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Pratt S, Wand BM, Hince DA, Travers MJ, Schneider L, Kelly S, Gibson W. Tactile localization accuracy at the low back. Atten Percept Psychophys 2024; 86:1008-1021. [PMID: 38332382 PMCID: PMC11062953 DOI: 10.3758/s13414-024-02843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
Localizing tactile stimulation is an important capability for everyday function and may be impaired in people with persistent pain. This study sought to provide a detailed description of lumbar spine tactile localization accuracy in healthy individuals. Sixty-nine healthy participants estimated where they were touched at nine different points, labelled in a 3 × 3 grid over the lumbar spine. Mislocalization between the perceived and actual stimulus was calculated in horizontal (x) and vertical (y) directions, and a derived hypotenuse (c) mislocalization was calculated to represent the direct distance between perceived and actual points. In the horizontal direction, midline sites had the smallest mislocalization. Participants exhibited greater mislocalization for left- and right-sided sites, perceiving sites more laterally than they actually were. For all vertical values, stimulated sites were perceived lower than reality. A greater inaccuracy was observed in the vertical direction. This study measured tactile localization for the low back utilizing a novel testing method. The large inaccuracies point to a possible distortion in the underlying perceptual maps informing the superficial schema; however, further testing comparing this novel method with an established tactile localization task, such as the point-to-point method, is suggested to confirm these findings.
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Affiliation(s)
- Simon Pratt
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Benedict M Wand
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Dana A Hince
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Mervyn J Travers
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Lee Schneider
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Sara Kelly
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - William Gibson
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia.
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Larson DJ, Summers E, Brown SHM. Exploring how metronome pacing at varying movement speeds influences local dynamic stability and coordination variability of lumbar spine motion during repetitive lifting. Hum Mov Sci 2024; 93:103178. [PMID: 38217964 DOI: 10.1016/j.humov.2024.103178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
Auditory metronomes have been used to preserve movement consistency when examining local dynamic stability (LDS) and coordination variability (CV) of lumbar spine motion during repetitive movements. However, the potential influence of the metronome itself on these outcome measures has rarely been considered. Therefore, this study investigated the influence of different metronome paces (i.e., lifting speeds) on measures of lumbar spine LDS and thorax-pelvis CV during a repetitive lifting/lowering task in comparison to self-paced movements. Ten participants completed 5 repetitive lift/lower trials, where participants completed 35 consecutive repetitions (analysis on last 30 repetitions) at a self-selected pace for the first and last trial, and were paced by a 10 lift/min, 15 lift/min, and 20 lift/min metronome, in randomized order, for the remaining three trials. The average self-paced lift/lower speed before and after experiencing the three different metronome paced speeds was 16.2 (±1.02) and 17.2 (±0.73) lifts/min, respectively, and the most-preferred metronome pace trial was 15 lifts/min. Thorax-pelvis CV during the self-paced trials were similar (p > 0.05) to the 15 lift/min metronome paced trials, while greater thorax-pelvis CV was observed for the 10 lift/min compared to the 15 lift/min and 20 lift/min and second self-paced trial (all p < 0.026). This movement speed effect was not observed for lumbar spine LDS; however, more-dynamically stable movements were observed during all metronome paced trials in comparison to the self-paced trials. This study highlights that careful consideration is required when employing a metronome to control/manipulate movement characteristics while examining neuromuscular control using non-linear dynamical systems measures.
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Affiliation(s)
- Dennis J Larson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada; Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Elspeth Summers
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada.
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Alshehri MA, Alzahrani H, van den Hoorn W, Klyne DM, Vette AH, Hendershot BD, Roberts BWR, Larivière C, Barbado D, Vera-Garcia FJ, van Dieen JH, Cholewicki J, Nussbaum MA, Madigan ML, Reeves NP, Silfies SP, Brown SHM, Hodges PW. Trunk postural control during unstable sitting among individuals with and without low back pain: A systematic review with an individual participant data meta-analysis. PLoS One 2024; 19:e0296968. [PMID: 38265999 PMCID: PMC10807788 DOI: 10.1371/journal.pone.0296968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Sitting on an unstable surface is a common paradigm to investigate trunk postural control among individuals with low back pain (LBP), by minimizing the influence lower extremities on balance control. Outcomes of many small studies are inconsistent (e.g., some find differences between groups while others do not), potentially due to confounding factors such as age, sex, body mass index [BMI], or clinical presentations. We conducted a systematic review with an individual participant data (IPD) meta-analysis to investigate whether trunk postural control differs between those with and without LBP, and whether the difference between groups is impacted by vision and potential confounding factors. METHODS We completed this review according to PRISMA-IPD guidelines. The literature was screened (up to 7th September 2023) from five electronic databases: MEDLINE, CINAHL, Embase, Scopus, and Web of Science Core Collection. Outcome measures were extracted that describe unstable seat movements, specifically centre of pressure or seat angle. Our main analyses included: 1) a two-stage IPD meta-analysis to assess the difference between groups and their interaction with age, sex, BMI, and vision on trunk postural control; 2) and a two-stage IPD meta-regression to determine the effects of LBP clinical features (pain intensity, disability, pain catastrophizing, and fear-avoidance beliefs) on trunk postural control. RESULTS Forty studies (1,821 participants) were included for the descriptive analysis and 24 studies (1,050 participants) were included for the IPD analysis. IPD meta-analyses revealed three main findings: (a) trunk postural control was worse (higher root mean square displacement [RMSdispl], range, and long-term diffusion; lower mean power frequency) among individuals with than without LBP; (b) trunk postural control deteriorated more (higher RMSdispl, short- and long-term diffusion) among individuals with than without LBP when vision was removed; and (c) older age and higher BMI had greater adverse impacts on trunk postural control (higher short-term diffusion; longer time and distance coordinates of the critical point) among individuals with than without LBP. IPD meta-regressions indicated no associations between the limited LBP clinical features that could be considered and trunk postural control. CONCLUSION Trunk postural control appears to be inferior among individuals with LBP, which was indicated by increased seat movements and some evidence of trunk stiffening. These findings are likely explained by delayed or less accurate corrective responses. SYSTEMATIC REVIEW REGISTRATION This review has been registered in PROSPERO (registration number: CRD42021124658).
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Affiliation(s)
- Mansour Abdullah Alshehri
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Hosam Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Wolbert van den Hoorn
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - David M. Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Albert H. Vette
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Canada
| | - Brad D. Hendershot
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, United States of America
| | - Brad W. R. Roberts
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Canada
| | - Christian Larivière
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal Rehabilitation Institute, Montreal, Quebec, Canada
| | - David Barbado
- Sport Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain
| | - Francisco J. Vera-Garcia
- Sport Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain
| | - Jaap H. van Dieen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jacek Cholewicki
- Center for Neuromusculoskeletal Clinical Research, Michigan State University, Lansing, Michigan, United States of America
- Department of Osteopathic Manipulative Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Maury A. Nussbaum
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Michael L. Madigan
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | | | - Sheri P. Silfies
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Paul W. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Lotz JC, Ropella G, Anderson P, Yang Q, Hedderich MA, Bailey J, Hunt CA. An exploration of knowledge-organizing technologies to advance transdisciplinary back pain research. JOR Spine 2023; 6:e1300. [PMID: 38156063 PMCID: PMC10751978 DOI: 10.1002/jsp2.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 12/30/2023] Open
Abstract
Chronic low back pain (LBP) is influenced by a broad spectrum of patient-specific factors as codified in domains of the biopsychosocial model (BSM). Operationalizing the BSM into research and clinical care is challenging because most investigators work in silos that concentrate on only one or two BSM domains. Furthermore, the expanding, multidisciplinary nature of BSM research creates practical limitations as to how individual investigators integrate current data into their processes of generating impactful hypotheses. The rapidly advancing field of artificial intelligence (AI) is providing new tools for organizing knowledge, but the practical aspects for how AI may advance LBP research and clinical are beginning to be explored. The goals of the work presented here are to: (1) explore the current capabilities of knowledge integration technologies (large language models (LLM), similarity graphs (SGs), and knowledge graphs (KGs)) to synthesize biomedical literature and depict multimodal relationships reflected in the BSM, and; (2) highlight limitations, implementation details, and future areas of research to improve performance. We demonstrate preliminary evidence that LLMs, like GPT-3, may be useful in helping scientists analyze and distinguish cLBP publications across multiple BSM domains and determine the degree to which the literature supports or contradicts emergent hypotheses. We show that SG representations and KGs enable exploring LBP's literature in novel ways, possibly providing, trans-disciplinary perspectives or insights that are currently difficult, if not infeasible to achieve. The SG approach is automated, simple, and inexpensive to execute, and thereby may be useful for early-phase literature and narrative explorations beyond one's areas of expertise. Likewise, we show that KGs can be constructed using automated pipelines, queried to provide semantic information, and analyzed to explore trans-domain linkages. The examples presented support the feasibility for LBP-tailored AI protocols to organize knowledge and support developing and refining trans-domain hypotheses.
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Affiliation(s)
- Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | | | - Paul Anderson
- Department of Computer Science & Software EngineeringCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Qian Yang
- Department of Information ScienceCornell UniversityIthacaNew YorkUSA
| | | | - Jeannie Bailey
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - C. Anthony Hunt
- Department of Bioengineering & Therapeutic SciencesUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
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Schmid S, Bangerter C, Schweinhardt P, Meier ML. Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics. FRONTIERS IN PAIN RESEARCH 2022; 2:715219. [PMID: 35295522 PMCID: PMC8915772 DOI: 10.3389/fpain.2021.715219] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Persistent low back pain (LBP) is a major health issue, and its treatment remains challenging due to a lack of pathophysiological understanding. A better understanding of LBP pathophysiology has been recognized as a research priority, however research on contributing mechanisms to LBP is often limited by siloed research within different disciplines. Novel cross-disciplinary approaches are necessary to fill important knowledge gaps in LBP research. This becomes particularly apparent when considering new theories about a potential role of changes in movement behavior (motor control) in the development and persistence of LBP. First evidence points toward the existence of different motor control strategy phenotypes, which are suggested to have pain-provoking effects in some individuals driven by interactions between neuroplastic, psychological and biomechanical factors. Yet, these phenotypes and their role in LBP need further validation, which can be systematically tested using an appropriate cross-disciplinary approach. Therefore, we propose a novel approach, connecting methods from neuroscience and biomechanics research including state-of-the-art optical motion capture, musculoskeletal modeling, functional magnetic resonance imaging and assessments of psychological factors. Ultimately, this cross-disciplinary approach might lead to the identification of different motor control strategy phenotypes with the potential to translate into clinical research for better treatment options.
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Affiliation(s)
- Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Bangerter
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Integrative Spinal Research, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Alan Edwards Center for Research on Pain, McGill University, Montreal, QC, Canada
| | - Michael L Meier
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Integrative Spinal Research, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Wattananon P, Klomjai W, Sung W. One session of motor control exercise improves joint position sense assessed by an iPhone application: a randomized controlled trial. J Phys Ther Sci 2019; 31:583-589. [PMID: 31417226 PMCID: PMC6642896 DOI: 10.1589/jpts.31.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/22/2019] [Indexed: 01/04/2023] Open
Abstract
[Purpose] To establish the test-retest reliability of an iPhone application and determine
the immediate effect of motor control exercise (MCE) on lumbar position sense.
[Participants and Methods] This study used a two-arm, randomized controlled trial design
with a blinded assessor. Sixty healthy participants were randomized into the exercise or
control group. The exercise group underwent 30-min MCE, whereas the control group rested
for 15 min. Lumbar motion measured by two iPhones with goniometer application was used to
determine the test-retest reliability. Absolute repositioning errors (pre- and post-test)
from the control and exercise groups were used to determine the immediate effect of MCE on
lumbar position sense. [Results] The test-retest reliability was 0.67–0.95. A significant
interaction effect was found for Angle*Time, main effect of Angle, and main effect of
Time. Post-hoc comparison showed a significant improvement in position sense at 45° and
60° in the exercise group. [Conclusion] The findings suggest that a mobile phone
application has the ability to detect changes in lumbar position sense between sessions
that exceed measurement error following MCE. One session of specific MCE can improve
lumbar position sense at high lumbar flexion.
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Affiliation(s)
- Peemongkon Wattananon
- Faculty of Physical Therapy, Mahidol University: 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
| | - Wanalee Klomjai
- Faculty of Physical Therapy, Mahidol University: 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
| | - Won Sung
- Good Shepherd Penn Partners, Penn Therapy and Fitness, USA
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Meier ML, Vrana A, Schweinhardt P. Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception. Neuroscientist 2018; 25:583-596. [PMID: 30387689 PMCID: PMC6900582 DOI: 10.1177/1073858418809074] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Motor control, which relies on constant communication between motor and sensory systems,
is crucial for spine posture, stability and movement. Adaptions of motor control occur in
low back pain (LBP) while different motor adaption strategies exist across individuals,
probably to reduce LBP and risk of injury. However, in some individuals with LBP, adapted
motor control strategies might have long-term consequences, such as increased spinal
loading that has been linked with degeneration of intervertebral discs and other tissues,
potentially maintaining recurrent or chronic LBP. Factors contributing to motor control
adaptations in LBP have been extensively studied on the motor output side, but less
attention has been paid to changes in sensory input, specifically proprioception.
Furthermore, motor cortex reorganization has been linked with chronic and recurrent LBP,
but underlying factors are poorly understood. Here, we review current research on
behavioral and neural effects of motor control adaptions in LBP. We conclude that back
pain-induced disrupted or reduced proprioceptive signaling likely plays a pivotal role in
driving long-term changes in the top-down control of the motor system via motor
and sensory cortical reorganization. In the outlook of this review, we
explore whether motor control adaptations are also important for other (musculoskeletal)
pain conditions.
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Affiliation(s)
- Michael Lukas Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, Zurich, Switzerland
| | - Andrea Vrana
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, Zurich, Switzerland.,Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada
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Larson DJ, Brown SH. The effects of trunk extensor and abdominal muscle fatigue on postural control and trunk proprioception in young, healthy individuals. Hum Mov Sci 2018; 57:13-20. [DOI: 10.1016/j.humov.2017.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 11/15/2022]
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10
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Beaudette SM, Smith SGVS, Bent LR, Brown SHM. Spine Posture Influences Tactile Perceptual Sensitivity of the Trunk Dorsum. Ann Biomed Eng 2017; 45:2804-2812. [PMID: 28924674 DOI: 10.1007/s10439-017-1924-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/12/2017] [Indexed: 11/27/2022]
Abstract
The purpose of the current work was to quantify the influence of posture-mediated skin deformation on trunk dorsum tactile perceptual sensitivity. Twelve young and healthy individuals were assessed while adopting three different spine postures (extension, neutral and flexion). Tactile sensitivity threshold tests (T10 and L4 vertebral levels) included measures of touch sensitivity, spatial acuity and stretch sensitivity. The results demonstrate that tactile sensitivity can differ due to changes in body posture. The skin of the trunk dorsum had increased thresholds for touch sensitivity, longitudinal spatial acuity and transverse stretch sensitivity in spine flexion. Furthermore, spine flexion also resulted in a reduced sensory threshold to stretching stimuli in the longitudinal direction. The opposite trends occurred when participants adopted spine extension. It is suggested that posture-mediated skin deformation generates changes in the amount of strain experienced by individual skin mechanoreceptors, and the relative spacing between mechanoreceptors. Furthermore, it is suggested that "pre-stretch" of the skin brings mechanoreceptors closer to their stretch activation thresholds, thereby increasing an individual's sensitivity to skin stretch when in spine flexion.
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Affiliation(s)
- Shawn M Beaudette
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Simone G V S Smith
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Leah R Bent
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada.
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Beaudette SM, Zwambag DP, Bent LR, Brown SH. Spine postural change elicits localized skin structural deformation of the trunk dorsum in vivo. J Mech Behav Biomed Mater 2017; 67:31-39. [DOI: 10.1016/j.jmbbm.2016.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
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