Systems approach to studying therapeutic horse riding and/P.Reeves/H.Clayton

突然，意想不到的负荷脊柱导致最严重和昂贵的背部损伤。在这些突发事件中，快速和适当的姿势控制反应对于使脊柱免受有害负荷是很重要的。不幸的是，腰痛（LBP）患者的姿势控制能力受损，这表明他们更有可能再次伤害自己并发展成慢性背痛。实验和建模工作表明，在LBP组中发现的较差的姿势控制，部分可以用姿势反应的较长延迟来解释。有几项研究表明，背部疼痛与姿势反应时间的增加有关。此外，有研究表明，姿势反应的可变性增加，表明姿势控制不那么精确。我们假设，如果整骨疗法（OMT）可以有效地减少躯体功能障碍和疼痛，那么应该实现姿势控制的改善，包括更快和更准确的反应。这种姿势控制的改善可以减轻突发事件带来的不利影响。为了验证这一假设，我们将开发姿态控制系统的客观性能测量，特别是对控制带宽（控制系统的速度）和精度（期望输出与实际输出之间的误差）的评估。这将有三个具体目的：(1)比较健康和腰痛个体的姿势控制；(2)比较OMT前后腰痛个体的姿势控制；(3)根据躯体功能障碍和姿势控制措施将受试者分为同质组，并评估疼痛和残疾方面的组间差异。位置和力控制都将在跟踪和稳定任务中进行评估。此外，模拟的提升任务将用于评估姿势控制系统对突然的、意外的扰动的响应，从转移的支持基础。拟议的研究将应用一种基于系统科学的创新方法，开发敏感和客观的临床研究工具，以评估姿势控制系统的性能变化。

Sudden, unexpected loading to the spine results in the most severe and costly back injuries. Fast and appropriate postural control responses during these sudden, unexpected events are important to spare the spine from harmful loading. Unfortunately, people with low back pain (LBP) have impaired postural control, which suggests that they are more likely to re-injure themselves and develop chronic back pain. Experimental and modeling work has demonstrated that poor postural control found in the LBP group, in part, can be explained by longer delays in postural responses. There are several studies documenting an increase in the postural response times associated with back pain. In addition, there are studies documenting increased variability in postural responses suggesting that postural control is less precise. We hypothesize that if osteopathic manipulative therapy (OMT) can effectively reduce somatic dysfunction and pain, then improvements in postural control, including faster and more accurate responses, should be realized. This improvement in postural control should then mitigate any adverse effects from a sudden, unexpected event. To test this hypothesis, we will develop objective performance measures of the postural control system, in particular assessment of the bandwidth of control (speed of the control system) and accuracy (error between desired and actual output). This will be accomplished with three specific aims: (1) to compare postural control in healthy and LBP individuals; (2) to compare postural control in LBP individuals before and after OMT; and (3) to classify subjects into homogeneous groups of measures of somatic dysfunction and postural control, and to evaluate group differences in terms of pain and disability. Both position and force control will be assessed during tracking and stabilization tasks. In addition, a simulated lifting task will be used to assess the response of the postural control system to sudden, unexpected perturbations from shifting the base of support. The proposed research will apply an innovative approach, based on Systems Science, to develop sensitive and objective clinical research tools that can assess performance changes in the postural control system.