Neck-shoulder pain is common in the general population and causes individual suffering as well as large costs for the society. Despite substantial efforts, there is still a shortage of methods for objective diagnosis and effective rehabilitation of such disorders. Thus, there is a great need to develop and evaluate new methods for these purposes. From clinical observations and recent research it has become evident that sensorimotor control can be impaired in people with neck-shoulder pain and may play a role in the pathogenesis of these disorders. In this thesis, precision of goal-directed arm movements, a previously unstudied class of movements in neck-shoulder pain, was studied. The main aim of the thesis was to investigate if people with chronic neck-shoulder pain have a reduced acuity of goal-directed movements of the upper extremity. A second aim was to study associations between reduced movement acuity and symptoms and self-rated characteristics. Upper limb repositioning acuity was assessed in blindfolded subjects performing tests of active, ipsilateral position-matching of two target positions (long and short) in movements constrained to horizontal-adduction of the shoulder. Reduced repositioning acuity, suggesting impaired shoulder proprioception, was found for both subjects with whiplash associated disorders (WAD) and non-specific neck-shoulder pain (NS). The degree of reduced acuity was shown to correlate with self-ratings of various health concepts, functioning and pain. A conspicuous finding was that there was lack of correlation between short and long target errors, along with the fact that associations between repositioning acuity and symptoms and self-rated characteristics was primarily found for the short target position. To further investigate the possible mechanisms underlying the disassociation between long and short target movement control, the association pattern between the outcome of several variants of ipsilateral position matching and velocity-discrimination tests, were studied. It was found that the perception of limb position in position-matching of short target locations appears to be predominantly based on movement velocity, whereas perception of limb position in movements to longer target locations may rely on a location-based perception mechanism. To extend the research on reduced upper extremity proprioception in neck-shoulder pain to a more natural movement situation, acuity of goal-directed pointing including full vision and 3D multi-joint movements was investigated in WAD, NS and healthy controls subjects. The results revealed a reduced acuity for both neck-pain groups. Moreover, distinct associations between end-point acuity and neck movement problems, limitations of some physical functions and, in WAD; some aspects of pain, were revealed. The findings demonstrate that the precision of upper limb movements can be reduced in chronic neck-shoulder pain. Substantial associations with symptoms and self-rated functioning suggest a clinical relevance of acuity measures of goal-directed arm movements. The findings indicate that tests of sensorimotor control can provide objective measures that may be useful in biopsychosocial profiling and characterization of subgroups of patients with chronic neck-shoulder pain, and that training target control of goal-directed movements should be considered in rehabilitation programs of people with these disorders.

Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results. The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (>3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS). Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances. Postural control was assessed in quiet standing on a force platform without vision. The center of pressure signal was decomposed into it’s slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain. Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a sub-group of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain. The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quiet standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up. In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.

Three-dimensional movement analysis was used to evaluate head and neck movement in patients with neck pain and matched controls. The aims were to further develop biomechanical models of head and neck kinematics, to investigate differences between subjects with non-specific neck pain and whiplash associated disorders (WAD), and to evaluate the potential of objective movement analysis as a decision support during diagnosis and follow-up of patients with neck pain. Fast, repetitive head movements (flexion, extension, rotation to the side) were studied in a group of 59 subjects with WAD and 56 controls. A back propagation artificial neural network classified vectors of collected movement variables from each individual according to group membership with a predictivity of 89%. The helical axis for head movement were analyzed in two groups of neck pain patients (21 with non-specific neck pain and 22 with WAD) and 24 matched controls. A moving time window with a cut-off angle of 4° was used to calculate finite helical axes. The centre of rotation of the finite axes (CR) was derived as the 3D intersection point of the finite axes. A downward migration of the axis during flexion/extension and a change of axis direction towards the end of the movements were observed. CR was at its most superior position during side rotations and at its most inferior during ball catching. This could relate to that side rotation was mainly done in the upper spine, while all cervical vertebrae were recruited to stabilize the head in the more complex catching task. Changes in movement strategy were observed in the neck pain groups: Neck pain subjects had lower mean velocities and ranges of movements as compared with controls during ball catching, which could relate to a stiffer body position in neck pain patients in order to stabilize the neck. In addition, the WAD group had a displaced axis position during head repositioning after flexion, while CR was displaced during fast side rotations in the non-specific neck pain group. Pain intensity correlated with axis and CR position, and may be one reason for the movement strategy changes. Increased amount of irregularities in the trajectory of the axis was found in the WAD group during head repositioning, fast repetitive head movements and catching. This together with an increased constant repositioning error during repositioning after flexion indicated motor control disturbances. A higher group standard deviation in neck pain groups indicated heterogeneity among subjects in this disturbance. Wireless motion sensors and electro-oculography was used simultaneously, as an initial step towards a portable system and towards a method to quantify head-eye co-ordination deficits in individuals with WAD. Twenty asymptomatic control subjects and six WAD subjects with eye disturbances (e.g. dizziness and double vision) were studied. The trial-to-trial repeatability was moderate to high for all evaluated variables (single intraclass correlation coefficients >0.4 in 28 of 32 variables). The WAD subjects demonstrated decreased head velocity, decreased range of head movement during gaze fixation and lowered head stability during head-eye co-ordination as possible deficits. In conclusion, kinematical analyses have a potential to be used as a support for physicians and physiotherapists for diagnosis and follow-up of neck pain patients. Specifically, the helical axis method gives information about how the movement is performed. However, a flexible motion capture system (for example based on wireless motion sensors) is needed. Combined analysis of several variables is preferable, as patients with different neck pain disorders seem to be a heterogeneous group.

Múltiples revisiones científicas han intentado determinar los factores pronósticos en la evolución del latigazo cervical sin llegar a un consenso. Nuestros resultados se han obtenido tras 8 años de estudio en pacientes controlados desde la primera visita en el servicio de Medicina Física y Rehabilitación del Hospital de Mataró. Se han utilizado escalas de valoración fáciles de cumplimentar y cuantificar para poder obtener los resultados en el mismo momento de la consulta. Este hecho es importante, ya que la mayoría de las escalas que se identifican en los artículos publicados son poco prácticas en la consulta diaria por la dificultad que conllevan en su cumplimentación y valoración. Los factores pronósticos que hemos identificado en nuestra muestran han sido: la edad, la presencia de “vértigos”, la intensidad del dolor cervical inicial valorada mediante la escala analógica visual y el grado de funcionalidad cervical inicial valorado mediante el Northwick Park Hospital Neck Pain Questionnaire.

The requirement to operate vehicles in low light and/or night environments whilst wearing night vision goggle (NVG) systems has become increasingly common during military operations. There is very limited research investigating injury risks associated with these systems during ground vehicle collisions. This study examined the injury risks associated with wearing the Australian Defence Force - Enhanced Combat Helmet (ECH) and NVG system, in frontal vehicle collisions. This project consisted of two components: (1) crash tests using a sled and (2) numerical simulations of impacts. Four dynamic sled tests were conducted using a 50th percentile, male, Hybrid III dummy positioned on a rigid seat. Frontal impact tests were performed at a 40 km/h change in velocity (*v) and 20 g deceleration. The test configurations were as follows: (a) Base; (no helmet or additional equipment); (b) ECH; and, (c) ECH and NVG. Condition (c) was carried out twice, to determine repeatability. The sled test protocols were reconstructed precisely with the numerical simulation package MADYMO and the simulations were shown to correlate well with the experimental results. Using this validated model, four parametric studies were undertaken to assess the influence of counterweights, seat cushion, seatbelt pre-tensioner, and the vehicle's *v and acceleration on injury risks. The study found that neck loads were within acceptable limits, with the exception of the neck extension moment, which was exceeded for all NVG conditions. Based on the parametric studies, no major improvements were observed in the neck extension moments with the use of counterweights or a seat cushion. In contrast the use of a seatbelt pre-tensioner was observed to decrease greatly this neck injury risk in certain scenarios. The study also identified that a *v of 15 km/h and peak acceleration of up to 14 g were required to keep the neck extension moment below the prescribed injury criteria. However, the high neck extension moment values may have been partially attributable to the stiff Hybrid III neck. This study identified a possible injury mechanism for soldiers using the ECH and NVG system during specific impact scenarios. The method applied in this project was designed to be repeatable.

Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Umeå Universitet, 2009. / Härtill 5 uppsatser.

Whiplash is a neck injury caused by the sudden differential movement between the head and torso. Whiplash injuries are most commonly reported as a consequence of rear impacts in car accidents. They are regarded as minor injuries, but can still lead to long-term disablement and discomfort in the neck. Whiplash injuries can be mitigated by better car seat designs. For this purpose, head restraint geometry must be improved first, and then the dynamic performance of the whole seat must be assessed at all crash seventies. A biofidelic human-body model is a key requirement in designing whiplash mitigating car seats. This thesis presents the development of a 50th percentile male multi-body human model and several energy absorbing car seat designs. The human-body model is specifically designed for rear impact and validated using the responses of seven volunteers from Japanese Automobile Research Institute (JARI) sled tests, which were performed at an impact speed of 8 kph with a rigid seat and without head restraint and seat belt. A generic multi-body car seat model is also developed to implement various seatback and recliner properties, anti-whiplash devices (A WDs) and head restraints. Using the same driving posture and the rigid seat in the JARI sled tests as the basic configuration, several anti-whiplash seats are designed to allow different types of motion for the seatback and seat-pan. The major findings of this research are: -The human-body model simulates the effects of muscle contraction and its overall response is superior in comparison to the currently used models and dummies. -A criterion called the S-shape index (SSI) is developed based on the intervertebral angles of the upper and lower cervical spine. -The car seat design concepts are able to control and use crash energy effectively with the aid of anti-whiplash devices for a wide range of crash seventies. -In order to reduce whiplash injury risk, this study advocates energy absorbing car seats which can also provide head restraint contact as early as possible.

Les cervicalgies constituent un enjeu médico-économique pour nos sociétés. Ceci justifie des recherches actives sur le rachis cervical afin de mieux appréhender les fondements des cervicalgies et fournir aux cliniciens des pistes permettant d'en prévenir les effets ou d'améliorer les traitements. Cette étude, qui inclut 66 sujets Asymptomatiques et pathologiques (arthrodèses, prothèses, whiplash), présente un protocole expérimental original et non invasif pour mesurer in vivo la cinématique tridimensionnelle de la tête par rapport au thorax. Elle quantifie les amplitudes angulaires des degrés de liberté principaux et couplés pour les mouvements de flexion-extension, d'inclinaison latérale, de rotation axiale et des mouvements complexes ainsi que les mouvements compensatoires des épaules. L'objectif final de ce travail est la comparaison entre les différentes populations

Einleitung & Problemstellung: Beschwerden nach Beschleunigungsverletzungen der Halswirbel-säule sind oft nur unzureichend einzuordnen und diagnostizierbar. Eine eindeutige Diagnostik ist jedoch für eine entsprechende Therapie wie auch möglicherweise entstehende versicherungsrechtliche Forderungen notwendig. Die Entwicklung eines geeigneten Diagnoseverfahrens liegt damit im Interesse von Betroffenen wie auch Kostenträgern. Neben Störungen der Weichteilgewebe ist fast immer die Funktion der Halsmuskulatur in Folge eines Traumas beeinträchtigt. Dabei wird vor allem die sensorische Funktion der HWS-Muskulatur, die an der Regulation des Gleichgewichts beteiligt ist, gestört. In Folge dessen kann angenommen werden, dass es zu einer Beeinträchtigung der Gleichgewichtsregulation kommt. Die Zielstellung der Arbeit lautete deshalb, die möglicherweise gestörte Gleichgewichtsregulation nach einem Trauma im HWS-Bereich apparativ zu erfassen, um so die Verletzung eindeutig diagnostizieren zu können. Methodik: Unter Verwendung eines posturographischen Messsystems mit Kraftmomentensensorik wurden bei 478 Probanden einer Vergleichsgruppe und bei 85 Probanden eines Patientenpools Kraftmomente unter der Fußsohle als Äußerung der posturalen Balanceregulation aufgezeichnet. Die gemessenen Balancezeitreihen wurden nichtlinear analysiert, um die hohe Variabilität der Gleichgewichtsregulation optimal zu beschreiben. Über die dabei gewonnenen Parameter kann überprüft werden, ob sich spezifische Unterschiede im Schwankungsverhalten anhand der plantaren Druckverteilung zwischen HWS-Traumatisierten und den Probanden der Kontrollgruppe klassifizieren lassen. Ergebnisse: Die beste Klassifizierung konnte dabei über Parameter erzielt werden, die das Schwankungsverhalten in Phasen beschreiben, in denen die Amplitudenschwankungen relativ gering ausgeprägt waren. Die Analysen ergaben signifikante Unterschiede im Balanceverhalten zwischen der Gruppe HWS-traumatisierter Probanden und der Vergleichsgruppe. Die höchsten Trennbarkeitsraten wurden dabei durch Messungen im ruhigen beidbeinigen Stand mit geschlossenen Augen erzielt. Diskussion: Das posturale Balanceverhalten wies jedoch in allen Messpositionen eine hohe individuelle Varianz auf, so dass kein allgemeingültiges Schwankungsmuster für eine Gruppen-gesamtheit klassifiziert werden konnte. Eine individuelle Vorhersage der Gruppenzugehörigkeit ist damit nicht möglich. Die verwendete Messtechnik und die angewandten Auswerteverfahren tragen somit zwar zu einem Erkenntnisgewinn und zur Beschreibung des Gleichgewichtsverhaltens nach HWS-Traumatisierung bei. Sie können jedoch zum derzeitigen Stand für den Einzelfall keinen Beitrag zu einer eindeutigen Bestimmung eines Schleudertraumas leisten. / Introduction & Problem definition: Disorders after acceleration injuries of the cervical spine can often be classified and diagnosed only inadequately. But an explicit diagnosis is necessary as a basis for an adequate therapy as well as for possibly arising demands pursuant to insurance law. The development of suitable diagnosis methods is in the interest of patients as well as the cost units. Apart from disorders of the soft tissues there are almost always impairments of the function of the neck musculature. Particularly the sensory function of the cervical spine musculature, which participates in the regulation of the equilibrium, is disturbed by that. As a result in can be assumed that the postural control is also disturbed. Therefore the aim of this study was to examine the possibly disturbed postural motor balance after a whiplash injury of the cervical spine with the help of apparatus-supported methods to be able to unambigiously diagnose. Methods: postural measuring system based on the force-moment sensortechnique was used to record the postural balance regulation of 478 test persons and 85 patients which had suffered a whiplash injury. Data analysis was accomplished by linear as well as by nonlinear time series methods in order to characterise the balance regulation in an optimal way. Thus it can be determined whether there can be classified specific differences in the plantar pressure distribution covering patients with a whiplash injury and the test persons of the control group. Results: The best classification could be achieved by parameters which describe the variation of the postural balance regulation in phases in which the differences of the amplitudes of the plantar pressure distribution were relatively small. The analyses showed significant differences in the postural motor balance between the group of patients with whiplash injuries and the control group. The most significant differences (highest discriminate rates) could be observed by measurements in both-legged position with closed eyes. Discussion: Although the results achieved support the hypothesis mentioned above, is must be conceded that the postural motor balance showed a high individual variation in all positions of measurement. Therefore no universal variation model could be classified for the entirety of either group. This way an individual forecast of the group membership is impossible. As a result the measurement technology being used and the nonlinear time series analyses can contribute to the gain of knowledge and to the description of the regulation of postural control after whiplash injury. But at present they cannot contribute to an explicit determination of a whiplash injury for a particular case.