Osteopathic manual therapy and postural control:Systems/J.Cholewicki/J.Choi

整骨手法治疗和姿势控制：Systems/J.Cholewicki/J.Choi

• 批准号: 8093418
• 负责人: Jacek Cholewicki
• 金额: $ 14.65万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8093418
• 关键词: Aftercare; American; Analgesics; Behavior; Biomechanics; Characteristics; Clinical; Clinical Research; Data; Diagnosis; Elements; Exhibits; Eye; Feedback; Functional disorder; Future; Goals; Health; Impairment; Individual; Literature; Low Back Pain; Lower Back Injury; Manuals; Measures; Mechanics; Mediating; Medical; Methods; Modeling; Monitor; Muscle; Muscle Spindles; Musculoskeletal Equilibrium; Musculoskeletal System; Osteopathic manipulation; Outcome Measure; Patients; Performance; Physical therapy; Population; Postural response; Procedures; Reflex action; Research; Risk; Science; Signal Transduction; Skeletal system; System; Task Performances; Techniques; Testing; Treatment outcome; Visual; base; cost; design; improved; mathematical model; motor control; neuromuscular; research study; response; skeletal disorder; tool; translational clinical trial; vibration

Low back pain (LBP) is a common and debilitating medical condition but the vast majority of clinical cases do not have a pathoanatomical diagnosis on the basis of standard clinical tests. Our previous research has shown that, compared with healthy controls, LBP patients have impaired postural control. Furthermore, individuals with a delayed muscle reflex response to sudden trunk loading are known to be at increased risk of sustaining low back injuries. Conservative treatment methods, including pain medication and physical therapy, are generally unsatisfactory. Osteopathic manual therapy (OMT) is a CAM therapy that is being chosen by an increasing number of LBP patients. Our preliminary studies suggest that OMT improves postural control in patients with non-specific LBP, who exhibit such impairments when tested with an unstable sitting task. However, the mechanisms responsible for changes in the control system due to OMT are unknown. We hypothesize that OMT targets impaired or altered function of the neuro-musculoskeletal system arising from a dysfunction in the muscle spindles. Therefore, we will apply a systems science approach to identify elements of the postural control system that change with the use of OMT. Aim 1 of the study will optimize critical tasks for assessing neuromuscular control in LBP patients. These critical task will then be used in Aim 2 to identify deficits in postural control of individuals with LBP and to document the effects of OMT on postural control. Aims 3 and 4 are designed to look separately and more specifically at the behavior of reflex responses and muscle spindles. In Aim 3, activation of the erector spinae muscles will be assessed in response to mechanical tapping to determine whether OMT changes the control strategy from co-activation to reciprocal inhibition. Degradations in postural control mediated via feedback from the muscle spindles in LBP patients will be assessed by the response to mechanical muscle vibrations in Aim 4. When completed, this project will deliver sensitive and objective clinical research tools that can model postural control, assess control capabilities, and identify control impairments. These tools will be useful in future clinical studies for characterizing motor control impairments in LBP patients, for standardizing and optimizing CAM treatments aimed at neuro-musculo-skeletal disorders, and for monitoring treatment outcomes.

腰痛 (LBP) 是一种常见且使人衰弱的疾病，但绝大多数临床病例没有基于标准临床测试的病理解剖学诊断。 我们之前的研究表明，与健康对照者相比，腰痛患者的姿势控制能力受损。 此外，已知对突然的躯干负荷有延迟的肌肉反射反应的人遭受腰部损伤的风险增加。保守治疗方法，包括止痛药和物理治疗，通常效果并不令人满意。整骨手法疗法 (OMT) 是一种 CAM 疗法，越来越多的 LBP 患者选择这种疗法。 我们的初步研究表明，OMT 可以改善非特异性腰痛患者的姿势控制，这些患者在进行不稳定的坐姿任务测试时会表现出这种损伤。 然而，由于 OMT 导致控制系统发生变化的机制尚不清楚。 我们假设 OMT 的目标是因肌梭功能障碍而导致的神经肌肉骨骼系统功能受损或改变。 因此，我们将应用系统科学方法来识别随着 OMT 的使用而变化的姿势控制系统的元素。 该研究的目标 1 将优化评估 LBP 患者神经肌肉控制的关键任务。 然后，这些关键任务将在目标 2 中用于识别腰痛患者的姿势控制缺陷，并记录 OMT 对姿势控制的影响。 目标 3 和 4 旨在分别更具体地研究反射反应和肌梭的行为。 在目标 3 中，将评估机械敲击对竖脊肌的激活情况，以确定 OMT 是否将控制策略从共同激活改变为相互抑制。 通过目标 4 中对机械肌肉振动的反应来评估 LBP 患者肌梭反馈介导的姿势控制退化。完成后，该项目将提供敏感且客观的临床研究工具，可以模拟姿势控制、评估控制能力，并识别控制缺陷。 这些工具将在未来的临床研究中发挥作用，用于表征 LBP 患者的运动控制障碍、标准化和优化针对神经肌肉骨骼疾病的 CAM 治疗以及监测治疗结果。