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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
Eleni Kapreli
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Musculoskeletal Abnormalities focused on measuring neck, motor control, motor learning

Eligibility Criteria

18 Years - 26 Years (Adult)All SexesAccepts Healthy Volunteers

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

    First Posted
    December 3, 2016
    Last Updated
    January 8, 2019
    Sponsor
    Eleni Kapreli
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    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
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    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.
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    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
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