Movement Control Impairment Research Articles

Persistence, not avoidance, is associated with low back pain-An observational cohort study.

Low back pain (LBP) is increasingly understood as a long-lasting condition with a variable course. Avoidance and persistence behaviour have been described to mediate pain persistence by potentially linking psychosocial factors and biomechanics. The resulting maladaptive changes in musculoskeletal structures can result in movement control impairment (MCI). This investigation aimed to observe avoidance and persistence behaviour and MCI in participants with acute LBP over 1 year and explore their association with pain persistence. In this observational cohort study, 165 participants were assessed at five time points: ≤ 1 month (baseline), 2, 3, 6, and 12 months after the onset of acute LBP. Simultaneously collected clinical data such as self-reported outcomes at baseline for avoidance and persistence and assessments of MCI were filled in linear mixed-effects regression models. The mixed-effects analysis revealed for the adjusted model that a one-point increase in persistence scores resulted in a 3.31-point increase in pain intensity while interacting with state anxiety over time (p = 0.05, 95% confidence interval 0.07-6.07). This effect was not found for avoidance behaviour at baseline (p = 0.21) and MCI. The relationship between persistence and pain intensity throughout measurement suggests that continuing usual activities beyond pain, coupled with feelings of distress, may lead to persistent LBP. These results underscore the need for a therapeutic shift toward a multidimensional approach that considers the physical and psychological characteristics of persons with LBP. Screening for activity patterns in acute LBP is critical for providing tailored treatment and counselling. In acute low back pain (LBP), maintaining usual activities despite pain and distress can contribute to the continuation of LBP. Alongside a multidimensional approach that considers physical and psychological factors, attitudes toward daily activities are also important. Screening for both maladaptive and adaptive activity patterns in individuals with acute LBP is essential for effective LBP management, improving patient outcomes, and preventing persistent pain.

Comparison of Single Session Auditory Versus Visual Feedback on Performance and Postural Balance in Hemiplegic Children With Cerebral Palsy.

Cerebral palsy (CP) is a pediatric disorder characterized by a motor impairment resulting from a permanent, non-progressive lesion in the brain. Cerebral palsy is marked by movement and postural control impairments, which greatly affect body structure, function, daily activities, and participation. To compare the single-session auditory versus visual feedback on performance and postural balance in children with hemiplegic cerebral palsy. The study was a crossover clinical trialinvolving a group of 25 patients diagnosed with CP hemiplegia, aged between 6 and 12 years, including both genders. Each patient underwent conventional balance therapy followed by either auditory feedback or visual feedback intervention. After a 48-hour wash-out period, they received conventional balance therapy again before undergoing the alternative intervention initially assigned. The Modified Ashworth scale (MAS), pediatric balance scale (PBS), timed one-leg stance, time up and go test (TUG), and center of pressure (CoP) displacements were assessed as the outcome measures before and after the interventions. Based on the one-leg stand test, TUG, and CoP displacement outcome measures results, both interventions improved balance time, speed of movement, and postural stability in children with hemiplegic spastic cerebral palsy (P < 0.05). Moreover, after a single session of the intervention, the visual feedback group demonstrated a significantly greater improvement in the TUG test, one-leg stand test, and CoP displacement compared to the auditory group (P < 0.05). The results of the study suggest that combining auditory or visual feedback with conventional balance therapy is effective in treating children with hemiplegic spastic cerebral palsy; furthermore, the utilization of visual feedback would be more effective. Further research is needed to determine the long-term effects of visual and auditory feedback on the assessed outcome measures.

Comparative Effects of Dynamic Neuromuscular Stabilization Exercises on Lumbar Proprioception, Movement Control and Functional Activity Limitation in Movement Control Impairment Subgroup of Non-Specific Chronic Low Back Pain: RCT Interim Analysis

Comparative Effects of Dynamic Neuromuscular Stabilization Exercises on Lumbar Proprioception, Movement Control and Functional Activity Limitation in Movement Control Impairment Subgroup of Non-Specific Chronic Low Back Pain: RCT Interim Analysis

Role of the interaction between lumbar kinematics and accelerometer-measured physical activity in bodily pain, physical functioning and work ability among health care workers with low back pain.

The aim of this study was to examine the associations of spinal kinematics and physical activity (PA) with bodily pain, physical functioning, and work ability among health care workers with low back pain (LBP). Spinal kinematics and PA were measured with a wireless Inertial Measurement Unit system (ValedoMotion®) and a waist-worn tri-axial accelerometer (Hookie AM20), respectively. Their association was assessed in relation to Work Ability Index (WAI), bodily pain and physical functioning (RAND-36) in 210 health care workers with recurrent LBP. Greater lumbar movement variability/less deterministic lumbar movement (in angular velocity) during a "Pick Up a Box" functional task was correlated with higher amounts of step counts (r=-0.29, p=0.01) and moderate PA (r=-0.24, p=0.03). A higher amount of PA (p=0.03) as well as less movement control impairment (p=0.04) and movement variability (p=0.03) were associated with greater work ability, whilst greater vigorous PA was the only parameter to explain higher physical functioning (p=0.02). PA and movement variability were relative to each other to explain bodily pain (p=0.01). These findings show the importance of considering the interaction between lumbar kinematics and physical activity while planning strategies to improve bodily pain, physical functioning and work ability among health care workers with LBP.

Hip Muscle Flexibility After Six Weeks of Lumbar Stabilization and Global Postural Reeducation Exercises in Men With Movement Control Dysfunction: A Randomized Clinical Trial

Background: Exercise therapy is one of the most effective methods for dealing with low back pain. The present study aimed to compare to examine the effects of two protocols, i.e., six weeks of lumbar stability exercises (LSE) and global postural reeducation exercises (GPR), followed by a subsequent period of non-training on hip muscle flexibility in men with chronic non-specific low back pain (NSLBP) with lumbar movement control impairment (MCI). Methods: In this randomized clinical trial, 46 men suffering from NSLBP with lumbar MCI were selected and randomly divided into three groups (i.e., two exercise groups - one control group). Training intervention groups were allowed to perform exercises for 6 weeks, three sessions per week. Universal goniometer was used to measure the flexibility of hip muscles (i.e., hamstring, rectus femoris, external rotator, and tensor fasciae latae). Repeated measures ANOVA was utilized to compare the effect and durability of the two training protocols on the dependent variables at a significant level. Results: The results showed that both training methods increased hamstring muscle flexibility (P=0.001). GPR method was found superior in increasing the flexibility of the right hip of the subjects in the post-test (P=0.032) and follow-up (P=0.024). However, no significant differences were observed in the other hip muscles flexibility. Conclusion: It was concluded that the GPR method, compared to the lumbar stabilization method, had a greater potential to increase the flexibility of shortened muscles by enhancing the contraction of the antagonist muscles to avoid postural asymmetry. It seems both training protocols were effective in improving hamstring muscle flexibility in people with NSLBP suffering from MCI and this result was observed after both training and 4 weeks of inactivity.

Intrarater and interrater agreement of a 6-item movement control test battery and the resulting diagnosis in patients with nonspecific chronic low back pain

ABSTRACT Objective To investigate the intrarater and interrater agreement of a 6-item test battery in nonspecific chronic low back pain (LBP) and investigate the agreement between raters to assign the resulting movement control (MC) diagnoses. Methods Thirty patients with chronic LBP (18–30 years) were included in this study. Six raters were trained and rated the videos of the patients during the execution of the tests. After one week, the raters re-watched the videos and repeated the examination. A diagnosis of MC was assigned for each patient. Agreement was analyzed using weighted kappa and prevalence-adjusted and bias-adjusted kappa (PABAK) coefficients. Results We showed an acceptable intrarater agreement for the 6-item test battery for four out of six raters, except for one test: prone knee flexion. The results of the interrater agreement between the three pairs of raters showed acceptable agreement levels (k > 0.4), except for two tests, “rocking on all four backward” and “prone knee flexion test.” For the diagnosis of MC impairment, acceptable agreement levels (k > 0.4) were observed for five out of six raters for intrarater agreement. For interrater assessment, we found an acceptable agreement between pairs of raters. Conclusion We showed acceptable levels of agreement between the intrarater and interrater for a 6-item test battery to identify MC impairment, except for two tests. Agreement in the MC diagnoses achieved acceptable levels for five of the six raters (intrarater) and all three pairs of raters (interrater). Such results support the use of the 6-item test battery to detect MC impairment.

Assessment of Movement Control Impairment in Mechanical Low Back Pain Post Menopause

Assessment of Movement Control Impairment in Mechanical Low Back Pain Post Menopause

Effect of Movement Control Spinal Exercise Programme on Pain and Mobility in Individual with Non-Specific Low Back Pain

Background: Low back pain is the most common condition that affects the majority of the population with up to 84% lifetime prevalence. A specific diagnosis of low back pain is only possible in 15% of patients and the majority of cases the pain is non – specific low back pain (NSLBP). The main objectives were to assess the effect of movement control spinal exercises (MVCSE) on NSLBP and to examine the effect of MCSE on mobility.&#x0D; Methods: The study was conducted in the physiotherapy out-patient department. After screening of the inclusion and exclusion criteria, 35 individuals with NSLBP were selected. A pre-test assessment was done, the protocol included warmup sessions, exercise protocol and cool down sessions. Exercises were demonstrated to the patients according to the spinal movements control impairment, the total duration of the protocol was of 6 weeks with one session of 1 hour per day. Later the post- test assessment was done and further statistical analysis was done.&#x0D; Results: After 6 weeks post evaluation, patients with flexion movement control impairment (MVCI) had improvement in their movement control; extension, lateral and rotational movement control impairments were the same as before.&#x0D; Conclusion: The patient- specific functional complaints and disabilities improved significantly after implementation of the individual based specific exercise programme, along with the regular physiotherapeutic interventions. Movement Control Spinal Exercise treatment has shown results in improving mobility and disability in the short term and long term for individuals with NSLBP and MVCI to than other interventions.

Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain

Motor control exercise (MCE) is commonly prescribed for patients with low back pain. Although MCE can improve clinical outcomes, lumbar multifidus muscle (LM) activation remains unchanged. Neuromuscular electrical stimulation (NMES) can be used to re-activate motor units prior to MCE which should result in increased LM activation. Therefore, this study aimed to explore the immediate effects of NMES combined with MCE on LM activation and motor performance. Twenty-five participants without low back pain (NoLBP) and 35 participants with movement control impairment (MCI) were recruited. Participants with MCI were further randomized to combined NMES with MCE (COMB) or sham-NMES with MCE (MCE) group. Ultrasound imaging was used to measure LM thickness at rest, maximum voluntary isometric contraction (MVIC), and NMES with MVIC. These data were used to calculate LM activation. Quadruped rocking backward was used to represent motor performance. LM activation and motor performance were measured at baseline and after one-session of intervention. Results showed that both COMB and MCE groups had significantly lower (P < 0.05) LM activation compared with NoLBP group at baseline. Additionally, both COMB and MCE groups demonstrated significant improvement (P < 0.05) in motor performance while COMB group demonstrated significantly greater improvement (P < 0.05) in LM activation compared with MCE group. Individuals with MCI still have persisting LM activation deficit. Our key findings suggest that combined NMES and MCE may have better ability to improve LM activation in individuals with MCI. These findings would support the utility of NMES to induce a priming effect before MCE.

The Effect of Exercise Programs on Pain Management and Motor Control in Patients with Nonspecific Chronic Low Back Pain: A Randomized Matched Subjects Trial.

Backgroud:Many exercise approaches have been suggested for the treatment of nonspecific chronic low back pain. However, the best exercise approach is still unknown. The purpose of this study was to compare the effect of three exercise approaches based on the Postural Restoration Institute (PRI) and National Academy of Sports Medicine (NASM) on the pain management and motor control of men with nonspecific chronic low back pain.Methods:The study was designed with matched subjects. Thirty-three participants were randomly assigned to three training groups: NASM (n = 11), PRI (n = 11), and NASM-PRI integration (n = 11). Interventions: The participants in each group performed the exercise for eight weeks, three sessions per week and about one hour each session. Pain was measured using a visual analog scale (VAS) scale and functional disability using the Roland–Morris questionnaire. Also, the movement control impairment was measured by the movement control impairment test set.Results:Repeated measures ANOVA showed no significant interaction effect between pain perception, functional disability, and movement control impairment of the groups (P >.05).Conclusions:The findings suggest that different types of exercise rehabilitation were not significantly different on pain reduction, functional disability, and movement control impairment. It is suggested that the participant's preference for an approach should also be considered for encouraging them to adhere to exercise.

Motor and Cognitive Performance in Patients with Liver Cirrhosis with Minimal Hepatic Encephalopathy.

Minimal hepatic encephalopathy (MHE) is associated with mild cognitive impairment and frailty. This study aims to identify cognitive and motor differences in cirrhotic patients with and without MHE, and the correlations between motor signs and cognitive performance. Gait, balance, hand strength and motor speed performance were evaluated in 66 cirrhotic patients (38 without and 28 with MHE, according to the Psychometric Hepatic Encephalopathy Score (PHES). Cognitive performance was measured with the Mini-Mental State Examination, Verbal Fluency Test, Aprendizaje Verbal España-Complutense Test (TAVEC), Wechsler Adult Intelligence Scale III, Hamilton Depression and Anxiety Rating Scale and Functioning Assessment Short Test (FAST). MHE patients performed worse than patients without MHE in cognitive and autonomous functioning, learning and long-term memory, and verbal fluency. The same pattern was found in gait, center of pressure movement, variability of hand strength performance and hand motor speed. In MHE patients, high correlations were found between balance and FAST test, gait velocity and verbal skills, hand strength variability and anxiety and depression, and motor speed and FAST and TAVEC. MHE patients showed worse motor and cognitive performance than patients without MHE. MHE patients could have impaired movement control expressed as bradykinesia, and this reduced motor performance could correlate with cognitive performance.

Lumbar Movement Dysfunction Based on Movement Control Impairment Classification System in Those Who Do and Do Not Develop Transient Low Back Pain During Prolonged Sitting

ObjectiveLong-term sitting triggers movement-related disorders. We used a movement control impairment (MCI) system to investigate lumbar movement dysfunction in those who did and did not develop transient low back pain (LBP) during prolonged sitting. MethodsTwelve patients who did and did not develop transient LBP during sitting for 2 hours were enrolled. We tested the movement control abilities of the 2 groups using 6 MCI tests (12 test items). ResultsThe mean MCI test score in the transient LBP developer group was significantly higher than that in the LBP non-developer group (P = .03). Lumbar flexion movement control as the backward rocking test was significantly more common in the transient LBP developer than in the LBP non-developer group (P < .027). Pelvic shifting and asymmetry during side-bending of the trunk were evident in both groups (all P > .05). However, pelvic shifting during side-bending of the trunk was evident only in the LBP group (33%; P = .093). ConclusionThe group exhibiting transient LBP had higher positive MCI test scores and exhibited more asymmetry than the other group. Even the non-LBP group exhibited poor lumbar flexion and rotation. Therefore, subjects with subclinical dysfunction caused by prolonged sitting may require homogenous subgroups classification for the early detection of mechanical risk factors and health and functional interventions.

Both reaching and grasping are impacted by temporarily induced paresthesia

Along with visual feedback, somatosensory feedback provides the nervous system with information regarding movement performance. Somatosensory system damage disrupts the normal feedback process, which can lead to a pins and needles sensation, or paresthaesia, and impaired movement control. The present study assessed the impact of temporarily induced median nerve paresthaesia, in individuals with otherwise intact sensorimotor function, on goal-directed reaching and grasping movements. Healthy, right-handed participants performed reach and grasp movements to five wooden Efron shapes, of which three were selected for analysis. Participants performed the task without online visual feedback and in two somatosensory conditions: 1) normal; and 2) disrupted somatosensory feedback. Disrupted somatosensory feedback was induced temporarily using a Digitimer (DS7AH) constant current stimulator. Participants’ movements to shapes 15 or 30 cm to the right of the hand’s start position were recorded using a 3 D motion analysis system at 300 Hz (Optotrak 3 D Investigator). Analyses revealed no significant differences for reaction time. Main effects for paresthaesia were observed for temporal and spatial aspects of the both the reach and grasp components of the movements. Although participants scaled their grip aperture to shape size under paresthaesia, the movements were smaller and more variable. Overall participants behaved as though they perceived they were performing larger and faster movements than they actually were. We suggest the presence of temporally induced paresthaesia affected online control by disrupting somatosensory feedback of the reach and grasp movements, ultimately leading to smaller forces and fewer corrective movements.

Movement Control Impairment and Low Back Pain: State of the Art of Diagnostic Framing.

Background and objectives: Low back pain is one of the most common health problems. In 85% of cases, it is not possible to identify a specific cause, and it is therefore called Non-Specific Low Back Pain (NSLBP). Among the various attempted classifications, the subgroup of patients with impairment of motor control of the lower back (MCI) is between the most studied. The objective of this systematic review is to summarize the results from trials about validity and reliability of clinical tests aimed to identify MCI in the NSLBP population. Materials and Methods: The MEDLINE, Cochrane Library, and MedNar databases have been searched until May 2018. The criteria for inclusion were clinical trials about evaluation methods that are affordable and applicable in a usual clinical setting and conducted on populations aged > 18 years. A single author summarized data in synoptic tables relating to the clinical property; a second reviewer intervened in case of doubts about the relevance of the studies. Results: 13 primary studies met the inclusion criteria: 10 investigated inter-rater reliability, 4 investigated intra-rater reliability, and 6 investigated validity for a total of 23 tests (including one cluster of tests). Inter-rater reliability is widely studied, and there are tests with good, consistent, and substantial values (waiter’s bow, prone hip extension, sitting knee extension, and one leg stance). Intra-rater reliability has been less investigated, and no test have been studied for more than one author. The results of the few studies about validity aim to discriminate only the presence or absence of LBP in the samples. Conclusions: At the state of the art, results related to reliability support the clinical use of the identified tests. No conclusions can be drawn about validity.

WITHDRAWN: Response to letter to editor concerning: Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and metaanalyse

WITHDRAWN: Response to letter to editor concerning: Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and metaanalyse

A comparison of foot kinetic parameters between pronated and normal foot structures during forward jump landing

BackgroundPronated foot is one of the most important factors that may lead to musculoskeletal injuries of the lower extremities. It is known that in a pronated foot, excessive mechanical loads are applied to the lower limb structures, which result in the altered foot biomechanics, including vertical ground reaction forces (VGRFs) and rate of loading (ROL). Therefore, the aim of this study was to determine the changes in foot kinetic parameters in the pronated compared to the normal foot structures. MethodsIn this cross-sectional study, 15 individuals (mean age of 23.27 ± 3.28 years) with asymptomatic pronated feet and 15 normal subjects (mean age of 23.40 ± 3.11 years) were recruited from both genders by using a simple non-random sampling method. VGRF, ROL, and the resultant vector of time to stabilization (RVTTS) were evaluated during the forward jump landing task by using a force plate. ResultsThe findings showed that the following parameters were significantly higher in the group of pronated feet than in the normal subjects: VGRF (3.30 ± 0.17 vs. 2.81 ± 0.15, p = .042), ROL (0.10 ± 0.01 vs. 0.07 ± 0.006, p = .020), and RVTTS (2592.80 ± 141.24 vs. 2114.00 ± 154.77, p = .030). ConclusionAll the measured foot kinetic parameters were higher in the pronated foot subjects than in the normal participants. An impaired movement control and greater forces imposed on the foot region of the pronated foot, compared to the normal foot individuals, were discovered indicating the former group's possible increase of susceptibility to various musculoskeletal injuries.

Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain

BackgroundLumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM.MethodsIn a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0–10%), Grade 1 (10–50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients’ low back dysfunction.ResultsThe main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability.ConclusionThis is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.

Movement control impairment tests in patients with low back pain and healthy controls and its correlation with clinical measures

BACKGROUND: To find out whether there is any movement impairment difference in the normal mechanics of musculoskeletal system between low back pain (LBP) patients and healthy individuals, applying battery of movement control impairment (MCI) tests and also relationship of diagnosis to major clinical measures. METHODS: Design is a case–control study. Three-trained physiotherapists executed a test battery of six tests, for which the reliability has been shown to be acceptable. A total of 180 participants, ninety LBP patients and ninety age-matched normal individuals were recruited to participate in the study after given consent. The differences between the groups were analyzed using the effect size (ES) (d). Chi-square test with cross-tabulation was done to find out odds and risk ratios of the participants to represent or remain in the patient group. A correlation analysis was done between all the movement impairment tests and the clinical measures such as numerical pain rating scale, straight leg raising, pain location, flexion, and extension ROM and pain duration. RESULTS: This study results demonstrated that there is a difference between participants with and without back pain which could be a diagnostic and in clinical practice may help to identify subgroups of patients in LBP. Tests such as one leg standing, rocking backward, and prone knee flexion are negatively related to back pain functional outcome indicating more difficulty in function if they are positive with LBP patients. There was no difference found regarding the presence or positive test result between the acute and chronic pain patients. CONCLUSION: The present study concluded that there was a significant difference between patients with LBP and normal individuals without back pain in actively controlling the movements of the low back. The ES between patients with LBP and healthy controls in movement control is large. Moreover, the pain score and extension range of motion are not related to any of the MCI tests.

The effect of motor control training on kinetics variables of patients with non-specific low back pain and movement control impairment: Prospective observational study

IntroductionThe purpose of this study was to determine the effects of motor control training on pain, disability and motor control indices in patients with nonspecific low back pain (NSLBP) and movement control impairment (MCI) and also to evaluate the correlation between the changes in disability and the motor control indices. MethodsThirty people with NSLBP and MCI based on a clinical examination were following either motor control training or normal activity over 8 weeks. ResultSignificant differences between pre and post training in the experimental group were found in pain, disability and motor control indices. There were significant correlations between disability index with vertical ground reaction force (r = 0.43) and center of pressure (anterior-posterior) (r = 0.44) values. ConclusionThe results of this study showed that motor control indices are responsive measures to capture change during motor control training directed at retraining neuromuscular control, reducing pain and disability.

Fatigue-Induced Changes in Movement Pattern and Muscle Activity During Ballet Releve on Demi-Pointe.

Fatigue in ballet dancers may lead to injury, particularly in the lower extremities. However, few studies have investigated the effects of fatigue on ballet dancers' performance and movement patterns. Thus, the current study examines the effect of fatigue on the balance, movement pattern, and muscle activities of the lower extremities in ballet dancers. Twenty healthy, female ballet dancers performed releve on demi-pointe before and after fatigue. The trajectory of the whole body movement and the muscle activities of the major lower extremity muscles were recorded continuously during task performance. The results show that fatigue increases the medial-lateral center of mass (COM) displacement and hip and trunk motion, but decreases the COM velocity and ankle motion. Moreover, fatigue reduces the activities of the hamstrings and tibialis anterior, but increases that of the soleus. Finally, greater proximal hip and trunk motions are applied to compensate for the effects of fatigue, leading to a greater COM movement. Overall, the present findings show that fatigue results in impaired movement control and may therefore increase the risk of dance injury.