Fear-avoidance beliefs, anxiety and depression are associated with motor control and dynamics parameters in patients with chronic low back pain.

PURPOSE: To evaluate the influence of fear-avoidance beliefs, anxiety and depression on dynamic and motor control parameters before and after Functional Restoration Program. METHODS: Patients were divided into three groups depending on clinical scores scores. Dynamic and motor control parameters were extracted from gait analysis. RESULTS: Patients showed different ways based on preferred walking speed, capacity benefit, peaks of propulsion and gait stability in function of clinical scores. CONCLUSION: Fear-avoidance beliefs associated to anxiety and depression influence biomechanics on overground walking. We depicted different ways to adapt their gait in function of biopsychosocial scores. Functional Restoration Program influence these ways.

Effect of preferred walking speed on the upper body range of motion and mechanical work during gait before and after spinal fusion for patients with idiopathic scoliosis.

BACKGROUND: Scoliosis may have an effect on gait parameters, the kinematics of the lower limbs and the spine, and mechanical work with specific gait speed. Imposed gait speed may influence these effects. Following spinal fusion in the case of idiopathic scoliosis, patients fear subsequent and considerable back stiffness and kinetic consequences. The aim of this retrospective study was to evaluate the upper body range of motion and mechanical work before and after spinal fusion in of free gait speed conditions. METHODS: Twenty-two patients with idiopathic scoliosis and twenty-two asymptomatic controls were included. Patients were analyzed before and one year after spinal fusion. Based on full body modeling and motion capture, we measured gait speed, cadence, stride length, the mobility of the upper and lower spinal segments (in each plane), and mechanical work (with and without dimensionless scaling strategy). FINDINGS: Patients walked significantly slower than controls. The same speed was noticed before and after fusion. Only the lower back kinematics in the frontal plane was reduced before fusion. Spinal fusion further reduced the mobility of the pelvis segment in the sagittal plane in comparison to controls. Scaling external work was associated with higher values for patients. INTERPRETATION: Spinal fusion improves pelvic and thorax-pelvis mobility (during the stance phase) in the frontal plane. The impact of scoliosis on the upper body range of motion was limited on the thorax-pelvis, corresponding to a stiffening effect. With such restrictions, an increase in normalized external work was observed for similar normalized internal work.

Alpha-phase synchrony EEG training for multi-resistant chronic low back pain patients: an open-label pilot study.

PURPOSE: Chronic low back pain (cLBP) affects a quarter of a population during its lifetime. The most severe cases include patients not responding to interventions such as 5-week-long in-hospital multi-disciplinary protocols. This document reports on a pilot study offering an alpha-phase synchronization (APS) brain rehabilitation intervention to a population of n = 16 multi-resistant cLBP patients. METHODS: The intervention consists of 20 sessions of highly controlled electroencephalography (EEG) APS operant conditioning (neurofeedback) paradigm delivered in the form of visual feedback. Visual analogue scale for pain, Dallas, Hamilton, and HAD were measured before, after, at 6-month and 12-month follow-up. Full-scalp EEG data were analyzed to study significant changes in the brain's electrical activity. RESULTS: The intervention showed a great and lasting response of most measured clinical scales. The clinical improvement was lasting beyond the 6-month follow-up endpoints. The EEG data confirm that patients did control (intra-session trends) and learned to better control (intersession trends) their APS neuromarker resulting in (nonsignificant) baseline changes in their resting state activity. Last and most significantly, the alpha-phase concentration (APC) neuromarker, specific to phase rather than amplitude, was found to correlate significantly with the reduction in clinical symptoms in a typical dose-response effect. CONCLUSION: This first experiment highlights the role of the APC neuromarker in relation to the nucleus accumbens activity and its role on nociception and the chronicity of pain. This study suggests APC rehabilitation could be used clinically for the most severe cases of cLBP. Its excellent safety profile and availability as a home-use intervention makes it a potentially disruptive tool in the context of nonsteroidal anti-inflammatory drugs and opioid abuses. These slides can be retrieved under Electronic Supplementary Material.

An index to quantify deviations from normal trunk mobility: Clinical correlation and initial test of validity.

BACKGROUND: In case of people suffering from chronic low back pain, specific movements of the hip, pelvis, and trunk are associated with pain. Comparing range of motion measurements for multiple planes and from different segments and lines in reference to those of healthy individuals seems interesting but present interpretations challenge in relation to important number of variables and correlation with clinical data. METHODS: The proposed index is based on using principal component analysis to quantify differences in trunk mobility between patients with chronic low back pain and a control group. Kinematic data were recorded for the cervical and thoracic vertebrae, the lumbar spine, and the pelvic and scapular belts during repeated trials (hip flexion and extension, hip bending, and trunk twists). Angular motion values were calculated. Principal component analysis was used to convert 10 discrete variables (kinematical data) extracted from control data into 10 independent variables. FINDINGS: The proposed index comprises the sum of the variables. Initial demonstration of its clinical utility and statistical tests of this index validity were revealed. It establishes correlations between the psychosocial impact of chronic low back pain, trunk mobility (as summarized by the index) and the positive effects of functional restoration program. INTERPRETATION: This index let to assess the absolute potential benefits of rehabilitation in term of kinematic motion. Functional restoration program promotes the physical functioning of patients by increasing their range of motion. This index uses kinematic motion to assess the potential benefits of such rehabilitation program.

Muscle Activation during Gait in Children with Duchenne Muscular Dystrophy.

The aim of this prospective study was to investigate changes in muscle activity during gait in children with Duchenne muscular Dystrophy (DMD). Dynamic surface electromyography recordings (EMGs) of 16 children with DMD and pathological gait were compared with those of 15 control children. The activity of the rectus femoris (RF), vastus lateralis (VL), medial hamstrings (HS), tibialis anterior (TA) and gastrocnemius soleus (GAS) muscles was recorded and analysed quantitatively and qualitatively. The overall muscle activity in the children with DMD was significantly different from that of the control group. Percentage activation amplitudes of RF, HS and TA were greater throughout the gait cycle in the children with DMD and the timing of GAS activity differed from the control children. Significantly greater muscle coactivation was found in the children with DMD. There were no significant differences between sides. Since the motor command is normal in DMD, the hyper-activity and co-contractions likely compensate for gait instability and muscle weakness, however may have negative consequences on the muscles and may increase the energy cost of gait. Simple rehabilitative strategies such as targeted physical therapies may improve stability and thus the pattern of muscle activity.