Inter-rater reliability of three standardized functional tests in patients with low back pain

<p>Abstract</p> <p>Background</p> <p>Of all patients with low back pain, 85% are diagnosed as "non-specific lumbar pain". Lumbar instability has been described as one specific diagnosis which several authors have described as delayed muscular responses, impaired postural control as well as impaired muscular coordination among these patients. This has mostly been measured and evaluated in a laboratory setting. There are few standardized and evaluated functional tests, examining functional muscular coordination which are also applicable in the non-laboratory setting. In ordinary clinical work, tests of functional muscular coordination should be easy to apply. The aim of this present study was to therefore standardize and examine the inter-rater reliability of three functional tests of muscular functional coordination of the lumbar spine in patients with low back pain.</p> <p>Methods</p> <p>Nineteen consecutive individuals, ten men and nine women were included. (Mean age 42 years, SD ± 12 yrs). Two independent examiners assessed three tests: "single limb stance", "sitting on a Bobath ball with one leg lifted" and "unilateral pelvic lift" on the same occasion. The standardization procedure took altered positions of the spine or pelvis and compensatory movements of the free extremities into account. The inter-rater reliability was analyzed by Cohen's kappa coefficient (κ) and by percentage agreement.</p> <p>Results</p> <p>The inter-rater reliability for the right and the left leg respectively was: for the single limb stance very good (κ: 0.88–1.0), for sitting on a Bobath ball good (κ: 0.79) and very good (κ: 0.88) and for the unilateral pelvic lift: good (κ: 0.61) and moderate (κ: 0.47).</p> <p>Conclusion</p> <p>The present study showed good to very good inter-rater reliability for two standardized tests, that is, the single-limb stance and sitting on a Bobath-ball with one leg lifted. Inter-rater reliability for the unilateral pelvic lift test was moderate to good. Validation of the tests in their ability to evaluate lumbar stability is required.</p

Regional differences in lumbar spinal posture and the influence of low back pain

<p>Abstract</p> <p>Background</p> <p>Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP.</p> <p>Methods</p> <p>One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx), Upper lumbar (ULx) and total lumbar (TLx) spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks.</p> <p>Results</p> <p>Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638), but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p < 0.001). Regional differences in range of motion from reference postures in sitting and standing were evident. BMI accounted for regional differences found in all sitting and some standing measures. LBP was not associated with differences in regional lumbar spine angles or range of motion, with the exception of maximal backward bending range of motion (F = 5.18, p = 0.007).</p> <p>Conclusion</p> <p>This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.</p

Maturation profile of thalamic neurons responsive to rotational and translational motions

Program/Poster no. 169.13/KK15Spatial information arising from the canals and otolith organs is processed in vestibular nuclear neurons that are randomly distributed without a clear topography. Topographic representation of the respective inputs was however documented in the inferior olive, a descending relay station. In search of stations that mediate the topographic representation of vestibular inputs, we further examined the thalamus and aimed to investigate the maturation profile of functionally activated vestibular-related thalamic neurons in postnatal rats (P4-P70/adult). Conscious animals were subjected to either horizontal/vertical rotations or linear translations, which are known to activate hair cells of canals and otolith organs, respectively. Neuronal Activated thalamic neurons were detected by immunohistochemistry for Fos expression. Normal stationary and labyrinthectomized controls that were subjected to vestibular stimulations showed sporadically scattered Fos-immunoreactive neurons. During postnatal development, Fos expression evoked by vestibular stimulation was not recognized in the thalamus until P28. Central medial thalamic nucleus (CM), middle paracentral thalamic nucleus (PC) and zone incerta (ZI) showed otolith organ-evoked Fos expression from P28 onwards. Rostral PC and mediodorsal thalamic nucleus (MD) responded to horizontal canal activation from P28 onwards. Subparafascicular thalamic nucleus (SPF) responded to both otolithic and horizontal canal activations by P28. Certain thalamic subnuclei, however, responded only in the adult stage. These included the centrolateral thalamic nuclei (CL) which showed Fos expression with otolithic stimulation whereas the rhomboid thalamic nucleus (Rh) showed Fos expression with stimulation of both the otolith and the horizontal canals. In the adult, MD was the only thalamic subnucleus that responded to otolithic and vertical/horizontal canal stimulations. Taken together, our results document the developmental topography of thalamic subnuclei in recognizing three-dimensional spatial orientation during angular and linear head movements

Glutamatergic transmission in the vestibular nucleus is critical to the formation of spatial topography and acquisition of spatial navigation in rats behaviour

Poster - 157. Central Physiology and Anatomy - Theme D: Sensory and Motor Systems: no. 157.0

Postnatal glutamatergic and GABAergic transmission within the vestibular nucleus is critical for the maturation of canal-related spatial map

Program no. 843.1 & Poster no. D8Poster Session 843: Development of Auditory and Vestibular SystemsN-methyl-D-aspartate (NMDA) receptor and γ-aminobutyric acid (GABA) receptor play important roles in regulating the maturation of different sensory systems, including the visual, auditory and somatosensory systems. With the use of Fos protein expression as a neuronal marker for postsynaptic activation after sinusoidal horizontal rotation, we have revealed the occurrence of a spatial map in the inferior olive (IO) and thalamus, the descending and ascending relay stations of the vestibular circuitry respectively. To ascertain the contribution of excitatory and inhibitory inputs on the formation of spatial map in the central vestibular system, Elvax slice loaded with NMDA receptor antagonist MK801 or GABAA receptor antagonist bicuculline methoiodine was implanted over the bilateral vestibular nucleus (VN) of neonatal rats. The rats were allowed to recover until adulthood. We found that adult rats pretreated at P1 with MK801 or bicuculline could stay on rotating rod for shorter times than the controls. Comparable motor deficits were observed in animals either with selective destruction of IO cells by 3-acetylpyridine treatment or with electrolytic lesion of thalamic subnuclei that expressed horizontal rotation triggered Fos-positive neurons. Derangement of spatial map in IO and thalamus was also observed in both MK801-treated and bicuculline-treated adult rats, suggesting that postnatal NMDA and GABA transmission within VN is critical for developmental establishment of neural network for spatial map that encodes rotational motion in mature animals

Postnatal refinement of gravity-related spatial coding to the central vestibular circuitry

This journal supplement is proceedings of the 36th International Congress of Physiological Sciences (IUPS2009)Poster Session: IV-11 Neurobiology & neuroscience: Sensory systems: P1PM-13-28The 36th International Congress of Physiological Sciences (IUPS2009), Kyoto, Japan, 27 July-1 August 2009. In Journal of Physiological Sciences, 2009, v. 59 suppl. 1, p. 20

Maturation of canal-related brainstem neurons in the detection of horizontal angular acceleration in rats

We examined the functional maturation of canal-related brainstem neurons in Sprague-Dawley rats at postnatal day (P) 1 to adult. Conscious animals were subjected to cycles of angular acceleration and deceleration so as to selectively activate hair cells of the horizontal semicircular canals. Brainstem neurons were monitored for c-fos expression by immune-hybridization histochemistry as an indicator of neuronal activation. Fos-immunoreactive canalrelated neurons were identifiable from P4 onwards in the vestibular nucleus and downstream vestibular relay stations, propositus hypoglossal nucleus, and inferior olive. In the vestibular nucleus and prepositus hypoglossal nucleus, the number of canal-related neurons increased progressively with age, reaching the adult level by P21. Those in the inferior olive increased in number from P4to P14 but decreased significantly afterwards until adulthood. The topography was not clear in the vestibular nucleus and pre-positus hypoglossal nucleus. Canal-related neurons in P4 -7 rats were spread throughout the rostrocaudal length of each subnucleus but clusters of canal-related neurons tended to form within specific subnuclei by P21. These were concentrated in the caudal halves of medial and spinal vestibular nuclei and the rostral parts of superior vestibular nucleus and prepositus hypoglossal nucleus. In the inferior olive, the topography was evident early in the course of development. Canal-related neurons were exclusively located in four subnuclei: dorsal medial cell column, dorsal cap, subnucleus A, and subnucleus C, but not in other subnuclei. Taken together, our data revealed the developmental profile of neuronal subpopulations within the horizontal canal system, thus providing an internal neural representation for postnatal coding of horizontal head rotations in spatial perception. © 2009 Wiley-Liss, Inc.link_to_subscribed_fulltex

Early postnatal disturbance of inhibitory transmission in the vestibular nucleus impacts on the thalamic spatial map and navigation behaviors

HKU Physiology Centennial Celebration - Titanium Jubilee of Department of Physiology, The University of Hong KongConference Theme: A Century of Advances in Physiology, Biophysics and Neuroscienc