ORCID Profile
0000-0003-1170-6263
Current Organisation
University of South Australia
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Publisher: Springer Science and Business Media LLC
Date: 11-2019
DOI: 10.1557/MRS.2019.254
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.GAITPOST.2022.02.004
Abstract: The Sensory Organisation Test (SOT) of computerised dynamic posturography (CDP) is a well-established clinical test used to measure postural control. Advances in technology have enabled new CDP systems to use immersive virtual reality, such as the Bertec® Balance Advantage®. While the Bertec provides an innovative approach to posturography, the reliability and learning effects of the Bertec in administering the SOT has not been thoroughly investigated. To evaluate the reliability and performance during repeated administration of the Bertec® Balance Advantage® SOT. Fourteen healthy adults (age 27.17 ± 5.5years 10 females) participated. Each participant performed five SOTs over three sessions. The first two sessions were approximately two days apart and the third one month later. In the first two sessions, two SOTs were conducted, and in the third session, one was performed. Composite, equilibrium, and ratio scores were used for analysis. Poor within-session reliability was found in the first session for the composite score (ICC: 0.73, 95% CI: 0.32-0.91), which improved by the second session (ICC: 0.84, 95% CI: 0.58-0.94). Poor within-session reliability (ICC <0.5) was found for all ratio and equilibrium scores, except for the equilibrium score of condition 3, which demonstrated moderate reliability (ICC: 0.84, 95% CI: 0.57-0.95). Poor between-session reliability was found for all outcomes. There was an increase in the composite and equilibrium scores for conditions 5 and 6 over the 5 tests, which plateaued after the fourth test, and were retained at 1 month. The data demonstrate a steady increase in performance with repeated exposure to the Bertec SOT, which was maintained one month later, indicating a learning effect. We recommend that a minimum of two familiarisation sessions should be administered to establish baseline performance and improve reliability.
Publisher: PeerJ
Date: 14-02-2020
DOI: 10.7717/PEERJ.8553
Abstract: People with chronic neck pain have impaired proprioception (i.e., sense of neck position). It is unclear whether this impairment involves disruptions to the proprioceptive representation in the brain, peripheral factors, or both. Implicit motor imagery tasks, namely left/right judgements of body parts, assess the integrity of the proprioceptive represention. Previous studies evaluating left/right neck judgements in people with neck pain are conflicting. We conducted a large online study to comprehensively address whether people with neck pain have altered implicit motor imagery performance. People with and without neck pain completed online left/right neck judgement tasks followed by a left/right hand judgement task (control). Participants judged whether the person in the image had their head rotated to their left or right side (neck task) or whether the image was of a left hand or a right hand (hand task). Participants were grouped on neck pain status (no pain months—acute ≥3 months—chronic) and pain location (none, left-sided, right-sided, bilateral). Outcomes included accuracy (primary) and response time (RT secondary). Our hypotheses—that (i) chronic neck pain is associated with disrupted performance for neck images and (ii) the disruption is dependent on the side of usual pain, were tested with separate ANOVAs. A total of 1,404 participants were recruited: 105 reported acute neck pain and 161 reported chronic neck pain. When grouped on neck pain status, people with chronic neck pain were less accurate than people without neck pain ( p = 0.001) for left/right neck judgements, but those with acute neck pain did not differ from those without neck pain ( p = 0.14) or with chronic neck pain ( p = 0.28). Accuracy of left/right hand judgements did not differ between groups ( p = 0.58). RTs did not differ between groups for any comparison. When grouped on neck pain location, people were faster and more accurate at identifying right-turning neck images than left-turning neck images, regardless of history or location of pain ( p 0.001 for both) people with no pain were more accurate and faster than people with bilateral neck pain ( p = 0.001, p = 0.015) and were faster than those with left-sided neck pain ( p = 0.021) people with right-sided neck pain were more accurate than people with bilateral neck pain ( p = 0.018). Lastly, there was a significant interaction between neck image and side of neck pain: people with right-sided neck pain were more accurate at identifying right-sided neck turning images than people with left-sided neck pain ( p = 0.008), but no different for left-sided neck turning images ( p = 0.62). There is evidence of impaired implicit motor imagery performance in people with chronic neck pain, which may suggest disruptions to proprioceptive representation of the neck. These disruptions seem specific to the neck (performance on hand images intact) but non-specific to the exact location of neck pain.
Publisher: Elsevier BV
Date: 06-2023
Publisher: BMJ
Date: 15-12-2012
DOI: 10.1136/BJSPORTS-2012-091873
Abstract: Yoga is a popular recreational activity in Western society and there is an abundance of literature suggesting that yoga may be beneficial for people with a chronic pain disorder. Despite consistently positive results in the literature, the mechanisms of effect are unclear. On the grounds that chronic pain is associated with disruptions of brain-grounded maps of the body, a possible mechanism of yoga is to refine these brain-grounded maps. A left/right body part judgement task is an established way of interrogating these brain-grounded maps of the body. To determine if people who do regular yoga practice perform better at a left/right judgement task than people who do not. Previously collected, cross-sectional data were used. Using a case-control design, participants who reported taking part in regular yoga were selected against age, gender, neck pain and arm pain-matched controls. Participants viewed 40 photographs of a model with their head turned to the left or right, and were asked to judge the direction of neck rotation. They then completed a left/right-hand judgement task. Of the 1737 participants, 86 of them reported regularly taking part in yoga. From the remaining participants, 86 matched controls were randomly selected from all matched controls. There was no difference between Groups (yoga and no yoga) for either response time (p=0.109) or accuracy (p=0.964). There was a difference between Tasks people were faster (p<0.001) and more accurate (p=0.001) at making left/right neck rotation judgements than they were at making left/right-hand judgements, regardless of group. People who do regular yoga perform no differently in a left/right judgement task than people who do not.
Publisher: Wiley
Date: 02-03-2022
DOI: 10.1111/AJAG.13058
Abstract: To ensure accurate data capture for a fall study through a system of daily contact with participants. Fifty‐eight adults older than 60 years of age and living independently in the community in Canberra, Australia, were recruited for a prospective fall study. We adopted a system of daily contact with study participants for at least 12 months, either by email or by text, asking whether they had suffered a fall in the previous 24 h. At the final testing session, we asked participants whether they had experienced a fall during the previous twelve months. We found no evidence that the daily reporting regime led to excess participant attrition. Only three participants withdrew over the course of the study, and the burden of responding was not cited as a factor in any of these cases. Of the 55 participants who completed the full twelve‐month study period, 38 (69%) experienced at least one fall. We also identified inconsistencies between recall of falls occurring during the last twelve months of the study and the contemporaneously recorded data. Previous studies have found that increasing the reporting demands on fall study participants will lead to higher attrition. This study demonstrates that it is possible to maintain participant engagement and minimise attrition with appropriate design of reporting procedures. We confirm existing evidence regarding the unreliability of retrospective recall of falls. The study highlights the importance of comprehensive and accurate data capture and points to the possibility of under‐reporting of fall incidence.
Publisher: SAGE Publications
Date: 03-2017
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.CORTEX.2017.06.024
Abstract: Spatially-defined disruption of autonomic and sensory function has been identified in Complex Regional Pain Syndrome (CRPS). This study aimed to determine whether motor performance is also disrupted in a spatially-defined manner in people with CRPS. Thirteen people with CRPS type 1 of the upper limb participated in two motor experiments. In Experiment 1 participants performed a circle drawing task that primarily tested motor accuracy. In Experiment 2 participants performed a button pressing task that tested motor co-ordination. In both experiments the motor tasks were performed with either hand (affected or healthy), and on either side of the body midline - that is, on the affected side of space or healthy side of space. There was a main effect of both Limb and Side for the motor tasks. In Experiment 1, motor accuracy for the circle drawing task was poorer when participants used their affected hand than when they used their healthy one (p < .001), and when the task was performed on the affected side of their body midline than when it was performed on the healthy side (p < .001). In Experiment 2, motor co-ordination for the button pressing task was poorer when participants used their affected hand than when they used their healthy one (p < .001), and when the task was performed on the affected side of the midline (p < .001), as compared to the healthy side of the midline. Unilateral CRPS is associated with a spatially-defined disruption of motor performance. Participants perform worse when the task is performed on the affected side of the body midline, regardless of whether they use their affected or healthy hand.
Publisher: Wiley
Date: 05-12-2014
DOI: 10.1111/JOOR.12249
Abstract: Alexithymia, or a lack of emotional awareness, is prevalent in some chronic pain conditions and has been linked to poor recognition of others' emotions. Recognising others' emotions from their facial expression involves both emotional and motor processing, but the possible contribution of motor disruption has not been considered. It is possible that poor performance on emotional recognition tasks could reflect problems with emotional processing, motor processing or both. We hypothesised that people with chronic facial pain would be less accurate in recognising others' emotions from facial expressions, would be less accurate in a motor imagery task involving the face, and that performance on both tasks would be positively related. A convenience s le of 19 people (15 females) with chronic facial pain and 19 gender-matched controls participated. They undertook two tasks in the first task, they identified the facial emotion presented in a photograph. In the second, they identified whether the person in the image had a facial feature pointed towards their left or right side, a well-recognised paradigm to induce implicit motor imagery. People with chronic facial pain performed worse than controls at both tasks (Facially Expressed Emotion Labelling (FEEL) task P < 0·001 left/right judgment task P < 0·001). Participants who were more accurate at one task were also more accurate at the other, regardless of group (P < 0·001, r(2) = 0·523). Participants with chronic facial pain were worse than controls at both the FEEL emotion recognition task and the left/right facial expression task and performance covaried within participants. We propose that disrupted motor processing may underpin or at least contribute to the difficulty that facial pain patients have in emotion recognition and that further research that tests this proposal is warranted.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.MATH.2012.10.006
Abstract: Understanding motor imagery of the hands and feet has led to promising new treatments for neurological and chronic pain disorders. We aimed to extend this line of research to the neck with a view to developing the definitive platform study upon which clinical and experimental studies can be based. In a cross-sectional experiment with a convenience s le, volunteers were shown 40 photographs of a model with their head turned to the left or right. Images were presented in random order and orientation. Participants judged the direction of neck rotation. They also completed a left/right hand judgment task. 1361 pain-free participants volunteered. Mean ± standard deviation response time (RT) for making left/right judgments of neck rotation was 1.621 ± 0.501 s. Median accuracy was 92.5%. RT was related to age, gender, and handedness (p < 0.001). That is, RT increased with age, was greater in females than in males and was greater in left-handers than in right-handers. Accuracy reduced with age (p < 0.001), but was unaffected by gender or handedness. Judgments were more accurate when images showed a neck rotated to the right than when they showed a neck rotated to the left (p < 0.001). The magnitude of image rotation affected both response time and accuracy (p < 0.001). In general, the performance parameters established for left/right limb judgments also apply for left/right neck rotation judgments. The current work establishes the definitive normative values against which clinical and experimental groups can be compared and reveals unpredicted effects of the direction neck rotation and the orientation of the image.
Publisher: Wiley
Date: 21-07-2022
DOI: 10.1002/EJP.2008
Abstract: ‘Everyday’ pain experiences are potentially critical in shaping our beliefs and behaviours around injury and pain. Influenced by social, cultural and environmental contexts, they form the foundation of one's understanding of pain and injury that is taken into adulthood. How to best communicate to young children about their everyday pain experiences, in order to foster adaptive beliefs and behaviours, is unknown. In this Delphi survey, we sought expert opinion on the key messages and strategies that parents/caregivers can consider when communicating with young children (aged 2–7 years) about ‘everyday’ pain that is most likely to promote recovery, resilience and adaptive pain behaviours. Eighteen experts participated including specialists in paediatric pain, trauma, child development and psychology educators and parents. The survey included three rounds. Response rate was over 88%. Two hundred fifty‐three items were raised 187 reached ‘consensus’ (≥80% agreement amongst experts). Key messages that the experts agreed to be ‘very important’ were aligned with current evidence‐based understandings of pain and injury. Strategies to communicate messages included parent/caregiver role modelling, responses to child pain and discussion during and/or after a painful experience. Other key themes included promoting emotional development, empowering children to use active coping strategies and resilience building. This erse set of childhood, pain and parenting experts reached consensus on 187 items, yielding 12 key themes to consider when using everyday pain experiences to promote adaptive pain beliefs and behaviours in young children. Parents and caregivers likely play a critical role in the development of children's fundamental beliefs and behaviours surrounding pain and injury that are carried into adulthood. Everyday pain experiences provide key opportunities to promote positive pain‐related beliefs and behaviours. This Delphi survey identified key messages and strategies that caregivers can consider to optimize learning, encourage the development of adaptive pain behaviours and build resilience for future pain experiences.
Publisher: Wiley
Date: 28-09-2020
DOI: 10.1002/EJP.1657
Publisher: Wiley
Date: 10-04-2023
DOI: 10.1111/AJAG.13191
Abstract: To examine whether measures of neuromuscular control and proprioceptive acuity were predictive of falls in an older community‐dwelling population and to develop a multivariate prediction model. Fifty‐eight adults aged above 60 living independently in the community were recruited for a prospective falls study. On entry, they undertook a Sensory Organisation Test (SOT) and an Active Movement Extent Discrimination Assessment (AMEDA) and completed a short fall risk questionnaire. Participants were monitored for falls over the subsequent 12 months. Prior to analysis, falls were classified into three categories based on the difficulty of the activity being undertaken and the demands of the environment in which the fall occurred. Logistic regression was used to predict the probability of a fall. For falls occurring under the least challenging circumstances, the model fitted using the AMEDA score and two of the questions from the fall risk questionnaire, related to balance and confidence, achieved a specificity of 87% and sensitivity of 83%. Falls occurring in more challenging circumstances could not be predicted with any accuracy based on the variables recorded at inception. This study highlights the importance of considering the heterogeneous nature of falls. Poorer proprioceptive acuity appears to play a role in falls occurring where neither the environment nor the activity is challenging, but not in falls occurring in other circumstances. Falls in the least‐challenging circumstances affected 15% of participants, but this group was considerably more likely to have multiple falls, increasing their vulnerability to adverse consequences.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JPAIN.2018.07.004
Abstract: The left/right judgment task (LRJT) is the most commonly used method of assessing motor imagery performance. Abnormally long response times are thought to reflect delayed processing of body/spatial representations, and poor accuracy is thought to reflect disrupted cortical proprioceptive representations or body schema. Slower and less accurate responses on the LRJT have been reported in a variety of chronic musculoskeletal pain conditions. To date, no systematic review of the literature has been conducted to assess if altered motor imagery performance as measured by the LRJT is characteristic of all chronic musculoskeletal pain conditions. Therefore, the aim of this study was to conduct a comprehensive systematic review and meta-analysis of the literature to answer the following question: Do people with chronic musculoskeletal pain have impaired left/right body part judgment? Twenty-five studies (2,266 participants) including a range of chronic pain populations who undertook an LRJT were identified from searches of 8 electronic databases from inception to March 2017. Results indicate that chronic musculoskeletal pain conditions affecting the limbs and face (P ≤ .01) are associated with altered motor imagery performance as measured by the LRJT. PERSPECTIVES: This review synthesizes evidence of altered motor imagery performance using the LRJT across chronic musculoskeletal pain conditions. Consistent evidence was found for altered motor imagery performance in peripheral pain conditions, but evidence was less consistent for axial conditions. Treatment to restore a normal body schema may be beneficial in chronic limb and facial pain.
Publisher: SAGE Publications
Date: 07-2021
DOI: 10.1177/00315125211029906
Abstract: Proprioceptive ability – the sense of where body parts are located in space - is one of many factors thought to affect falls risk among the elderly. Active movement extent discrimination is an approach to measuring proprioception that is administered in an ecologically valid testing environment to better reflect the exercise of proprioceptive skills in daily life. The Active Movement Extent Discrimination Apparatus (AMEDA) was developed to objectively measure this proprioceptive discrimination. However, the current absolute identification testing protocol is cognitively demanding, and it yields results that are insufficiently reliable to assess performance at the in idual level. The objectives of this pilot study were to test the reliability and feasibility of a proposed new AMEDA testing protocol and to explore how performance related to cognitive ability and any perceived dysfunction in the foot or ankle. We tested 42 participants (aged 19 – 94 years) three times on the ankle AMEDA using a newly developed protocol that asked participants to report whether a given angle of ankle inversion was shallower or deeper than the immediately preceding inversion. Participants also completed the Stroop test, as a measure of cognitive ability, and two validated questionnaires for identifying foot or ankle dysfunction (the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure). The proportion of correct responses for the AMEDA test showed the expected sigmoid shape of the psychometric function as signal strength increased. The intraclass correlation coefficient measured over the three tests was 0.65 (95% confidence interval: 0.49 - 0.78), suggesting moderate reliability. We found a positive and statistically significant correlation between AMEDA performance and Stroop results but no relationship between the AMEDA score and questionnaire-measured foot or ankle dysfunction. This study confirmed that the alternative testing protocol was simple to administer and easily understood by participants.
Publisher: Wiley
Date: 24-04-2020
DOI: 10.1002/EJP.1571
Publisher: Frontiers Media SA
Date: 17-11-2020
Publisher: Elsevier BV
Date: 10-2019
Publisher: Wiley
Date: 12-04-2020
DOI: 10.1002/EJP.1573
Abstract: This journal recently published a paper by Suso‐Marti et al., entitled “Effectiveness of motor imagery and action observation training on musculoskeletal pain intensity: A systematic review and meta‐analysis” (2020). Motor imagery training and action observation training are rehabilitation approaches that involve imagining oneself executing a particular action, and watching actions that are performed by others, respectively. Both are thought to activate similar neural substrates that are responsible for the actual execution of an action (Eaves et al., 2016). Motor imagery and action observation have been used to enhance motor skill performance in several groups – including athletes and musicians who require highly accurate and precise movement for professional performances, and a similar approach has been employed during rehabilitation with variable outcomes in people after stroke, spinal cord injury and persistent pain.
Publisher: Elsevier BV
Date: 03-1998
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.JPAIN.2021.03.141
Abstract: The purpose of the current study was to determine whether auditory prepulse inhibition (PPI) and/or prepulse facilitation (PPF) were altered in people with fibromyalgia (FM) when compared with controls. Eyeblink responses were recorded from 29 females with FM and 27 controls, while they listened to 3 blocks of auditory stimuli that delivered pulses with either PPI or PPF. Using a linear mixed model, our main findings were that there was a GROUP*CONDITION interaction (F
Publisher: Frontiers Media SA
Date: 17-10-2023
Publisher: BMJ
Date: 18-12-2016
DOI: 10.1136/BJSPORTS-2015-095356
Abstract: Neural representations, or neurotags, refer to the idea that networks of brain cells, distributed across multiple brain areas, work in synergy to produce outputs. The brain can be considered then, a complex array of neurotags, each influencing and being influenced by each other. The output of some neurotags act on other systems, for ex le, movement, or on consciousness, for ex le, pain. This concept of neurotags has sparked a new body of research into pain and rehabilitation. We draw on this research and the concept of a cortical body matrix-a network of representations that subserves the regulation and protection of the body and the space around it-to suggest important implications for rehabilitation of sports injury and for sports performance. Protective behaviours associated with pain have been reinterpreted in light of these conceptual models. With a particular focus on rehabilitation of the injured athlete, this review presents the theoretical underpinnings of the cortical body matrix and its application within the sporting context. Therapeutic approaches based on these ideas are discussed and the efficacy of the most tested approaches is addressed. By integrating current thought in pain and cognitive neuroscience related to sports rehabilitation, recommendations for clinical practice and future research are suggested.
Publisher: SAGE Publications
Date: 03-2017
Publisher: Wiley
Date: 04-03-2016
DOI: 10.1002/ANA.24616
Abstract: Pathological limb pain patients show decreased attention to some stimuli on the painful limb and increased attention to others, a paradox that has dogged the field for over a decade. We hypothesized that pathological pain involves a spatial inattention confined to bodily representations. Patients showed inattention to the painful side for visual processing of body parts but not letters, tactile processing but not auditory, and body-part bisection tasks but not line bisection tasks. We propose the new term "somatospatial inattention" to describe bodily-specific spatial inattention associated with pathological limb pain.
Publisher: Informa UK Limited
Date: 04-03-2017
Publisher: SAGE Publications
Date: 03-12-2021
Abstract: The Active Movement Extent Discrimination Apparatus (AMEDA) has been used for measuring proprioception at various joints in the body for more than two decades. The utility of this instrument for discriminating groups has been reported in terms of an area under the curve (AUC) derived from an absolute identification test. This metric has supported statistically significant group differences, but it is not clear whether the AMEDA’s testing protocol is suitable for measuring in idual proprioception acuity changes. This study aimed to test the reliability, variance and absolute AUC scores obtained with the AMEDA with reference to other studies that have tested absolute identification acuity in other domains and the theoretical underpinnings of the testing protocol. We re-analyzed raw data from a 2013 study involving 65 people, most of whom were tested three times over two separate sessions on the ankle AMEDA by now assessing the accuracy of in idual responses and calculating the sensitivity index, d’, in addition to the AUC. To assess reliability, we calculated the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for those who completed all three tests. Fewer than 50% of presented stimuli were accurately identified and relatively poor discrimination was achieved between adjacent stimuli (in only one case was the median d’ value greater than 1). The ICC of AUC scores across the three tests was poor (0.47). The SEM was 0.04, while 90% of participants’ AUC scores fell between 0.59 and 0.76. The variation in performance at the in idual level was substantial, producing a large SEM relative to the population spread of scores. We considered potential theoretical factors that may be affecting these results and concluded that an alternative approach will be needed in order for the apparatus to be used to explore in idual proprioceptive performance.
Publisher: Frontiers Media SA
Date: 06-05-2022
DOI: 10.3389/FPAIN.2022.898855
Abstract: Evidence suggests that children's popular media may model maladaptive and distorted experiences of pain to young children. In a recent study, pain depicted in popular media targeting 4–6-year-olds was frequently and unrealistically portrayed, evoked little response or empathy from observing characters, and perpetuated unhelpful gender stereotypes. Parents play a critical role in both children's pain experiences and children's media consumption. Yet, no study to date has examined parents' beliefs and attitudes regarding how pain is portrayed in media for young children. The present study aimed to fill this gap by examining how parents perceive and appraise painful instances depicted in children's popular media. Sixty parents (48% fathers) of children aged 4 to 6 years completed a semi-structured interview to assess their general beliefs and attitudes toward how pain is portrayed in children's media. Inductive reflexive thematic analysis was conducted to identify and analyze key patterns in the data. Qualitative analyses generated two major themes representing parental beliefs regarding pain that is portrayed in children's media: “entertaining pain” and “valuable lessons”. Findings reveal that parents believe that pain portrayed in popular media serves either a function of entertaining and amusing children or can provide valuable lessons about appropriate emotional responses and empathic reactions. Further, pain portrayals could also instill valuable lessons and provide children with a point of reference and language for their own painful experiences. Parents serve as a primary socialization agent for young children thus, it is important that parents remain aware of underlying messages about how pain is portrayed in children's popular media so that they can optimally discuss these portrayals, promote their children's pain education and understanding and positively impact future pain experiences.
Publisher: Frontiers Media SA
Date: 2013
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 2017
Publisher: SAGE Publications
Date: 09-2016
DOI: 10.1177/1558944716660555JL
Abstract: Objective: An emerging body of evidence suggests an association between pain and altered neural representations of the body. The integrity of these neural representations can be assessed with a timed motor imagery task such as the left/right judgment task (LRJT). The purpose of this investigation was to systematically evaluate the literature and use meta-analytical methods to establish whether performance of the LRJT is impaired in people with upper limb pain. Materials and Methods: The literature was systematically searched across 8 databases for studies that reported use of the LRJT and also reported upper limb pain. Fifteen studies were found that included 6 upper limb pain conditions and 749 participants. Studies were grouped into 2 categories: (1) studies that compared response time and accuracy with healthy controls (between group comparison) and (2) studies that compared response time and accuracy for affected limb with the subject’s healthy limb (within group comparison). Data were pooled, mean effect size calculated, and forest plots produced using RevMan 5.5. Results: Response times were slower in people with upper limb pain when compared with healthy controls (effect size: 1.42 95% CI, 0.54 to 2.30). The pain group were also slower in identifying images corresponding to their painful limb than their healthy limb (effect size: 0.71 95% CI, 0.24 to 1.17). Accuracy was reduced in people with upper limb pain compared with healthy controls (effect size: −0.76 95% CI, −1.17 to −0.35). The pain group were also less accurate identifying images corresponding to their painful limb compared with the healthy limb (effect size: −0.63 95% CI, −1.21 to −0.06). Conclusions: The findings of this meta-analysis and synthesis suggest that performance of the LRJT is impaired in people with upper limb pain conditions. Response times (RTs) are slower and accuracy is worse than healthy control subjects or healthy limbs. This reflects disturbances in cortical motor imagery processing and may indicate cortical changes associated with upper limb pain.
Publisher: Walter de Gruyter GmbH
Date: 11-02-2017
DOI: 10.1515/REVNEURO-2016-0057
Abstract: Upregulation of defensive reflexes such as the nociceptive flexion reflex (NFR) has been attributed to sensitisation of peripheral and spinal nociceptors and is often considered biomarkers of pain. Experimental modulation of defensive reflexes raises the possibility that they might be better conceptualised as markers of descending cognitive control. Despite strongly held views on both sides and several narrative reviews, there has been no attempt to evaluate the evidence in a systematic manner. We undertook a meta-analytical systematic review of the extant English-language literature from inception. Thirty-six studies satisfied our a priori criteria. Seventeen were included in the meta-analysis. Reflexive threshold was lower in people with clinical pain than it was in pain-free controls, but reflex size, latency, and duration were unaffected. The pattern of difference was not consistent with sensitisation of nociceptive neurones, as these changes were not isolated to the affected body part but was more consistent with top-down cognitive control reflective of heightened protection of body tissue. The pattern of modulation is dependent on potentially complex evaluative mechanisms. We offer recommendations for future investigations and suggest that defensive reflex threshold may reflect a biomarker of a broader psychological construct related to bodily protection, rather than sensitisation of primary nociceptors, spinal nociceptors, or pain.
Publisher: Public Library of Science (PLoS)
Date: 15-06-2016
No related grants have been discovered for Sarah Wallwork.