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.

下背痛（LBP）是一种常见的和衰弱的医疗条件，但绝大多数临床病例没有一个病理解剖诊断的基础上，标准的临床测试。 我们以前的研究表明，与健康对照组相比，LBP患者的姿势控制受损。 此外，已知对突然躯干负荷具有延迟肌肉反射反应的个体处于持续下背部损伤的增加的风险中。保守的治疗方法，包括止痛药和物理治疗，通常不能令人满意。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改善了非特异性LBP患者的姿势控制，这些患者在进行不稳定的坐姿测试时表现出这种障碍。 然而，由于OMT的控制系统的变化负责的机制是未知的。 我们假设OMT的目标是由肌梭功能障碍引起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的方法来确定使用OMT改变的姿势控制系统的元素。 本研究的目标1将优化评估LBP患者神经肌肉控制的关键任务。 这些关键任务将用于目标2，以确定LBP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旨在单独观察反射反应和肌梭的行为。 在目标3中，将评估竖脊肌的激活以响应机械敲击，以确定OMT是否将控制策略从共激活改变为相互抑制。 将通过目标4中对机械肌肉振动的反应来评估LBP患者中通过肌梭反馈介导的姿势控制退化。 完成后，该项目将提供敏感和客观的临床研究工具，可以模拟姿势控制，评估控制能力，并确定控制障碍。 这些工具将在未来的临床研究中用于表征LBP患者的运动控制障碍，用于标准化和优化针对神经肌肉骨骼疾病的CAM治疗，以及用于监测治疗结果。