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문제 정의
- This study compared the immediate effects of CCFE and CCFE-VG on CVA and the activity of the SCM and AS muscles in subjects with FHP. CCFE-VG significantly increased CVA and the activity of the SCM and AS muscles across all CCFE phases compared to CCFE alone.
가설 설정
- Therefore, the present study investigated the immediate effects of VG on the CVA and the muscle activity of SCM and AS during CCFE in subjects with FHP. We hypothesized that the CVA would increase as would the amplitude of muscle activity of SCM and AS when VG was provided.
제안 방법
- After one intervention was performed, the subject took a 20 min rest to minimize any carry-over effect between interventions. All measurements were made twice by the principal investigator immediately after each intervention, and the mean of the two measurements was used for statistical analysis. The principal investigator took the measurement in a separate space to ensure that neither the investigators nor the subject were biased from the results.
- In the third phase, the subjects were asked to perform progressing ranges of CCFE by increasing the amount of pressure on the feedback dial, flattening the cervical lordosis. In the fourth phase, the subject performed CCFE gradationally to reach the fifth phase of pressure target levels from 20 mmHg to 30 mmHg in 2 mmHg increments. The PI confirmed that the subject could hold the target level consistently for 10 seconds without depending on retraction, dominant contraction of the superficial neck flexor muscles, or a jerk and quick CCFE movement.
- The subjects were asked to look forward and to hold and watch the feedback dial to identify the pressure level. In the sixth phase, the subjects performed CDEM during the CCFE slowly so that it could coincide with CCFE in a gradational process to reach the fifth phase of target pressure levels from a baseline of 20 mmHg to the final level of 30 mmHg in 2 mmHg increments. The PI stood by the subjects and supervised them while they held the target pressure level steadily for 10 seconds without retraction and dominant use of the cervical flexor muscles, then performed CDEM in order at the same time.
- USA) between the back of the head and bed. In the third phase, the subjects were asked to perform progressing ranges of CCFE by increasing the amount of pressure on the feedback dial, flattening the cervical lordosis. In the fourth phase, the subject performed CCFE gradationally to reach the fifth phase of pressure target levels from 20 mmHg to 30 mmHg in 2 mmHg increments.
- Future studies should apply CCFE-VG to subjects with FHP and pain around the neck and shoulder and examine the long-term effects of CCFE-VG. Moreover, this study could not measure the muscle activity of the deep neck flexor because it was performed by using surface EMG. Finally, although we tried to study the effects of visual gazing in CCFE, viewing angles and eyeball movements were not recorded.
- Once the first CCFE was achieved correctly, the subject performed the second phase of the exercise using a pressure biofeedback unit (Stabilizer™, Chattanooga Group Inc. USA) between the back of the head and bed.
- It should be noted that this study has several limitations. Specifically, the long-term effects of CCFE-VG could not be determined because the study was designed to investigate the immediate effects of CCFE-VG using a cross-sectional design. Additionally, the findings in this study cannot be generalized to other patient populations that have FHP with neck and shoulder pain.
- In the sixth phase, the subjects performed CDEM during the CCFE slowly so that it could coincide with CCFE in a gradational process to reach the fifth phase of target pressure levels from a baseline of 20 mmHg to the final level of 30 mmHg in 2 mmHg increments. The PI stood by the subjects and supervised them while they held the target pressure level steadily for 10 seconds without retraction and dominant use of the cervical flexor muscles, then performed CDEM in order at the same time. The contraction time was 10 seconds with 10 repetitions.
- The primary goal of this study was to compare the immediate effects of CCFE and CCFE-VG on (1) CVA and (2) the activity of the SCM and AS muscles in subjects with FHP. Comparison of CCFE and CCFE-VG measures showed that the CVA increased significantly in CCFE-VG compared to CCFE alone.
- In the first phase of the exercise, the PI taught the subject to perform controlled CCFE slowly in the supine position. The subject focused on sagittal rotation movement of the head slide in caudad and cephalad directions on the bed rather than a retraction movement. Once the first CCFE was achieved correctly, the subject performed the second phase of the exercise using a pressure biofeedback unit (Stabilizer™, Chattanooga Group Inc.
- 880) has previously been reported [10], no studies have investigated the effects of VG on CVA and the amplitude of muscle activity of SCM and AS during CCFE in subjects with FHP. Therefore, the present study investigated the immediate effects of VG on the CVA and the muscle activity of SCM and AS during CCFE in subjects with FHP. We hypothesized that the CVA would increase as would the amplitude of muscle activity of SCM and AS when VG was provided.
- CCFE and CCFE-VG were used for the intervention. To prevent carryover effects, randomization was conducted using a website (http://www.randomization.com) to determine the sequence of intervention. All intervention procedures were performed by the second investigator.
- When these protocols proceeded successfully, the fifth phase began, in which the subjects performed CCFE using a pressure biofeedback unit (Stabilizer™, Chattanooga Group Inc. USA) between the back of the head and the bed.
대상 데이터
- The CVA was recorded using a digital camera (Samsung, Seoul, Korea) and the ImageJ image analysis software (National Institutes of Health, USA) was used to assess the kinematics data. The digital camera was placed perpendicular to the ground with its lens 80 cm from the lateral aspect of the subject and pointing directly at the subject’s shoulder to minimize parallax error [14].
- The subjects (12 males, 7 females) were 19 young adults with FHP who volunteered to participate in this study (age=21.789±1.228 years, height=170.789±8.541 cm, weight=66.036±10.348 kg, body mass index=22.546±2.136, CVA before interventions=45.680±5.987°, 17 right and 2 left side).
데이터처리
- A one-sample Kolmogorov-Smirnov test was used to confirm the assumption of normal distribution. A paired-t test was used to measure the significance of differences in the CVA following CCFE and CCFE-VG intervention and in the activity of the SCM and AS muscles during CCFE and CCFE-VG in the same group with FHP. The level of significance was set at .
이론/모형
- A one-sample Kolmogorov-Smirnov test was used to confirm the assumption of normal distribution. A paired-t test was used to measure the significance of differences in the CVA following CCFE and CCFE-VG intervention and in the activity of the SCM and AS muscles during CCFE and CCFE-VG in the same group with FHP.
성능/효과
- In the fourth phase, the subject performed CCFE gradationally to reach the fifth phase of pressure target levels from 20 mmHg to 30 mmHg in 2 mmHg increments. The PI confirmed that the subject could hold the target level consistently for 10 seconds without depending on retraction, dominant contraction of the superficial neck flexor muscles, or a jerk and quick CCFE movement. Recruitment of the superficial muscles was monitored by the PI using palpation.
- Increased activation of the SCM and AS by VG in CCFE-VG could improve stability in the cervical spine and help maintain its neutral alignment. Together, our results indicate that CCFE-VG as the motor relearning intervention could lead to greater improvement in FHP by harmonious activation of the local and global muscles in the neck compared to CCFE alone.
후속연구
- Additionally, the findings in this study cannot be generalized to other patient populations that have FHP with neck and shoulder pain. Future studies should apply CCFE-VG to subjects with FHP and pain around the neck and shoulder and examine the long-term effects of CCFE-VG. Moreover, this study could not measure the muscle activity of the deep neck flexor because it was performed by using surface EMG.
- We assumed that subjects who participated in the study followed instructions to move the eyeball downward without flexion of the head in CCFE. Therefore, further studies should be conducted to record kinetic eyeball movement.
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