Perceptual-motor strategies during locomotion in patients with chronic non-specific low back pain : towards new methods of analysis and follow-up

La lombalgie chronique non spécifique (LCNS) a été identifiée comme l’une des principales causes d'invalidité dans le monde. Elle est évaluée majoritairement grâce à des échelles ou questionnaires, rapportant l'influence de facteurs cognitifs, émotionnels et comportementaux. Cependant, peu d'études l'ont évaluée dans des situations de la vie quotidienne, telles que passer à travers une ouverture de porte ou éviter un piéton sur sa trajectoire. L'objectif de cette thèse a été d'évaluer l'influence de la LCNS dans des paradigmes de locomotion en interaction avec l'environnement, faisant intervenir des facteurs situationnels et sociaux afin de proposer de nouvelles méthodes d'analyse et de suivi des patients. Les participants LCNS ont été comparés à des adultes asymptomatiques (AA) dans 3 tâches de marche dirigée vers un but : 1) une tâche de passage à travers différentes largeurs d'ouvertures où les participants LCNS ont cessé de tourner leurs épaules pour une ouverture plus étroite que les AA, 2) une tâche faisant intervenir des facteurs situationnels (ouverture large ou étroite) et sociaux (expérimentateur au milieu des deux ouvertures) où les participants LCNS modifient leur décision de franchir une ouverture en fonction des facteurs situationnels, et 3) une tâche de croisement de piétons où les participants LCNS semblent bien percevoir les conditions de l'interaction (seuil de déclenchement d’une adaptation et distance de croisement) mais contribuent différemment. En conclusion, la LCNS semble affecter les décisions des participants utilisant des stratégies perceptivo-motrices basées sur le contexte situationnel plutôt que sur le contexte social.Chronic non-specific low back pain (cNSLBP) has been identified as one of the leading causes of disability worldwide. It is mainly assessed using scales or questionnaires, reporting the influence of cognitive, emotional and be- havioural factors. However, few studies have assessed it in everyday situations, such as passing through a doorway or avoiding a pedestrian in the path. The aim of this thesis was to evaluate the influence of cNSLBP in locomotion paradigms interacting with the environment, involving situational and social factors, in order to propose new methods for analysing and follow-up patients. cNSLBP participants were compared to asymptomatic adult (AA) in 3 goal-directed walking tasks: 1) a task of passing through different widths of apertures where cNSLBP participants stopped turning their shoulders for a narrower opening than AA, 2) a task involving situational (wide or narrow aperture) and social factors (experimenter in the middle of the two apertures) where cNSLBP participants modified their decision to pass through an aperture according to the situational factors, and 3) a pedestrian crossing task where cNSLBP participants seemed to perceive the interaction conditions well (threshold for triggering an adaptation and crossing distance) but contributed differently. In conclusion, cNSLBP seems to affect the decisions of participants using perceptual-motor strategies based on the situational context rather than the social context

Stratégies perceptive-motrices durant la locomotion des patients atteints d'une lombalgie chronique non-spécifique : vers de nou­velles méthodes d'analyse et de suivi

Chronic non-specific low back pain (cNSLBP) has been identified as one of the leading causes of disability worldwide. It is mainly assessed using scales or questionnaires, reporting the influence of cognitive, emotional and be- havioural factors. However, few studies have assessed it in everyday situations, such as passing through a doorway or avoiding a pedestrian in the path. The aim of this thesis was to evaluate the influence of cNSLBP in locomotion paradigms interacting with the environment, involving situational and social factors, in order to propose new methods for analysing and follow-up patients. cNSLBP participants were compared to asymptomatic adult (AA) in 3 goal-directed walking tasks: 1) a task of passing through different widths of apertures where cNSLBP participants stopped turning their shoulders for a narrower opening than AA, 2) a task involving situational (wide or narrow aperture) and social factors (experimenter in the middle of the two apertures) where cNSLBP participants modified their decision to pass through an aperture according to the situational factors, and 3) a pedestrian crossing task where cNSLBP participants seemed to perceive the interaction conditions well (threshold for triggering an adaptation and crossing distance) but contributed differently. In conclusion, cNSLBP seems to affect the decisions of participants using perceptual-motor strategies based on the situational context rather than the social context.La lombalgie chronique non spécifique (LCNS) a été identifiée comme l’une des principales causes d'invalidité dans le monde. Elle est évaluée majoritairement grâce à des échelles ou questionnaires, rapportant l'influence de facteurs cognitifs, émotionnels et comportementaux. Cependant, peu d'études l'ont évaluée dans des situations de la vie quotidienne, telles que passer à travers une ouverture de porte ou éviter un piéton sur sa trajectoire. L'objectif de cette thèse a été d'évaluer l'influence de la LCNS dans des paradigmes de locomotion en interaction avec l'environnement, faisant intervenir des facteurs situationnels et sociaux afin de proposer de nouvelles méthodes d'analyse et de suivi des patients. Les participants LCNS ont été comparés à des adultes asymptomatiques (AA) dans 3 tâches de marche dirigée vers un but : 1) une tâche de passage à travers différentes largeurs d'ouvertures où les participants LCNS ont cessé de tourner leurs épaules pour une ouverture plus étroite que les AA, 2) une tâche faisant intervenir des facteurs situationnels (ouverture large ou étroite) et sociaux (expérimentateur au milieu des deux ouvertures) où les participants LCNS modifient leur décision de franchir une ouverture en fonction des facteurs situationnels, et 3) une tâche de croisement de piétons où les participants LCNS semblent bien percevoir les conditions de l'interaction (seuil de déclenchement d’une adaptation et distance de croisement) mais contribuent différemment. En conclusion, la LCNS semble affecter les décisions des participants utilisant des stratégies perceptivo-motrices basées sur le contexte situationnel plutôt que sur le contexte social

Stratégies perceptive-motrices durant la locomotion des patients atteints d'une lombalgie chronique non-spécifique : vers de nou­velles méthodes d'analyse et de suivi

Chronic non-specific low back pain (cNSLBP) has been identified as one of the leading causes of disability worldwide. It is mainly assessed using scales or questionnaires, reporting the influence of cognitive, emotional and be- havioural factors. However, few studies have assessed it in everyday situations, such as passing through a doorway or avoiding a pedestrian in the path. The aim of this thesis was to evaluate the influence of cNSLBP in locomotion paradigms interacting with the environment, involving situational and social factors, in order to propose new methods for analysing and follow-up patients. cNSLBP participants were compared to asymptomatic adult (AA) in 3 goal-directed walking tasks: 1) a task of passing through different widths of apertures where cNSLBP participants stopped turning their shoulders for a narrower opening than AA, 2) a task involving situational (wide or narrow aperture) and social factors (experimenter in the middle of the two apertures) where cNSLBP participants modified their decision to pass through an aperture according to the situational factors, and 3) a pedestrian crossing task where cNSLBP participants seemed to perceive the interaction conditions well (threshold for triggering an adaptation and crossing distance) but contributed differently. In conclusion, cNSLBP seems to affect the decisions of participants using perceptual-motor strategies based on the situational context rather than the social context.La lombalgie chronique non spécifique (LCNS) a été identifiée comme l’une des principales causes d'invalidité dans le monde. Elle est évaluée majoritairement grâce à des échelles ou questionnaires, rapportant l'influence de facteurs cognitifs, émotionnels et comportementaux. Cependant, peu d'études l'ont évaluée dans des situations de la vie quotidienne, telles que passer à travers une ouverture de porte ou éviter un piéton sur sa trajectoire. L'objectif de cette thèse a été d'évaluer l'influence de la LCNS dans des paradigmes de locomotion en interaction avec l'environnement, faisant intervenir des facteurs situationnels et sociaux afin de proposer de nouvelles méthodes d'analyse et de suivi des patients. Les participants LCNS ont été comparés à des adultes asymptomatiques (AA) dans 3 tâches de marche dirigée vers un but : 1) une tâche de passage à travers différentes largeurs d'ouvertures où les participants LCNS ont cessé de tourner leurs épaules pour une ouverture plus étroite que les AA, 2) une tâche faisant intervenir des facteurs situationnels (ouverture large ou étroite) et sociaux (expérimentateur au milieu des deux ouvertures) où les participants LCNS modifient leur décision de franchir une ouverture en fonction des facteurs situationnels, et 3) une tâche de croisement de piétons où les participants LCNS semblent bien percevoir les conditions de l'interaction (seuil de déclenchement d’une adaptation et distance de croisement) mais contribuent différemment. En conclusion, la LCNS semble affecter les décisions des participants utilisant des stratégies perceptivo-motrices basées sur le contexte situationnel plutôt que sur le contexte social

Locomotion behavior of chronic non-specific low back pain (cNSLBP) patient while walking through apertures

International audienceBACKGROUND AND AIM: NSLBP is characterized by symptoms without clear patho-anatomical causes and cLBP has been identified as one of the leading global causes of disability [1]. The majority of clinical trials assess cNSLBP using scales or questionnaires reporting an influence of cognitive, emotional and behavioral factors [2]. Previous studies have evaluated the motor consequences of cNSLBP using biomechanical analysis, showing alterations in the kinematics and dynamics of locomotion [3,4]. However, few studies have evaluated cNSLBP participants in ecological situations, such as walking with obstacles or avoidance, allowing a simultaneous evaluation of cognitive, perceptual and motor components in a situation closer to the one encountered in daily life. In this context, using a horizontal aperture crossing paradigm [5], this study aimed to 1) understand the effect of cNSLBP in action strategies and (2) identify factors that may influence these decisions. METHODS: Healthy adults (N=15) and cNSLBP adults (N=15) performed a walking protocol composed of 3 random blocks of 19 trials with aperture ranging from 0.9 to 1.8 x shoulder width. The dimensions of the obstacle causing an individual to change their actions (shoulders rotation, velocity, trunk stability) is referred to as the Critical Point (CP). RESULTS: In these preliminary results considering shoulder width, welch's t-test showed that the average CP in the healthy group was significantly larger (1.20 SD = 0.052) than the one of cNSLBP group (1.15, SD = 0.029) (t(20.08) = 3.07, p<0.01, d = 1.16). CONCLUSIONS: This analysis on shoulder data is a first attempt to investigate the influence of cNSLBP on motor behavior and decisions in an ecological paradigm. Results show a slightly more risky behavior of patients with smaller CP. Future work is required to study walking speed profile and to relate behavioral data with variables that can influence pain perception (intensity, duration, kinesiophobia, fear avoidance beliefs, catastrophism and psychological inflexibility).[1] Maher et al. (2017) The Lancet. [2] Chiarotto et al. (2015) European Spine Journal. [3] Koch et al. (2019) Frontiers in psychology. [4] Moissenet et al. (2021) Scientific reports. [5] Higuchi et al. (2006) Experimental Brain Research

Locomotion behavior of chronic non-specific low back pain (cNSLBP) patient while walking through apertures

International audienceBACKGROUND AND AIM: NSLBP is characterized by symptoms without clear patho-anatomical causes and cLBP has been identified as one of the leading global causes of disability [1]. The majority of clinical trials assess cNSLBP using scales or questionnaires reporting an influence of cognitive, emotional and behavioral factors [2]. Previous studies have evaluated the motor consequences of cNSLBP using biomechanical analysis, showing alterations in the kinematics and dynamics of locomotion [3,4]. However, few studies have evaluated cNSLBP participants in ecological situations, such as walking with obstacles or avoidance, allowing a simultaneous evaluation of cognitive, perceptual and motor components in a situation closer to the one encountered in daily life. In this context, using a horizontal aperture crossing paradigm [5], this study aimed to 1) understand the effect of cNSLBP in action strategies and (2) identify factors that may influence these decisions. METHODS: Healthy adults (N=15) and cNSLBP adults (N=15) performed a walking protocol composed of 3 random blocks of 19 trials with aperture ranging from 0.9 to 1.8 x shoulder width. The dimensions of the obstacle causing an individual to change their actions (shoulders rotation, velocity, trunk stability) is referred to as the Critical Point (CP). RESULTS: In these preliminary results considering shoulder width, welch's t-test showed that the average CP in the healthy group was significantly larger (1.20 SD = 0.052) than the one of cNSLBP group (1.15, SD = 0.029) (t(20.08) = 3.07, p<0.01, d = 1.16). CONCLUSIONS: This analysis on shoulder data is a first attempt to investigate the influence of cNSLBP on motor behavior and decisions in an ecological paradigm. Results show a slightly more risky behavior of patients with smaller CP. Future work is required to study walking speed profile and to relate behavioral data with variables that can influence pain perception (intensity, duration, kinesiophobia, fear avoidance beliefs, catastrophism and psychological inflexibility).[1] Maher et al. (2017) The Lancet. [2] Chiarotto et al. (2015) European Spine Journal. [3] Koch et al. (2019) Frontiers in psychology. [4] Moissenet et al. (2021) Scientific reports. [5] Higuchi et al. (2006) Experimental Brain Research

Locomotion behavior of chronic non-specific low back pain (cNSLBP) patient while walking through apertures

International audienceBACKGROUND AND AIM: NSLBP is characterized by symptoms without clear patho-anatomical causes and cLBP has been identified as one of the leading global causes of disability [1]. The majority of clinical trials assess cNSLBP using scales or questionnaires reporting an influence of cognitive, emotional and behavioral factors [2]. Previous studies have evaluated the motor consequences of cNSLBP using biomechanical analysis, showing alterations in the kinematics and dynamics of locomotion [3,4]. However, few studies have evaluated cNSLBP participants in ecological situations, such as walking with obstacles or avoidance, allowing a simultaneous evaluation of cognitive, perceptual and motor components in a situation closer to the one encountered in daily life. In this context, using a horizontal aperture crossing paradigm [5], this study aimed to 1) understand the effect of cNSLBP in action strategies and (2) identify factors that may influence these decisions. METHODS: Healthy adults (N=15) and cNSLBP adults (N=15) performed a walking protocol composed of 3 random blocks of 19 trials with aperture ranging from 0.9 to 1.8 x shoulder width. The dimensions of the obstacle causing an individual to change their actions (shoulders rotation, velocity, trunk stability) is referred to as the Critical Point (CP). RESULTS: In these preliminary results considering shoulder width, welch's t-test showed that the average CP in the healthy group was significantly larger (1.20 SD = 0.052) than the one of cNSLBP group (1.15, SD = 0.029) (t(20.08) = 3.07, p<0.01, d = 1.16). CONCLUSIONS: This analysis on shoulder data is a first attempt to investigate the influence of cNSLBP on motor behavior and decisions in an ecological paradigm. Results show a slightly more risky behavior of patients with smaller CP. Future work is required to study walking speed profile and to relate behavioral data with variables that can influence pain perception (intensity, duration, kinesiophobia, fear avoidance beliefs, catastrophism and psychological inflexibility).[1] Maher et al. (2017) The Lancet. [2] Chiarotto et al. (2015) European Spine Journal. [3] Koch et al. (2019) Frontiers in psychology. [4] Moissenet et al. (2021) Scientific reports. [5] Higuchi et al. (2006) Experimental Brain Research

Etude du paradigme de passage à travers une ouverture horizontale dans une population présentant une lombalgie chronique commune

International audienc

Gait adaptability in chronic low back pain: reduced complexity during aperture passing

International audienceBackground and Aim. Chronic non-specific low back pain (cNSLBP) is a leading global cause of disability worldwide, exhibiting inadequate pathological and anatomical explanations. Prior research has indicated that cNSLBP not only impacts the kinematics and dynamics of locomotion but also influences adaptive behavior. Individuals with cNSLBP tend to adopt riskier strategies when passing through openings, which may be a means of minimising shoulder rotations [1]. Given that the majority of human movements are inherently non-linear [2], the analysis of movement variability complexity through metrics such as Sample Entropy (SEn) -an index of time-series (ir)regularity- provides valuable insights into movement and adaptive capacities. This approach is relevant in the context of pathologies such as cNSLBP, which are associated with reduced movement complexity [3]. The aim of this study was to compare gait adjustments and behavioral complexity between individuals with cNSLBP and healthy participants when approaching horizontal openings.Methods. Fifteen asymptomatic adults (AA) and fourteen individuals with cNSLBP completed a walking protocol along a 14-meter path. The protocol consisted of 3 randomized blocks of 19 trials, with apertures ranging from 0.9 to 1.8 times the participants' shoulder width, designed to induce trials that either required or did not require shoulder adaptive rotations. Movements were recorded using the Qualisys motion capture system. The changes in behavioral complexity related to the change of aperture width were quantified using SEn, where lower entropy indicates greater regularity and reduced complexity [2]. The analysis period covered the 2 seconds preceding the crossing of the opening [2].Results. The results indicated that in the AA group, SEn increased as the aperture ratio increased. Similarly, the cNSLBP group also showed an increase in SEn with wider apertures, but the rate of increase was significantly lower compared to the AA group. This suggests that individuals with cNSLBP may struggle to increase movement complexity or degrees of freedom [4], resulting in less adaptable, more constrained movements even when facing wider apertures.Conclusions. The findings support that cNSLBP affects adaptive locomotor behavior, as movement complexity increases with the widening of the aperture, although this increase is less pronounced in cNSLBP participants. These results align with existing literature, which has demonstrated that individuals with low back pain tend to exhibit lower movement variability and complexity compared to those without pain. This suggests that their movements are more stereotyped and less varied [5]. This reduced complexity may partially explain why their navigation strategies tend to be riskier. Future research is to explore different phases of the adaptive aperture crossing task, including the stable walking period [2] and the approach phase [1].References1 - Bilhaut et al., 2023, Gait and Posture.2 - Muroi et al., 2023, Journal of Motor Behavior.3 - Gizzi et al., 2019, European Journal of Pain.4 - Kodama et al., 2022, Journal of Motor Behavior.5 - Laird et al., 2014, BMC Musculoskeletal Disorders