Maarten A. Immink

Assessing proprioception: a systematic review of possibilities

Proprioception is a vital aspect of motor control and when degraded or lost can have a profound impact on function in diverse clinical populations. This systematic review aimed to identify clinically related tools to measure proprioceptive acuity, to classify the construct(s) underpinning the tools, and to report on the clinimetric properties of the tools. We searched key databases with the pertinent search terms, and from an initial list of 935 articles, we identified 57 of relevance. These articles described 32 different tools or methods to quantify proprioception. There was wide variation in methods, the joints able to be tested, and the populations sampled. The predominant construct was active or passive joint position detection, followed by passive motion detection and motion direction discrimination. The clinimetric properties were mostly poorly evaluated or reported. The Rivermead Assessment of Somatosensory Perception was generally considered to be a valid and reliable tool but with low precision; other tools with higher precision are potentially not clinically feasible. Clinicians and clinical researchers can use the summary tables to make more informed decisions about which tool to use to match their predominant requirements. Further discussion and research is needed to produce measures of proprioception that have improved validity and utility.

Brief Mindfulness-Based Therapy for Chronic Tension-Type Headache: A Randomized Controlled Pilot Study

BACKGROUND Mindfulness-based therapy (MBT) has been demonstrated to be effective for reducing chronic pain symptoms; however, the use of MBT for Chronic Tension-Type Headache (CTH) exclusively has to date not been examined. Typically, MBT for chronic pain has involved an 8-week program based on Mindfulness Based Stress Reduction. Recent research suggests briefer mindfulness-based treatments may be effective for chronic pain. AIMS To conduct a pilot study into the efficacy of brief MBT for CTH. METHOD We conducted a randomized controlled trial of a brief (6-session, 3-week) MBT for CTH. RESULTS Results indicated a significant decrease in headache frequency and an increase in the mindfulness facet of Observe in the treatment but not wait-list control group. CONCLUSION Brief MBT may be an effective intervention for CTH.

CONTEXTUAL INTERFERENCE : A RESPONSE PLANNING ACCOUNT

In two of the three experiments that are reported subjects were trained in either a blocked or a random practice schedule and allowed to self-select the amount of time they used to plan an upcoming movement. According to the reconstruction hypothesis (Lee & Magill, 1985) random practice participants engage greater movement planning processes (i.e. action plan re-construction) during acquisition than do their blocked practice counterparts. It was predicted that such reconstructive activity would be manifest as greater study time being used by random practice subjects as they readied themselves for an imminent response. Data from Experiments 1 and 2 supported this study time prediction while also revealing the typical retention benefit associated with random practice. Interestingly, the acquisition benefit often apparent with blocked practice was not evident when the random practice participants were given sufficient time to plan the upcoming response. These conclusions were supported by data from Experiment 3 that involved a direct manipulation of the amount of study time afforded random and blocked practice participants. Taken together, these data are consistent with the suggestion from the reconstruction hypothesis that more time is necessary for intratrial planning processes during random practice formats. Furthermore, acquisition differences that are commonly observed between high and low contextual interference practice conditions may, at least in part, be associated with the completion of the extra planning processes entertained by random practice participants as the movement is being executed.

Becoming connected: the lived experience of yoga participation after stroke

Purpose. To investigate the personal experiences and perceived outcomes of a yoga programme for stroke survivors. Method. This article reports on a preliminary study using qualitative methods to investigate the personal experiences and perceived outcomes of a yoga programme. Nine individuals who had experienced stroke were interviewed following a 10-week yoga programme involving movement, breathing and meditation practices. An interpretative phenomenological approach was used to determine meanings attached to yoga participation as well as perceptions of outcomes. Results. Interpretative themes evolving from the data were organised around a bio-psychosocial model of health benefits from yoga. Emergent themes from the analysis included: greater sensation; feeling calmer and becoming connected. These themes respectively revealed perceived physical improvements in terms of strength, range of movement or walking ability, an improved sense of calmness and the possibility for reconnecting and accepting a different body. Conclusion. The study has generated original findings that suggest that from the perspective of people who have had a stroke yoga participation can provide a number of meaningful physical, psychological and social benefits and support the rationale for incorporating yoga and meditation-based practices into rehabilitation programmes.

Consolidating behavioral and neurophysiologic findings to explain the influence of contextual interference during motor sequence learning

Motor sequence learning under high levels of contextual interference (CI) disrupts initial performance but supports delayed test and transfer performance when compared to learning under low CI. Integrating findings from early behavioral work and more recent experimental efforts that incorporated neurophysiologic measures led to a novel account of the role of CI during motor sequence learning. This account focuses on important contributions from two neural regions—the dorsal premotor area and the SMA complex—that are recruited earlier and more extensively during the planning of a motor sequence in a high CI context. It is proposed that activation of these regions is critical to early adaptation of sequence structure amenable to long-term storage. Moreover, greater CI enhances access to newly acquired motor sequence knowledge through (1) the emergence of temporary functional connectivity between neural sites previously described as crucial to successful long-term performance of sequential behaviors, and (2) heightened excitability of M1—a key constituent of the temporary coupled neural circuits, and the primary candidate for storage of motor memory.

Yoga management of breast cancer-related lymphoedema: a randomised controlled pilot-trial.

BackgroundSecondary arm lymphoedema continues to affect at least 20% of women after treatment for breast cancer requiring lifelong professional treatment and self-management. The holistic practice of yoga may offer benefits as an adjunct self-management option. The aim of this small pilot trial was to gain preliminary data to determine the effect of yoga on women with stage one breast cancer-related lymphoedema (BCRL). This paper reports the results for the primary and secondary outcomes.MethodsParticipants were randomised, after baseline testing, to receive either an 8-week yoga intervention (n = 15), consisting of a weekly 90-minute teacher-led class and a 40-minute daily session delivered by DVD, or to a usual care wait-listed control group (n = 13). Primary outcome measures were: arm volume of lymphoedema measured by circumference and extra-cellular fluid measured by bioimpedance spectroscopy. Secondary outcome measures were: tissue induration measured by tonometry; levels of sensations, pain, fatigue, and their limiting effects all measured by a visual analogue scale (VAS) and quality of life based on the Lymphoedema Quality of Life Tool (LYMQOL). Measurements were conducted at baseline, week 8 (post-intervention) and week 12 (four weeks after cessation of the intervention).ResultsAt week 8, the intervention group had a greater decrease in tissue induration of the affected upper arm compared to the control group (p = 0.050), as well as a greater reduction in the symptom sub-scale for QOL (p = 0.038). There was no difference in arm volume of lymphoedema or extra-cellular fluid between groups at week 8; however, at week 12, arm volume increased more for the intervention group than the control group (p = 0.032).ConclusionsAn 8-week yoga intervention reduced tissue induration of the affected upper arm and decreased the QOL sub-scale of symptoms. Arm volume of lymphoedema and extra-cellular fluid did not increase. These benefits did not last on cessation of the intervention when arm volume of lymphoedema increased. Further research trials with a longer duration, higher levels of lymphoedema and larger numbers are warranted before definitive conclusions can be made.

The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment

BackgroundWomen who develop secondary arm lymphoedema subsequent to treatment associated with breast cancer require life-long management for a range of symptoms including arm swelling, heaviness, tightness in the arm and sometimes the chest, upper body impairment and changes to a range of parameters relating to quality of life. While exercise under controlled conditions has had positive outcomes, the impact of yoga has not been investigated. The aim of this study is to determine the effectiveness of yoga in the physical and psycho-social domains, in the hope that women can be offered another safe, holistic modality to help control many, if not all, of the effects of secondary arm lymphoedema.Methods and designA randomised controlled pilot trial will be conducted in Hobart and Launceston with a total of 40 women receiving either yoga intervention or current best practice care. Intervention will consist of eight weeks of a weekly teacher-led yoga class with a home-based daily yoga practice delivered by DVD. Primary outcome measures will be the effects of yoga on lymphoedema and its associated symptoms and quality of life. Secondary outcome measures will be range of motion of the arm and thoracic spine, shoulder strength, and weekly and daily physical activity. Primary and secondary outcomes will be measured at baseline, weeks four, eight and a four week follow up at week twelve. Range of motion of the spine, in a self-nominated group, will be measured at baseline, weeks eight and twelve. A further outcome will be the women’s perceptions of the yoga collected by interview at week eight.DiscussionThe results of this trial will provide information on the safety and effectiveness of yoga for women with secondary arm lymphoedema from breast cancer treatment. It will also inform methodology for future, larger trials.Trial registrationACTRN12611000202965

Randomized Controlled Trial of Yoga for Chronic Poststroke Hemiparesis: Motor Function, Mental Health, and Quality of Life Outcomes

Abstract Purpose: To assess the efficacy of yoga for motor function, mental health, and quality of life outcomes in persons with chronic poststroke hemiparesis. Method: Twenty-two individuals participated in a randomized controlled trial involving assessment of task-orientated function, balance, mobility, depression, anxiety, and quality of life domains before and after either a 10-week yoga intervention (n = 11) or no treatment (n = 11). Results: The yoga intervention did not result in any significant improvements in objective motor function measures, however there was a significant improvement in quality of life associated with perceived motor function (P = .0001) and improvements in perceived recovery approached significance (P = .072). Memory-related quality of life scores significantly improved after yoga intervention (P = .022), and those participating in the intervention exhibited clinically relevant decreases in state and trait anxiety. Conclusions: Preliminary results offer promise for yoga as an intervention to address mental health and quality of life in persons with stroke-related activity limitations. There is a need to more rigorously evaluate these yoga benefits with a larger randomized controlled trial, which, based on this preliminary trial, is feasible.

Contextual dependencies during perceptual-motor skill performance: influence of task difficulty.

The present experiment was designed to address the role of task difficulty for the development of contextual-dependent behaviour during perceptual-motor task acquisition. Task difficulty in the present study was manipulated by restricting the time that the subject; (a) viewed task-relevant information, and (b) was afforded to execute a sequence of key presses. Assuming these manipulations made the acquisition of the key press tasks more difficult, it was hypothesised that reducing the time for either of these processes would result in a greater dependence on reinstating the training context at the time of test. This was based on previous findings reported by Wright and Shea (1991) which indicated that task difficulty can contribute to the development of context-dependent behaviour. The results of the study revealed that viewing time was a potent difficulty manipulation. This is supported by the slower acquisition rates for subjects exposed to short as opposed to long viewing conditions during training. More importantly, the impact of changing the intentional-incidental stimuli relationship that was apparent during training, during the test was greatest for the individuals who experienced shorter viewing times during the training phase. Thus, the proposed influence of task difficulty on contextual-dependent performance was supported. This dependency was manifested as a slowing in both the initiation and execution of the correct key presses. It is proposed that individuals trained in the more difficult viewing condition during training, when faced with an incongruence in the acquisition and test stimuli, must engage additional data-driven verification processes to supplement their extant knowledge in order to execute an appropriate response.

Pain Sensitivity Mediates The Relationship between Stress and Headache Intensity in Chronic Tension-Type Headache

BACKGROUND A central model for chronic tension-type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined. OBJECTIVE To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers. METHOD Self-reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis. RESULTS Pain sensitivity significantly mediated the relationship between stress and headache intensity. CONCLUSIONS The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed.