Exercise Program Based on Motor Learning and Forward Head Posture Correction
Primary Purpose
Musculoskeletal Abnormalities, Deformity
Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Exercise program based on motor learning principles
Sponsored by
About this trial
This is an interventional treatment trial for Musculoskeletal Abnormalities focused on measuring neck, motor control, motor learning
Eligibility Criteria
Inclusion Criteria:
- Students at Technological Educational Institute of Sterea Ellada,
- Aged 18-26 years old
- Males and females
- Craniocervical angle < 50 degrees (statical Forward Head Posture in standing position)
Exclusion Criteria:
- Injury or surgery in cervical spine
- Accompanying neurologic, musculoskeletal or mental problems
- Any medical administration
- Intense continuous or intermittent neck pain
- BMI >25
- Participation in any rehabilitation or physiotherapy sessions considering neck dysfunction the last 6 months
- Change in physical activities during the research period of 6 weeks
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
No Intervention
Experimental
Arm Label
Control
Intervention
Arm Description
The control group will not participate in any exercise program. However, at the end, home based exercises and special advice will be given to the participants.
The intervention group will participate in an exercise program based on motor learning principles for 4 weeks/3 sessions per week, for a total of 12 sessions of 30-45 minutes each.
Outcomes
Primary Outcome Measures
Change in Static Forward Head Posture (sFHP)
The sFHP will be assessed by calculating the craniovertebral angle through lateral photographs in standing. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle on the photographs will be carried out using AutoCAD software. A performance curve will be developed using the measurements during the 4 weeks practice and 2 weeks after the end of protocol (retension test).
Change of Dynamic Forward Head Posture (dFHP)
The dFHP will be assessed by calculating the craniovertebral angle through video motion during walking. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle The calculation of the angle will be carried out using Kinovea and AutoCAD softwares. dFHP will be regarded as a transfer test. Transfer tests are tests involving some novel situation, so that people must adapt the skill they have been practicing to the characteristics of this new situation.
Secondary Outcome Measures
Overall self-esteem
Sorensen self-esteem test will be used which has been translated into Greek and has been tested for its reliability and validity.
Mood
A ten point Visual Analogue Scale (VAS) will be used
Overall physical fatigue
A ten point VAS scale will be used
Overall mental fatigue
A ten point VAS scale will be used
Attention-concentration
Attention- concentration questionnaire will be used. It has been developed in Greek language and has been tested for its reliability and validity.
Verbal Comprehension index
The Wechsler Adult Intelligence Scale (WAIS-IV) (similarities) will be used. Participants will be given a number of pairs of words or concepts and have to describe how they are similar.
Perceptual Organization Index
The WAIS-IV (Matrix Reasoning) will be used. Participants will be given pictures of sets of drawings and have to choose the correct drawing that is missing from each set.
Change in Deep neck flexors endurance
The first stage of the test allows for the quantification of the performance of craniocervical flexion action, while the second stage examines the isometric endurance of deep neck flexors, during which the participant adopts the crook lying position. The air chamber of a pressure biofeedback device is positioned under the cervical area and the participant is asked to perform a head nod action at five different pressure levels (22, 24, 26, 28 and 30 mmHg). The test is initially performed at a pressure level of 22 mmHg and proceeds to the next pressure level if the participant is able to maintain in the position for 10 seconds on three separate occasions. The Chattanooga stabilizer pressure biofeedback will be used.
Change in Discomfort
The Discomfort will be assessed using a ten point grade VAS scale, where 0 is no pain and 10 worst pain.
Change in Area of Discomfort
The Discomfort (Head, Neck, Shoulders and upper arms, Middle back, Lower back, Forearms and Wrists/hands areas) will be assessed using a body chart
Weight
Measurement of weight with scale (kilograms)
Height
Measurement of height (cm)
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03006497
Brief Title
Exercise Program Based on Motor Learning and Forward Head Posture Correction
Official Title
The Efficacy of Exercise Program Based on Motor Learning Principles in Correction of Forward Head Posture
Study Type
Interventional
2. Study Status
Record Verification Date
January 2019
Overall Recruitment Status
Completed
Study Start Date
January 2017 (undefined)
Primary Completion Date
May 2017 (Actual)
Study Completion Date
December 30, 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Eleni Kapreli
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The aim of this study is to investigate the efficiency of an exercise program based on principles of motor learning in correction of Forward Head Position (FHP) in asymptomatic patients.
Detailed Description
Epidemiological studies have shown that bad posture and poor body control occurs at puberty, with forward head posture (FHP) and rounded shoulders being the most common biomechanical deviations in sagittal plane. The FHP is defined as an anterior displacement of the head with hyperextension of the cervical spine and this is associated with a reduction in the length of the upper portion of the trapezius, posterior portion of the cervical extensor muscles, the sternocleidomastoid and the levator scapulae. FHP can be evaluated by measuring craniovertebral angle (CVA) which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7.
CVA, smaller than 50 degrees, constitute a criterion of abnormal posture of cervical spine, suggesting FHP. People with FHP present incomplete balance control, thereby affecting the position of the center of gravity and motor control of the body. The establishment of altered motor control strategies could lead to balance disorders, neck muscle imbalances, chronic neck pain and even respiratory dysfunction.
Despite the efforts of researchers to create effective treatment programs based on strength training and stretching exercises, positive long-term results have been a problem in FHP correction. For this reason, re-education of posture and body alignment, through exercise programs based on motor learning, with cognitive elements (attention, motivation, feedback, reasoning), could be proved a more effective therapeutic strategy.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Musculoskeletal Abnormalities, Deformity
Keywords
neck, motor control, motor learning
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
52 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Control
Arm Type
No Intervention
Arm Description
The control group will not participate in any exercise program. However, at the end, home based exercises and special advice will be given to the participants.
Arm Title
Intervention
Arm Type
Experimental
Arm Description
The intervention group will participate in an exercise program based on motor learning principles for 4 weeks/3 sessions per week, for a total of 12 sessions of 30-45 minutes each.
Intervention Type
Other
Intervention Name(s)
Exercise program based on motor learning principles
Intervention Description
The exercise program will include simple activities exposing volunteers in various environmental conditions with a view to adjust their head posture in such conditions. The progressiveness of exercises will be based on the two-dimensional classification system of Gentile (1987). Furthermore, external attentional focus will be used.
Primary Outcome Measure Information:
Title
Change in Static Forward Head Posture (sFHP)
Description
The sFHP will be assessed by calculating the craniovertebral angle through lateral photographs in standing. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle on the photographs will be carried out using AutoCAD software. A performance curve will be developed using the measurements during the 4 weeks practice and 2 weeks after the end of protocol (retension test).
Time Frame
Change from Baseline sFHP at 4 weeks and Change from Baseline sFHP at 6 weeks
Title
Change of Dynamic Forward Head Posture (dFHP)
Description
The dFHP will be assessed by calculating the craniovertebral angle through video motion during walking. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle The calculation of the angle will be carried out using Kinovea and AutoCAD softwares. dFHP will be regarded as a transfer test. Transfer tests are tests involving some novel situation, so that people must adapt the skill they have been practicing to the characteristics of this new situation.
Time Frame
Change from Baseline dFHP t at 4 weeks and Change from Baseline dFHP at 6 weeks
Secondary Outcome Measure Information:
Title
Overall self-esteem
Description
Sorensen self-esteem test will be used which has been translated into Greek and has been tested for its reliability and validity.
Time Frame
Baseline; week 4; week 6
Title
Mood
Description
A ten point Visual Analogue Scale (VAS) will be used
Time Frame
Baseline; week 4; week 6
Title
Overall physical fatigue
Description
A ten point VAS scale will be used
Time Frame
Baseline; week 4; week 6
Title
Overall mental fatigue
Description
A ten point VAS scale will be used
Time Frame
Baseline; week 4; week 6
Title
Attention-concentration
Description
Attention- concentration questionnaire will be used. It has been developed in Greek language and has been tested for its reliability and validity.
Time Frame
Baseline; week 4; week 6
Title
Verbal Comprehension index
Description
The Wechsler Adult Intelligence Scale (WAIS-IV) (similarities) will be used. Participants will be given a number of pairs of words or concepts and have to describe how they are similar.
Time Frame
Baseline
Title
Perceptual Organization Index
Description
The WAIS-IV (Matrix Reasoning) will be used. Participants will be given pictures of sets of drawings and have to choose the correct drawing that is missing from each set.
Time Frame
Baseline
Title
Change in Deep neck flexors endurance
Description
The first stage of the test allows for the quantification of the performance of craniocervical flexion action, while the second stage examines the isometric endurance of deep neck flexors, during which the participant adopts the crook lying position. The air chamber of a pressure biofeedback device is positioned under the cervical area and the participant is asked to perform a head nod action at five different pressure levels (22, 24, 26, 28 and 30 mmHg). The test is initially performed at a pressure level of 22 mmHg and proceeds to the next pressure level if the participant is able to maintain in the position for 10 seconds on three separate occasions. The Chattanooga stabilizer pressure biofeedback will be used.
Time Frame
Change from Baseline Deep neck flexors endurance at 4 weeks and Change from Baseline Deep neck flexors endurance at 6 weeks
Title
Change in Discomfort
Description
The Discomfort will be assessed using a ten point grade VAS scale, where 0 is no pain and 10 worst pain.
Time Frame
Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
Title
Change in Area of Discomfort
Description
The Discomfort (Head, Neck, Shoulders and upper arms, Middle back, Lower back, Forearms and Wrists/hands areas) will be assessed using a body chart
Time Frame
Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
Title
Weight
Description
Measurement of weight with scale (kilograms)
Time Frame
Baseline
Title
Height
Description
Measurement of height (cm)
Time Frame
Baseline
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
26 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Students at Technological Educational Institute of Sterea Ellada,
Aged 18-26 years old
Males and females
Craniocervical angle < 50 degrees (statical Forward Head Posture in standing position)
Exclusion Criteria:
Injury or surgery in cervical spine
Accompanying neurologic, musculoskeletal or mental problems
Any medical administration
Intense continuous or intermittent neck pain
BMI >25
Participation in any rehabilitation or physiotherapy sessions considering neck dysfunction the last 6 months
Change in physical activities during the research period of 6 weeks
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eleni V Kapreli, MSc, PhD
Organizational Affiliation
Technological Educational Institute of Sterea Ellada
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Stefani Argyrou, BSc
Organizational Affiliation
Technological Educational Institute of Sterea Ellada
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
Undecided
IPD Sharing Plan Description
Individual Participant Data (IPD) are to be shared with other researchers, when it will be available
Citations:
PubMed Identifier
22114988
Citation
Christakou A, Zervas Y, Psychountaki M, Stavrou NA. Development and validation of the attention questionnaire of rehabilitated athletes returning to competition. Psychol Health Med. 2012;17(4):499-510. doi: 10.1080/13548506.2011.630402. Epub 2011 Nov 25.
Results Reference
background
PubMed Identifier
23199797
Citation
Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Respiratory weakness in patients with chronic neck pain. Man Ther. 2013 Jun;18(3):248-53. doi: 10.1016/j.math.2012.10.014. Epub 2012 Nov 28.
Results Reference
background
PubMed Identifier
25585517
Citation
Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Reliability of the chin tuck neck flexion test for assessing endurance of short neck flexors in healthy individuals. Physiother Theory Pract. 2015 May;31(4):299-302. doi: 10.3109/09593985.2014.1002874. Epub 2015 Jan 14.
Results Reference
background
PubMed Identifier
26957743
Citation
Han J, Park S, Kim Y, Choi Y, Lyu H. Effects of forward head posture on forced vital capacity and respiratory muscles activity. J Phys Ther Sci. 2016 Jan;28(1):128-31. doi: 10.1589/jpts.28.128. Epub 2016 Jan 30.
Results Reference
background
PubMed Identifier
22506241
Citation
Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012 Feb;36(1):98-104. doi: 10.5535/arm.2012.36.1.98. Epub 2012 Feb 29.
Results Reference
background
PubMed Identifier
17959320
Citation
Kapreli E, Vourazanis E, Strimpakos N. Neck pain causes respiratory dysfunction. Med Hypotheses. 2008;70(5):1009-13. doi: 10.1016/j.mehy.2007.07.050. Epub 2007 Oct 23.
Results Reference
background
PubMed Identifier
23768277
Citation
Rosario JL, Diogenes MS, Mattei R, Leite JR. Can sadness alter posture? J Bodyw Mov Ther. 2013 Jul;17(3):328-31. doi: 10.1016/j.jbmt.2012.12.001. Epub 2012 Dec 23.
Results Reference
background
PubMed Identifier
26028408
Citation
Ruivo RM, Carita AI, Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study. Man Ther. 2016 Feb;21:76-82. doi: 10.1016/j.math.2015.05.001. Epub 2015 May 13.
Results Reference
background
PubMed Identifier
23219786
Citation
Silva AG, Johnson MI. Does forward head posture affect postural control in human healthy volunteers? Gait Posture. 2013 Jun;38(2):352-3. doi: 10.1016/j.gaitpost.2012.11.014. Epub 2012 Dec 7.
Results Reference
background
PubMed Identifier
15130869
Citation
Wulf G, Mercer J, McNevin N, Guadagnoli MA. Reciprocal influences of attentional focus on postural and suprapostural task performance. J Mot Behav. 2004 Jun;36(2):189-99. doi: 10.3200/JMBR.36.2.189-199.
Results Reference
background
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Exercise Program Based on Motor Learning and Forward Head Posture Correction
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