Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery

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Abstract

Background

Cervical spondylotic myelopathy (CSM) is a degenerative cervical disease in which the spinal cord is compressed. Patients with CSM experience balance disturbance because of impaired proprioception. The weighting of the sensory inputs for postural control in patients with CSM is unclear. Therefore, this study investigated the weighting of sensory systems in patients with CSM.

Method

Twenty-four individuals with CSM (CSM group) and 24 age-matched healthy adults (healthy control group) were analyzed in this observational study. The functional outcomes (modified Japanese Orthopaedic Association Scale [mJOA], Japanese Orthopaedic Association Cervical Myelopathy Questionnaire [JOACMEQ], Nurick scale) and static balance (eyes-open and eyes-closed conditions) were assessed for individuals with CSM before surgery, 3 and 6 months after surgery. Time-domain and time–frequency-domain variables of the center of pressure (COP) were analyzed to examine the weighting of the sensory systems.

Results

In the CSM group, lower extremity function of mJOA and Nurick scale significantly improved 3 and 6 months after surgery. Before surgery, the COP mean velocity and total energy were significantly higher in the CSM group than in the control group for both vision conditions. Compared with the control group, the CSM group exhibited lower energy content in the moderate-frequency band (i.e., proprioception) and higher energy content in the low-frequency band (i.e., cerebellar, vestibular, and visual systems) under the eyes-open condition. The COP mean velocity of the CSM group significantly decreased 3 months after surgery. The energy content in the low-frequency band (i.e., visual and vestibular systems) of the CSM group was closed to that of the control group 6 months after surgery under the eyes-open condition.

Conclusion

Before surgery, the patients with CSM may have had compensatory sensory weighting for postural control, with decreased weighting on proprioception and increased weighting on the other three sensory inputs. After surgery, the postural control of the patients with CSM improved, with decreased compensation for the proprioceptive system from the visual and vestibular inputs. However, the improvement remained insufficient because the patients with CSM still had lower weighting on proprioception than the healthy adults did. Therefore, patients with CSM may require balance training and posture education after surgery.

Trial registration

Trial Registration number: NCT03396055

Name of the registry: ClinicalTrials.gov

Date of registration: January 10, 2018 - Retrospectively registered

Date of enrolment of the first participant to the trial: October 19, 2015

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Most cited references 52

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Measures of postural steadiness: differences between healthy young and elderly adults.

T Prieto, J B Myklebust, R G Hoffmann … (1996)

Measures of postural steadiness are used to characterize the dynamics of the postural control system associated with maintaining balance during quiet standing. The objective of this study was to evaluate the relative sensitivity of center-of-pressure (COP)-based measures to changes in postural steadiness related to age. A variety of time and frequency domain measures of postural steadiness were compared between a group of twenty healthy young adults (21-35 years) and a group of twenty healthy elderly adults (66-70 years) under both eyes-open and eyes-closed conditions. The measures that identified differences between the eyes-open and eyes-closed conditions in the young adult group were different than those that identified differences between the eye conditions in the elderly adult group. Mean velocity of the COP was the only measure that identified age-related changes in both eye conditions, and differences between eye conditions in both groups. The results of this study will be useful to researchers and clinicians using COP-based measures to evaluate postural steadiness.

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Postural control system.

J Massion (1994)

The postural control system has two main functions: first, to build up posture against gravity and ensure that balance is maintained; and second, to fix the orientation and position of the segments that serve as a reference frame for perception and action with respect to the external world. This dual function of postural control is based on four components: reference values, such as orientation of body segments and position of the center of gravity (an internal representation of the body or postural body scheme); multisensory inputs regulating orientation and stabilization of body segments; and flexible postural reactions or anticipations for balance recovery after disturbance, or postural stabilization during voluntary movement. The recent data related to the organization of this system will be discussed in normal subjects (during ontogenesis), the elderly and in patients with relevant deficits.

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Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.

Julia Treleaven (2008)

The receptors in the cervical spine have important connections to the vestibular and visual apparatus as well as several areas of the central nervous system. Dysfunction of the cervical receptors in neck disorders can alter afferent input subsequently changing the integration, timing and tuning of sensorimotor control. Measurable changes in cervical joint position sense, eye movement control and postural stability and reports of dizziness and unsteadiness by patients with neck disorders can be related to such alterations to sensorimotor control. It is advocated that assessment and management of abnormal cervical somatosensory input and sensorimotor control in neck pain patients is as important as considering lower limb proprioceptive retraining following an ankle or knee injury. Afferent information from the cervical receptors can be altered via a number of mechanisms such as trauma, functional impairment of the receptors, changes in muscle spindle sensitivity and the vast effects of pain at many levels of the nervous system. Recommendations for clinical assessment and management of such sensorimotor control disturbances in neck disorders are presented based on the evidence available to date.

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Author and article information

Contributors

Iu-Shiuan Lin: r05428013@ntu.edu.tw

Dar-Ming Lai: dmlai@ntu.edu.tw

Jian-Jiun Ding: jjding@ntu.edu.tw

Andy Chien: achien@mail.cmu.edu.tw

Chih-Hsiu Cheng: chcheng@mail.cgu.edu.tw

Shwu-Fen Wang: sfwang@ntu.edu.tw

Jaw-Lin Wang: jlwang@ntu.edu.tw

Chi-Lin Kuo: 103830@ntuh.gov.tw

Wei-Li Hsu:

ORCID: http://orcid.org/0000-0003-4577-140X

+886-2-3366-8127 , wlhsu@ntu.edu.tw

Journal

Journal ID (nlm-ta): J Neuroeng Rehabil

Journal ID (iso-abbrev): J Neuroeng Rehabil

Title: Journal of NeuroEngineering and Rehabilitation

Publisher: BioMed Central (London )

ISSN (Electronic): 1743-0003

Publication date (Electronic): 25 July 2019

Publication date PMC-release: 25 July 2019

Publication date Collection: 2019

Volume: 16

Electronic Location Identifier: 96

Affiliations

[1 ]ISNI 0000 0004 0546 0241, GRID grid.19188.39, School and Graduate Institute of Physical Therapy, College of Medicine, , National Taiwan University, ; Floor 3, No. 17, Xuzhou Rd., Zhongzheng District, Taipei, Taiwan

[2 ]ISNI 0000 0004 0573 0483, GRID grid.415755.7, Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, ; Taipei, Taiwan

[3 ]ISNI 0000 0004 0572 7815, GRID grid.412094.a, Department of Surgery, , National Taiwan University Hospital, ; Taipei, Taiwan

[4 ]ISNI 0000 0004 0546 0241, GRID grid.19188.39, Graduate Institute of Communication Engineering, College of Electrical Engineering and Computer Science, , National Taiwan University, ; Taipei, Taiwan

[5 ]ISNI 0000 0001 0083 6092, GRID grid.254145.3, Department of Physical Therapy, Graduate Institute of Rehabilitation Science, , China Medical University, ; Taichung, Taiwan

[6 ]GRID grid.145695.a, School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, , Chang Gung University, ; Taoyuan, Taiwan

[7 ]ISNI 0000 0004 0572 7815, GRID grid.412094.a, Physical Therapy Center, , National Taiwan University Hospital, ; Taipei, Taiwan

[8 ]ISNI 0000 0004 0546 0241, GRID grid.19188.39, Department of Biomedical Engineering, College of Medicine and College of Engineering, , National Taiwan University, ; Taipei, Taiwan

Author information

Wei-Li Hsu http://orcid.org/0000-0003-4577-140X

Article

Publisher ID: 564

DOI: 10.1186/s12984-019-0564-2

PMC ID: 6659243

PubMed ID: 31345240

SO-VID: 866ca658-5fa9-479a-82ec-e9adaee36020

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 31 January 2019

Date accepted : 4 July 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004663, Ministry of Science and Technology, Taiwan;

Award ID: 105-2628-E-002-006-MY3

Award Recipient : Wei-Li Hsu

Funded by: FundRef http://dx.doi.org/10.13039/501100007647, College of Medicine, National Taiwan University;

Award ID: NTU-CDP-108L7733

Award Recipient : Wei-Li Hsu

Custom metadata

ScienceOpen disciplines: Neurosciences

Keywords: sensory integration,time-frequency analysis,gabor transform,center of pressure

Data availability:

ScienceOpen disciplines: Neurosciences

Keywords: sensory integration, time-frequency analysis, gabor transform, center of pressure

Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery

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Trial registration

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The Dynamic Brain

Most cited references 52

Measures of postural steadiness: differences between healthy young and elderly adults.

Postural control system.

Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.

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