Cervical kinematic training with and without interactive VR training for chronic neck pain - a randomized clinical trial

Impairments in cervical kinematics are common in patients with neck pain. A virtual reality (VR) device has potential to be effective in the management of these impairments. The objective of this study was to investigate the effect of kinematic training (KT) with and without the use of an interactive VR device. In this assessor-blinded, allocation-concealed pilot clinical trial, 32 participants with chronic neck pain were randomised into the KT or kinematic plus VR training (KTVR) group. Both groups completed four to six training sessions comprising of similar KT activities such as active and quick head movements and fine head movement control and stability over five weeks. Only the KTVR group used the VR device. The primary outcome measures were neck disability index (NDI), cervical range of motion (ROM), head movement velocity and accuracy. Kinematic measures were collected using the VR system that was also used for training. Secondary measures included pain intensity, TAMPA scale of kinesiophobia, static and dynamic balance, global perceived effect and participant satisfaction. The results demonstrated significant (p < 0.05) improvements in NDI, ROM (rotation), velocity, and the step test in both groups post-intervention. At 3-month post-intervention, these improvements were mostly sustained; however there was no control group, which limits the interpretation of this. Between-group analysis showed a few specific differences including global perceived change that was greater in the KTVR group

High variability of the subjective visual vertical test of vertical perception, in some people with neck pain - should this be a standard measure of cervical proprioception?

Background: Subjective visual vertical (SVV) assesses visual dependence for spacial orientation, via vertical perception testing. Using the computerized rod-and-frame test (CRFT), SVV is thought to be an important measure of cervical proprioception and might be greater in those with whiplash associated disorder (WAD), but to date research findings are inconsistent

Characteristics of visual disturbances reported by subjects with neck pain

Visual symptoms are often reported by patients with neck pain. The aim of the study was to report on the prevalence and most troublesome visual disturbances in subjects with neck pain. Seventy subjects with neck pain and seventy healthy control subjects answered questions about the presence and magnitude (/12) - product of frequency (0-4) and intensity (0-3) of each of 16 visual symptoms noted to be associated with neck pain and other possible causes. A visual complaint index (VCI) (/168) was generated from the sum of the magnitude rating of 14 significant symptoms. The neck pain group had significantly (P > 0.05) greater prevalence and magnitude of 14/16 visual complaints and VCI (mean 27.4) compared to control subjects (mean 6.2). The most prevalent symptoms were 'need to concentrate to read' (70%) and 'sensitivity to light' (58.6%). The least prevalent were 'double vision' (28.6%) and 'dizzy reading' (38.6%). The most troublesome symptoms (greatest magnitude) were 'need to concentrate to read' (3.4/12), 'visual fatigue' (3/12), 'difficulty judging distances' (2.1/12) and 'sensitivity to light' (2.1/12) while the least troublesome complaints were 'double vision' (0.5/12), 'red eyes' (1/12) and 'spots and words moving' (1/12). The characteristics of the visual symptoms were mostly consistent for those previously associated with neck pain. Subjects with traumatic neck pain had a significantly higher VCI compared to those with idiopathic neck pain. The results could help with differential diagnosis. The visual symptoms might be related to eye movement control disturbances in neck pain, however further research is required. Crown Copyright (C) 2014. Published by Elsevier Ltd. All rights reserved

Altered trunk head co-ordination in those with persistent neck pain

Background: Decreased neck motion and sensorimotor deficits have been identified in those with neck pain. It is thought that these might be related to altered reflex mechanisms between the neck, eyes and the vestibular system. Trunk, head co-ordination might also be altered in neck pain. Objectives: This study investigated trunk head co-ordination ability in subjects with neck pain compared to asymptomatic controls. Method: Twenty–four subjects with persistent neck pain and twenty-six age and gender matched healthy controls performed 3 trials of 3 trunk movements whilst trying to keep the head still - (1) alternate trunk movement to the left and right (2) trunk movement to the left (3) trunk movement to the right. Wireless motion sensors positioned over the sternum and the forehead measured trunk and head range and velocity of motion. Analysis: ANOVA was used to compare trunk and head range and velocity of motion during the 3 tasks. Results: Neck pain subjects had significantly less trunk movement (p < 0.05) and velocity (p

Neck Pain Driving Index: appropriateness of the rating scale and unidimensionality of the strategic, tactical, and operational levels

Objective: To establish an appropriate scoring system using Rasch scores for the strategic, tactical, and operational levels of the Neck Pain Driving Index (NPDI) and to refine the NPDI by testing the unidimensionality of each driving performance level using Rasch analysis

Minimum repetitions for stable measures of visual dependency using the dot version of the computer-based Rod-Frame test

Visual dependency is a condition where spatial orientation is mainly dependent on visual information. It can be affected in conditions such as vestibular disorders, brain injuries and neck pain including whiplash. Visual dependency can be assessed with a computer-based, dot version, Rod-Frame test (C-RFTdot) by measuring the deviation of a rod (comprised of two dots) from the true vertical within tilted frames at 18 degrees in both clockwise and anticlockwise directions. However, the number of test repetitions differs between studies. The purpose of this study was to investigate the minimum number of repetitions to obtain stable C-RFTdot outcomes. Thirty-one asymptomatic subjects were recruited. With a frame tilt of 18 degrees (clockwise and anticlockwise), the rod was pre-set at 20 degrees in both clockwise and anticlockwise directions. The rod could be rotated, using a mouse, to a minimum of 0.01 degrees. The clockwise and anticlockwise deviations from the true vertical were positive values and negative values, respectively. A session consisted of two measures of deviations of pre-set rod conditions in each frame. Their signed values were averaged for analysis. Eight sessions were conducted. The differences between the mean values of N-1 and N repetitions (

The Neck Pain Driving Index (NPDI) for chronic whiplash-associated disorders: development, reliability, and validity assessment

BACKGROUND CONTEXT: Driving is a functional complaint of many individuals with chronic whiplash-associated disorders (WAD). Current driving scales do not include the most troublesome driving tasks for this group, which suggests that a new tool is required to assess perceived driving difficulty in this population

A description of neck motor performance, neck pain, fatigue, and mental effort while driving in a sample with chronic whiplash-associated disorders

Objective: Individuals with chronic whiplash-associated disorders (WADs) often note driving as a difficult task. This study’s aims were to (1) compare, while driving, neck motor performance, mental effort, and fatigue in individuals with chronic WAD against healthy controls and (2) investigate the relationships of these variables and neck pain to self-reported driving difficulty in the WAD group. Design: This study involved 14 participants in each group (WAD and control). Measures included self-reported driving difficulty and measures of neck pain intensity, overall fatigue, mental effort, and neck motor performance (head rotation and upper trapezius activity) while driving a simulator. Results: The WAD group had greater absolute path of head rotation in a simulated city area and used greater mental effort (P = 0.04), but there were no differences in other measures while driving compared with the controls (all P Q 0.05). Self-reported driving difficulty correlated moderately with neck pain intensity, fatigue level, and maximum velocity of head rotation while driving in the WAD group (all P G 0.05). Conclusions: Individuals with chronic WAD do not seem to have impaired neck motor performance while driving yet use greater mental effort. Neck pain, fatigue, and maximum head rotation velocity could be potential contributors to self-reported driving difficulty in this group