1,721,308 research outputs found
Enhancing postural control, pain and disability through proprioceptive training in individuals with low back pain: a proof-of-concept.
No full textLow back pain (LBP) is a leading cause of global disability. Individuals with LBP often exhibit impaired proprioceptive postural control, which may contribute to the persistence of their condition. The effectiveness of targeted proprioceptive training in addressing these deficits and alleviating pain and disability remains unclear. This study aimed to evaluate the impact of proprioceptive training on (1) proprioceptive postural control and (2) associated pain and disability in individuals with LBP.
Twenty-five individuals with recurrent LBP (14 men, 11 women; mean age 47 ± 10 years; BMI 24.1 ± 2.3) participated in an 8-week proprioceptive training program focusing on sensing, differentiating, and localizing lumbar postures, movements, and muscle activation. Participants integrated these exercises into their daily routines.
Postural control assessments were performed on stable and unstable surfaces with visual input occluded. Muscle vibration stimulated ankle and back muscle spindles to induce center of pressure (COP) displacements, measured using a force plate. A ratio of COP displacement in response to ankle versus back muscle vibration was calculated. Clinical outcomes were assessed with the Modified Low Back Pain Disability Questionnaire (MDQ) and self-reported percentage improvements in pain and disability (0–100%). Non-parametric statistical methods were used.
Proprioceptive training led to increased COP displacement in response to back muscle vibration on stable (p = 0.036) and unstable surfaces (p = 0.043). The ratio of ankle-to-back muscle vibration indicated greater reliance on lumbar proprioception under unstable conditions (p = 0.034). Clinically, MDQ scores improved significantly (pre-training: 27 ± 10; post-training: 14 ± 10, p < 0.001), alongside substantial reductions in disability (51%) and pain (49%).
Proprioceptive training improved lumbar proprioception and postural control, likely through enhanced muscle spindle sensitivity and segmental control. Participants shifted from rigid ankle strategies to adaptive lumbar proprioceptive reliance, improving adaptability to unstable conditions. These benefits were accompanied by significant reductions in pain and disability, underscoring the clinical value of proprioceptive training for individuals with LBP.Research Foundation Flanders - FWO (grant 11B6522N, grant G072122N
Enhancing postural control, pain and disability through proprioceptive training in individuals with low back pain: a proof-of-concept.
No full textLow back pain (LBP) is a leading cause of global disability. Individuals with LBP often exhibit impaired proprioceptive postural control, which may contribute to the persistence of their condition. The effectiveness of targeted proprioceptive training in addressing these deficits and alleviating pain and disability remains unclear. This study aimed to evaluate the impact of proprioceptive training on (1) proprioceptive postural control and (2) associated pain and disability in individuals with LBP.
Twenty-five individuals with recurrent LBP (14 men, 11 women; mean age 47 ± 10 years; BMI 24.1 ± 2.3) participated in an 8-week proprioceptive training program focusing on sensing, differentiating, and localizing lumbar postures, movements, and muscle activation. Participants integrated these exercises into their daily routines.
Postural control assessments were performed on stable and unstable surfaces with visual input occluded. Muscle vibration stimulated ankle and back muscle spindles to induce center of pressure (COP) displacements, measured using a force plate. A ratio of COP displacement in response to ankle versus back muscle vibration was calculated. Clinical outcomes were assessed with the Modified Low Back Pain Disability Questionnaire (MDQ) and self-reported percentage improvements in pain and disability (0–100%). Non-parametric statistical methods were used.
Proprioceptive training led to increased COP displacement in response to back muscle vibration on stable (p = 0.036) and unstable surfaces (p = 0.043). The ratio of ankle-to-back muscle vibration indicated greater reliance on lumbar proprioception under unstable conditions (p = 0.034). Clinically, MDQ scores improved significantly (pre-training: 27 ± 10; post-training: 14 ± 10, p < 0.001), alongside substantial reductions in disability (51%) and pain (49%).
Proprioceptive training improved lumbar proprioception and postural control, likely through enhanced muscle spindle sensitivity and segmental control. Participants shifted from rigid ankle strategies to adaptive lumbar proprioceptive reliance, improving adaptability to unstable conditions. These benefits were accompanied by significant reductions in pain and disability, underscoring the clinical value of proprioceptive training for individuals with LBP.Research Foundation Flanders - FWO (grant 11B6522N, grant G072122N
Disturbed proprioceptive postural control may be related to impaired multifidus muscle quality in people with low back pain.
No full textBackground and Aim
Low back pain (LBP) is the leading cause of disability worldwide. Impaired proprioception during postural control might be a contributing factor to LBP, but it remains unknown if this relates to structural changes in spine-controlling muscles such as the lumbar multifidus.
Therefore, this study aimed (1) to investigate potential differences in lumbar proprioceptive use during standing as well as multifidus size and echo-intensity between people with and without LBP, and (2) to determine the association between proprioceptive use during standing l and multifidus size and echo-intensity.
Methods
In 36 participants with recurrent LBP (19 men, 17 women; Age= 44 ± 11 years; BMI= 25.3 ± 3.7) and 32 healthy controls (11 men, 21 women; Age= 38 ± 11 years ; BMI= 22.2 ± 2.4), proprioceptive use was evaluated by applying muscle vibration to ankle and back muscles during standing on stable and unstable ground. Center of pressure displacements in response to vibration were measured with a force plate (Kistler). Multifidus volume was measured from lumbar level L2 to L5, cross-sectional area and echo-intensity were measured at lumbar level L5 with three-dimensional freehand ultrasound (SonixTouch Q+ with Optitrack V120:Trio, NaturalPoint, USA). Between-group differences were assessed using non-parametric tests. Spearman correlations were calculated and Bonferroni corrections were applied for multiple comparisons (p= 0.013).
Results
Compared to healthy controls, people with LBP showed a more ankle-steered postural control (p= 0.019), decreased lumbar proprioceptive reliance on unstable ground (p= 0.04) and increased multifidus echo-intensity (p 0.60). After Bonferroni correction, only center of pressure displacement during back muscle vibration on stable ground showed a small negative correlation with multifidus echo-intensity (r= -0.38, p= 0.015).
Conclusions
This study confirmed that compared to healthy controls, people with LBP showed impaired ability to up-weight lumbar proprioceptive use during more challenging postural conditions. This decreased proprioceptive acuity could perhaps be related to impaired multifidus quality, but not to multifidus size. However, there was only a moderate correlation on stable ground, and a few trends for significance after Bonferroni correction, but no associations in more complex postural conditions. Future studies could use larger samples with more advanced measurement techniques to determine muscle quality, such as muscle biopsies, or texture analysis for echo-intensity. This further clarify the relation between muscle quality and proprioceptive postural control in people with LBP.FWO (grant 11B6522N, grant G072122N
The forgotten role of back muscle characteristics to tailor exercise therapy for recurrent non-specific low back pain: Study protocol for the Back-to-Back study
No full textBackground and aims: Current treatments for non-specific low back pain (NSLBP) have only limited effects. Identifying phenotypes of patients that share underlying mechanisms towards which clinicians could direct treatment could improve the effects. Previous studies found macroscopic, microscopic, electrophysiological, and proprioceptive changes in the back muscles of patients with NSLBP. However, no studies delineated NSLBP phenotypes based on back muscle characteristics.
Methods: We will evaluate various characteristics of the lumbar multifidus and erector spinae in 90 patients with NSLBP and 55 healthy controls: muscle volume with 3D freehand ultrasound, muscle fiber type composition with minimally-invasive muscle biopsies, proprioceptive use during postural control by applying muscle vibration during standing on a force plate, and muscle activation and oxygenation with electromyography and near-infrared spectroscopy (Fig. 1). We will determine the most discriminating muscle characteristics between patients with NSLBP and controls, based upon which phenotypes will be delineated. Then, the patients with NSLBP will be randomized into two groups receiving a 16-week program of proprioceptive training or resistance training. The effect of both programs on back muscle characteristics and disability will be evaluated halfway the program, at the end of the program, and 16 weeks after the end of training.
Results: The protocol is submitted to the Ethical Committees of UZ/KU Leuven and UHasselt. The study is funded by the Research Foundation - Flanders (FWO) (G072122N). Participant recruitment and data collection are anticipated to start in March 2023.
Conclusions: We expect the results to help improve the patient-tailored exercise therapy for NSLBP
Foot-floor contact pattern in children and adults with Dravet Syndrome
Full text linkBackground
Dravet Syndrome (DS) is a developmental and epileptic encephalopathy characterized by severe drug-resistant seizures and associated with cognitive and motor impairments. Walking problems are frequently observed. As the foot plays a key role during walking, compromised foot function can be a feature of deviant gait.
Aim
To investigate foot function in DS by characterizing foot-floor contact patterns using pedobarography.
Methods
A total of 31 children and adults were included in the DS group (aged 5.2-32.8 years, 17 female, 174 steps) and 30 in the control group (aged 6.0-32.9, 16 female, 180 steps). The foot-floor contact pattern was evaluated based on progression, length and smoothness (spectral arc length) of the center of pressure (CoP). Linear mixed models were used to identify differences between non-heel strikes and heel strikes and between the DS and control group.
Results
Fifteen participants with DS showed inconsistency in the type of foot-floor contact (heel strikes and non-heel strikes). Heel strikes of participants with DS had significantly reduced time of CoP under the hindfoot and increased time under the midfoot region compared to the control group. Significant time and age effects were detected.
Conclusions and implications
Deviant foot-floor contact patterns were observed in DS. Possible gait immaturity and instability as well as implications for interventions are discussed
Back-to-Back, a proof of concept study investigating the role of back muscle characteristics to tailor exercise therapy for recurrent non-specific low back pain: study protocol and preliminary analysis of proprioceptive postural control results
No full textBackground and aim
Non-specific low back pain (NSLBP) is the main cause of disability worldwide and current treatments have limited effects. Alterations in macroscopic, microscopic, electrophysiological and hemodynamic lumbar muscle characteristics and proprioceptive postural control (PPC) are found in people with NSLBP and directing treatment based on shared underlying mechanisms (phenotypes), could improve its effects. Therefore, this study aims to determine the most discriminating lumbar muscle characteristics between patients with NSLBP and healthy controls, investigate their interrelatedness and relationship with PPC and delineate NSLBP phenotypes based on them. Additionally, to investigate whether proprioceptive exercises have a greater effect on specific NSLBP phenotypes.
Methods
Lumbar multifidus and erector spinae muscle characteristics will be evaluated and compared in 53 people with recurrent NSLBP and 47 healthy controls. For PPC, the COP displacements in response to vibration to the ankle and back muscles are measured on a force plate, while standing on stable and unstable surface with vision occluded. Proprioceptive dominance is evaluated by the Relative Proprioceptive Weighting (RPW) ratio, with lower RPW values indicating more lumbar proprioceptive reliance. Muscle volume is investigated with 3D freehand ultrasound, and muscle activation and oxygenation with electromyography and near-infrared spectroscopy, respectively. The 53 people with NSLBP also receive a 16-week intervention focusing on improving their ability to sense and discriminate low back position, muscle activation and lumbar movement. These proprioceptive exercises are integrated into the patients’ daily lives and comprise a high-load lifting exercise. Their effects are evaluated at 8 weeks, 16 weeks and 16 weeks after the end of the intervention.
Results
Recruitment is ongoing, currently five people with recurrent NSLBP are enrolled and analysed descriptively. Preliminary results on PPC include increased lumbar proprioceptive reliance after eight (Pre: 0.69 ± 0.04; Post: 0.46 ± 0.30 stable and Pre: 0.58 ± 0.13; Post: 0.44 ± 0.31 unstable) and 16 weeks (Post: 0.40 ± 0.30 stable and Post: 0.34 ± 0.16 unstable) and increased COP displacement in response to lumbar vibration on stable (Pre: 0.018 ± 0.011; Post: 0.020 ±0.012) and unstable (Pre: 0.015 ± 0.013; Post: 0.021 ± 0.009) after 16 weeks of intervention.
Conclusion
Preliminary results show increased lumbar proprioceptive use and a switch in dominant reliance from ankle to lumbar proprioception in response to this proprioceptive intervention, translating to improved PPC. Further effects on the different lumbar muscle characteristics and their correlation with PPC will be investigated. Phenotypes of people with NSLBP will be delineated and the effects of this intervention on them will be examined. Results may improve patient-tailored exercise therapy for people with NSLBP.Research Foundation Flanders (FWO) - grant numbers 11B6522N and G072122
Back-to-Back, a proof of concept study investigating the role of back muscle characteristics to tailor exercise therapy for recurrent non-specific low back pain: study protocol and preliminary analysis of proprioceptive postural control results
No full textBackground and aim
Non-specific low back pain (NSLBP) is the main cause of disability worldwide and current treatments have limited effects. Alterations in macroscopic, microscopic, electrophysiological and hemodynamic lumbar muscle characteristics and proprioceptive postural control (PPC) are found in people with NSLBP and directing treatment based on shared underlying mechanisms (phenotypes), could improve its effects. Therefore, this study aims to determine the most discriminating lumbar muscle characteristics between patients with NSLBP and healthy controls, investigate their interrelatedness and relationship with PPC and delineate NSLBP phenotypes based on them. Additionally, to investigate whether proprioceptive exercises have a greater effect on specific NSLBP phenotypes.
Methods
Lumbar multifidus and erector spinae muscle characteristics will be evaluated and compared in 53 people with recurrent NSLBP and 47 healthy controls. For PPC, the COP displacements in response to vibration to the ankle and back muscles are measured on a force plate, while standing on stable and unstable surface with vision occluded. Proprioceptive dominance is evaluated by the Relative Proprioceptive Weighting (RPW) ratio, with lower RPW values indicating more lumbar proprioceptive reliance. Muscle volume is investigated with 3D freehand ultrasound, and muscle activation and oxygenation with electromyography and near-infrared spectroscopy, respectively. The 53 people with NSLBP also receive a 16-week intervention focusing on improving their ability to sense and discriminate low back position, muscle activation and lumbar movement. These proprioceptive exercises are integrated into the patients’ daily lives and comprise a high-load lifting exercise. Their effects are evaluated at 8 weeks, 16 weeks and 16 weeks after the end of the intervention.
Results
Recruitment is ongoing, currently five people with recurrent NSLBP are enrolled and analysed descriptively. Preliminary results on PPC include increased lumbar proprioceptive reliance after eight (Pre: 0.69 ± 0.04; Post: 0.46 ± 0.30 stable and Pre: 0.58 ± 0.13; Post: 0.44 ± 0.31 unstable) and 16 weeks (Post: 0.40 ± 0.30 stable and Post: 0.34 ± 0.16 unstable) and increased COP displacement in response to lumbar vibration on stable (Pre: 0.018 ± 0.011; Post: 0.020 ±0.012) and unstable (Pre: 0.015 ± 0.013; Post: 0.021 ± 0.009) after 16 weeks of intervention.
Conclusion
Preliminary results show increased lumbar proprioceptive use and a switch in dominant reliance from ankle to lumbar proprioception in response to this proprioceptive intervention, translating to improved PPC. Further effects on the different lumbar muscle characteristics and their correlation with PPC will be investigated. Phenotypes of people with NSLBP will be delineated and the effects of this intervention on them will be examined. Results may improve patient-tailored exercise therapy for people with NSLBP.Research Foundation Flanders (FWO) - grant numbers 11B6522N and G072122
Back muscle characteristics to tailor exercise therapy for low back pain: study protocol and preliminary results of the “Back-to-Back” proof of concept study
No full textNon-specific low back pain (NSLBP) is the leading cause of disability. People with NSLBP exhibit alterations in their lumbar muscle characteristics and proprioceptive postural control (PPC). Defining shared underlying mechanisms and guiding treatment based on them may improve the limited effects of current treatments. This study will define the most distinctive lumbar muscle characteristics among people with NSLBP and healthy controls, and examine their interrelatedness and correlation with PPC to delineate NSLBP phenotypes. The effects of a proprioceptive intervention on these phenotypes will be investigated.
In 53 people with recurrent NSLBP and 47 healthy controls, the characteristics of the lumbar multifidus and erector spinae muscles will be investigated and compared. To evaluate PPC, ankle and back muscle vibration are applied during standing on stable and unstable ground with vision occluded. The vibration-induced Center of Pressure (COP) displacements are measured with a force plate and used to calculate relative proprioceptive reliance. Muscle activation and oxygenation are measured with electromyography and near-infrared spectroscopy, respectively, and muscle volume with 3D freehand ultrasound. The 53 people with NSLBP participate in a 16-week proprioceptive intervention, integrated into their daily lives and comprising a high-load lifting exercise. Its effects are evaluated midway, at the end and 16 weeks after the end of-intervention.
Recruitment is in progress and preliminary descriptive results of the five enrolled participants with NSLBP on PPC comprise an increase in back vibration induced COP displacement (Pre: 0.018 ± 0.011; Post: 0.020 ±0.012 stable and Pre: 0.015 ± 0.013; Post: 0.021 ± 0.009 unstable) at the end of intervention and an increased lumbar proprioceptive reliance at midway (Pre: 0.69 ± 0.04; Post: 0.46 ± 0.30 stable and Pre: 0.58 ± 0.13; Post: 0.44 ± 0.31 unstable) and end (Post: 0.40 ± 0.30 stable and Post: 0.34 ± 0.16 unstable) of intervention.
This proprioceptive intervention improved PPC, based on preliminary results. It increased the use of lumbar proprioception, leading to a shift from dominance in ankle proprioception to lumbar. The lumbar muscle characteristics and their correlation with PPC will be examined and the effects of this intervention on the delineated NSLBP phenotypes will be assessed. Patient-tailored exercise therapy for NSLBP may benefit from these results.Research Foundation Flanders - FWO (grant G072122N
Optimalisatie van spasticiteitsreductie met Botuline toxine type A injecties bij kinderen met hersenverlamming. Belang van motorische eindplaat gerichte injecties.
No full textCerebral palsy (CP) is the most common cause of physical disability in children. It is defined as a disorder of the development of movement and posture that is attributed to a non-progressive disturbance of the developing brain. In many CP patients this brain lesion causes spasticity and t he elicited increased tone leads to contractures and bony malformations. An optimal use of spasticity reduction with Botulinum toxin type A (BTX) injections, started at a young age, can prevent these complications to some extent. While m any clinical studies reported overall good results of this treatment, they also demonstrated considerable variation in outcome. This is partly due to injection variables. BTX blocks neurotransmission by inhibiting the release of Acetylcholineat the motor end plate (MEP). Animal studies already have shown thatinjecting the toxin near the MEP zone increases its paralytic effect. This was, so far, only confirmed in one human study on the biceps brachiimuscle of adults with spastic hemiplegia after acquired brain lesion (Gracies et al, 2009). Besides the lack of strong clinical evidence of theimportance of MEP targeted injections in children with CP, the clinician was confronted with the very limited information on the localization of the MEP-zones in the lower limb muscles. The overall goal of this thesis was to improve the effectiveness of lower limb treatment with intramuscular BTX injections in children with CP, by optimizing the injection location. A thorough literature search -collecting all relevant histological and anatomical studies- provided information on the exact localization of the MEP zone or the terminal nerve ramifications of most of the frequently injected lower limb muscles. After comparing these with clinical practice, it became clear that for many muscles its location was somewhat different than the currently injected areas. In the review article, o ptimal injection sites in relation to external anatomical landmarks were presented . As no informationwas found on the innervation of the psoas muscle, a cadaver dissection study was performed on 24 adult psoas muscles. With stereoscopic microscopic dissection as far as the terminal nerve ramifications, the region of intramuscular nerve endings, corresponding with the MEP zone, was identified. For both the medial hamstrings (semitendinosus, semimembranosus and gracilis muscle) as well as the psoas muscle, there was enough evidence to conclude that current popular injection techniques were not injecting the toxin at a site close to the MEP zone. To explore the clinical importance of injecting these MEP zones in children with CP, both injection techniques (current versus MEP targeted) were compared for bothmuscle groups through the application of innovative assessments. An instrumented spasticity assessment was used to evaluate the effectof BTX in the medial hamstrings. Biomechanical (position and torque) and electrophysiological signals were measured when applying passive stretches to the medial hamstrings at different velocities. First, the sensitivity of this assessment was studied on nineteen children before and after BTX injections. The biomechanical and e lectrophysiological parameters proved to be adequately sensitive to assess the response to treatment with BTX with an average of 53% reduction in velocity-dependent root mean square electromyography (RMS-EMG) and a 47% reduction in torque. A second methodological study was set up to assess whether parameters obtained from the instrumented spasticity assessment were more sensitive than clinical scales in detecting treatment response and whether they could help explain response variability. Thirty-one children with CP (40 medial hamstring muscle groups) had a clinical and instrumented spasticity assessments of the medial hamstrings before and after BTX injection. It was concluded that the instrumented spasticity assessment showed higher responsiveness than the clinical scales. The amount of RMS-EMG was considered a promising parameter to predict treatment response. Following these methodological studies, a prospective randomized trial was set up, including 34 gracilis muscles which were injected with BTX in 27 children with CP (8.5±2.5y). Seventeen muscles were treated by proximal injections (at 25% of the length of the upper leg) and 17 muscles by MEP targeted injections (half the dosage at 30% and half at 60% of the upper leg). Clinical and instrumented spasticity assessments were performed before and after the injections. The MEP targeted injections showed a significantly better decline in pathological EMG signal compared to the conventional proximal injections, demonstrated by a higher reduction of the normalized RMS-EMG parameter. This difference could not be demonstrated using the clinical scale. It was concluded that BTX injection in the gracilis muscle at the sites with a high concentration of MEPs resulted in improved spasticity reduction in children with CP. Further, we demonstrated that different injection protocols could be compared sensitively and objectively using the instrumented spasticity assessment that integrates biomechanical and electrophysiological measures. The ultimate goal is to optimize motor function and thus to understand the influence of spasticity and tone reduction treatment on functional activities, such as gait. Therefore, a study was set up to search for functional mar ke rs of spasticit y of the gastrocnemius and hamstring muscles during gait. Because spasticity is a velocity dependent feature, it has been suggested that signs of spasticity during gait may be highlighted by increasing the walking velocity. Gait parameters (kinematic, kineti c and E MG pa ra met er s, muscle length and muscle lengthening velocity MLV) of 17 typical developing ( TD) children ( 10.46±2 .36y) and 53 patients dia gnose d with spastic CP (9.8±3.0y ) were collected during a 3D gait analysis at different walking velocities (normal, fast and as fast as possible without running) and compared at twosimilar non-dimensional velocities, estimated by a linear regression model. A number of gastrocnemius and hamstrings related parameters could be considered as functional markers for spasticity, due to significantly different difference scores (between slow and fast walking velocity) between CP and TD. The spastic gastrocnemius muscle, while walking at high velocity, was characterized by a higher ankle angular velocity, planta r fle x ion mom e nt and powe r a bsorption during loading response. Additionally, this muscle demonstrated an increa s e d EMG signal during stance phase. The increa s e d wa lki ng v e loci t y a f fe c ted the spastic ha mst ring s a t the leve l of the hip a nd kne e joi nt s a t mid- stanc e by a delayed max im u m kne e e x tension mom e nt and b y an incr ea sed hip e x tension mom e nt and power generation. The hamstrings also presented with a lower MLV during swin g pha se. To evaluate both injection techniques for the psoas muscle, a quantitative evaluation using muscle volume assessment by digital magnetic resonance imagination (MRI) segmentation was done. The temporary chemical denervation caused by BTX injections leads to muscle atrophy. MRI sensitively identifies these changes inmuscle volume as was confirmed by a good intra-class correlation (0.988) and within-subject coefficient of variation of 3.506% in our study. Inseven spastic diplegic children, the MEP targeting versus a widely usedmore distal injection technique were compared. Five patients received two different injection techniques randomly applied to both psoas musclesand in two patients a bilateral MEP targeting technique was used. MRI images of the psoas were taken before, two months and -in three patients-six months after the injections. The average injection volume two months after the injection (in relation to pre-injection volume) for the nineMEP targeted muscles was 79,5% versus 107.8% for the five distal injected psoas muscles. This difference was statistically significant. In all five asymmetric injected patients, the MEP targeted psoas had an averageof 27% (range 9-37%) larger volume reduction than the more distal injected psoas muscle. This atrophy remained even six months after the treatment. We therefore concluded that i njections in the MEP zone of the muscle, which is the more proximal part of the psoas muscle, caused muscleatrophy -as a demonstration of the effect of the toxin-, in contrary tomore distal injections were this atrophy was not observed. The newly developed assessment tools (the instrumented spasticity assessment and the digital MRI segmentation muscle volume assessment) proved to be reliable and valid to compare different BTX injection protocols. The results from the gracilis and psoas study have shown that BTX injections atthe sites with high MEP concentrations, have an improved efficacy compared to injections more distant from these MEPs. It is therefore reasonable to state that all BTX injections preferably should be given close to the MEP zone(s) of the injected skeletal muscles. The effect on functionof the child with CP when using these more efficient MEP targeted BTX injections will be further explored by studying the effect on the functional spasticity markers during gait. Future studies comparing different dosage and dilution protocols injected at these MEP zones, documented by the sensitive instrumented spasticity assessment and muscle volume measurement, can further improve the treatment efficacy. This can eventually lead to the use of lower dosages thus decreasing economic costs and the risk of side effects.status: Publishe
The forgotten role of back muscle characteristics to tailor exercise therapy for recurrent non-specific low back pain: Study protocol for the Back-to-Back study
No full textBackground and aims: Current treatments for non-specific low back pain (NSLBP) have only limited effects. Identifying phenotypes of patients that share underlying mechanisms towards which clinicians could direct treatment could improve the effects. Previous studies found macroscopic, microscopic, electrophysiological, and proprioceptive changes in the back muscles of patients with NSLBP. However, no studies delineated NSLBP phenotypes based on back muscle characteristics.
Methods: We will evaluate various characteristics of the lumbar multifidus and erector spinae in 90 patients with NSLBP and 55 healthy controls: muscle volume with 3D freehand ultrasound, muscle fiber type composition with minimally-invasive muscle biopsies, proprioceptive use during postural control by applying muscle vibration during standing on a force plate, and muscle activation and oxygenation with electromyography and near-infrared spectroscopy (Fig. 1). We will determine the most discriminating muscle characteristics between patients with NSLBP and controls, based upon which phenotypes will be delineated. Then, the patients with NSLBP will be randomized into two groups receiving a 16-week program of proprioceptive training or resistance training. The effect of both programs on back muscle characteristics and disability will be evaluated halfway the program, at the end of the program, and 16 weeks after the end of training.
Results: The protocol is submitted to the Ethical Committees of UZ/KU Leuven and UHasselt. The study is funded by the Research Foundation - Flanders (FWO) (G072122N). Participant recruitment and data collection are anticipated to start in March 2023.
Conclusions: We expect the results to help improve the patient-tailored exercise therapy for NSLBP
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