions. Results showed that neither vestibular nor somatosensory loss resulted in delayed or disorganized postural responses. However, both types of sensory deficits altered the type of postural response selected under a given set of conditions. Somatosensory loss resulted in an increased hip strategy for postural correction, similar to the movement strategy used by control subjects while standing across a shortened surface. Vestibular loss resulted in a normal ankle strategy but lack of a hip strategy, even when required for the task of maintaining equilibrium on a shortened surface. Neither somatosensory nor vestibular loss resulted in difficulty in utilizing remaining sensory information for orientation during quiet stance. These results support the hypothesis that cutaneous and joint somatosensory information from the feet and ankles may play an important role in assuring that the form of postural movements are appropriate for the current biomechanical constraints of the surface and/or foot. The results also suggest that vestibular information is necessary in controlling equilibrium in a task requiring use of the hip strategy. Thus, both somatosensory and vestibular sensory information play important roles in the selection of postural movement strategies appropriate for their environmental contexts.

879 citations


"Changes in coordination of postural..." refers background in this paper

  • ...A loss of somatosensory information from the lower limbs, resulting from a disease or an experimental manipulation, has been shown to induce postural control abnormalities [39,46]....

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  • ...clinical practice [39], evaluates utilization of visual, vestibular and proprioceptive sensors by manipulating the accuracy of visual and/or somatosensory inputs during quiet stance [36]....

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