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The purpose of this study was to observe the joint reposition error and tactile acuity of patients with chronic mild to moderate neck pain and compare those values to healthy controls to further investigate the effect of neck pain on neck function and the need for sensorimotor training in patients with chronic neck pain. In spite of some inconsistencies in the literature and methodology, both the two-point discrimination test and the joint reposition error test can give clinicians valuable, inexpensive and quick objective data that can be used in the diagnostic portion of an examination as well as in designing and assessing change during a rehabilitation program. This study found a significant increase in neck joint reposition error (JRE) in flexion in participants suffering from neck pain when compared to healthy controls. JRE averaged 2.75° ± 1.52° in flexion healthy controls and 4.53° ± 1.74° in flexion in participants with chronic neck pain. Additionally, the dermatome found to be most affected by neck pain was C5. Further research is needed to examine both the effect of proprioceptive training on neck pain and the effectiveness of the two-point discrimination threshold test and the joint reposition error test as diagnostic tools and indicators of progress in the treatment of chronic neck pain.

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Le toucher joue un rôle prépondérant dans notre vie quotidienne. Il est connu depuis longtemps que l’acuité tactile peut être améliorée par effet de la plasticité cérébrale, suite à entraînement. Une autre forme d’amélioration, indépendante de l’entraînement, peut être obtenue grâce à une simple stimulation mécanique d’une petite région de la peau, appelée stimulation somatosensorielle répétée (RSS). Avant de commencer ce travail de thèse, il avait été montré que la RSS pouvait améliorer l’acuité tactile localement (sur le doigt stimulé) et aussi à distance (sur le visage) mais la topographie de l’amélioration tactile, notamment sur les autres doigts, demeurait inconnue. Également, l’hypothèse d’appliquer la RSS sur une autre région du corps (notamment le visage) et vérifier ses effets à la fois locaux sur le visage, ainsi qu’à distance sur les doigts, n’avait jamais été investiguée. Le but de mon travail de thèse constituait donc à investiguer la topographie de l’amélioration tactile induite par RSS au sein d’une même et entre plusieurs régions du corps. Une première étude a révélé que la RSS d’un doigt est capable d’induire une amélioration tactile locale ainsi qu’à distance entre les deux mains. La deuxième étude a prouvé que la RSS d’une région du visage est capable d’induire une amélioration tactile locale ainsi qu’une amélioration tactile à distance sur la main. De plus, l’effet d’amélioration tactile entre la main et le visage est bidirectionnel. Dans leur ensemble, les données expérimentales constituent une contribution significative à l'étude de la topographie des changements tactiles induits par la RSS / Touch plays a fundamental role in our daily activities. It has long been known that, thanks to brain plasticity, tactile acuity can be improved following training. Another form of tactile improvement, independent from training, can be achieved through a simple mechanical stimulation of a small region of the skin, called repetitive somatosensory stimulation (RSS). RSS of a finger was well known to improve tactile acuity locally (on the stimulated finger) and also remotely (on the face). However, topography of tactile improvement, especially on other unstimulated fingers, was unknown. In addition, the hypothesis of applying the RSS to another body region (notably the face) and investigate the possible effects, both in face and fingers, was not explored. The aim of this work of thesis was therefore investigating the topography of the RSS-induced tactile improvement within and between body regions. One first study revealed that RSS of a finger induces tactile improvement both locally and remotely in fingers. The second study showed that, when applied on the face, RSS is able to induce tactile improvement both locally, on the face, and remotely, in the hand, demonstrating that the tactile improvement between the hand and the face is bidirectional. Overall, the experimental data I provide constitute a significant contribution to the study of the topography of RSS-induced tactile changes

Damage to the nervous system may cause sensorimotor impairment, often resulting in chronic neuropathic pain. Phantom limb pain affects multiple amputees and the treatment options are limited. A promising treatment option to reduce chronic pain is by training sensory discrimination. At the Center for Bionics and Pain Research, a sensory training device has been developed. Transcranial direct current stimulation (tDCS) is a technique to stimulate different regions of the cerebral cortex. In studies, anodal tDCS of the sensorimotor cortex has shown to improve tactile acuity. Until now, the effect of the sensory discrimination training, performed with the sensory training device, in combination with tDCS has not been tested. The purpose of this master’s thesis was to determine the effect of tDCS applied on the sensorimotor cortex on the outcomes of sensory discrimination training. The purpose was also to compare the effect of two different methods of stimulation, namely conventional and High Definition tDCS. 16 able-bodied participants underwent three single sessions with 40 minutes of sensory discrimination training: one session combined with conventional tDCS, one session combined with High Definition tDCS and one session without tDCS. The tactile acuity was determined by the two-point discrimination test and the Semmes-Weinstein monofilament test, prior to and one hour after each session. This study showed that 40 minutes of sensory discrimination training was sufficient to improve the two-point discrimination in the sensory trained areas, compared to the sensory untrained areas (p=0.02). However, the improvement in two-point discrimination was not statistically significant between the interventions, i.e. the improvement in two-point discrimination for the sessions with brain modulation was not statistically significant compared to the session without brain modulation. The monofilament assessments showed an improvement in monofilament score for the sensory untrained skin patches (p=0.053). This study concluded that single sessions of training was enough to improve two-point discrimination but not monofilament score at the site of stimulation. This study lays a foundation for what parameters to include in future studies.