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Non-specific chronic neck pain (NCNP) is commonly seen in office workers. Individuals with NCNP not only demonstrate impaired neck movement control and muscle activation, but also show abnormal scapular kinematics and muscle activation timing. Office workers with NCNP also show higher activity of upper trapezius during computer typing and have difficulty relaxing upper trapezius after typing. These changes related to scapula may increase strain over neck. In addition to the altered neuromuscular control, recent studies found neuroplasticity changes in the central nervous system on patients of chronic musculoskeletal disorders. Therefore, few studies found shifts and alterations of motor cortex representation of neck muscles in individuals with NCNP, which was correlated with delayed muscle activation of deep neck flexors muscle in functional activities. However, no studies have explored that whether this corticospinal adaptation also happens over scapular muscles, especially after a computer typing task. The objectives of this proposal are to investigate the differences in corticospinal and neuromuscular control of shoulder complex between office workers with and without NCNP. Thirty-five individuals with NCNP and 35 healthy controls will be recruited. Twenty young healthy subjects will be also recruited for a pilot study to test the reliability of all the measures. Scapular kinematics and muscle activation will be tested during arm elevation. Corticospinal parameters of trapezius and serratus anterior will be tested with transcranial magnetic stimulation (TMS), including active motor threshold, motor evoked potential, cortical silent period, short interval intracortical facilitation, short interval intracortical inhibition and cortical mapping. Corticospinal parameters, except cortical mapping, will be measured again after a 30-minute computer typing task. Scapular muscle activation will be also recorded during the typing task.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental group: Non-specific chronic neck pain group | Other | Subjects with non-specific chronic neck pain will be included to perform 30-minute computer typing task and assess neurophysiological measurements of scapular muscles, scapular kinematics and muscle activation. |
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| Control group: Healthy subjects group | Other | Healthy subjects will be included to compare the differences in neurophysiological measurements of scapular muscles, scapular kinematics and muscle activation between healthy subjects and subjects with non-specific chronic neck pain. Subjects in this group will received the same assessment as the NCNP group. |
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| Pilot study: Healthy subjects group | Other | Healthy subjects will be included to test reliability of single-pulse and paired-pulse TMS, including its associated neurophysiological measurements, and also to test reliability of Liberty electromagnetic tracing system and surface electromyography. Subjects in this group will received the same assessment as the NCNP group. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 30-minute computer typing task | Other | The subject sits in front of a computer screen and perform computer typing tasks for 30 minutes. The same computer table and chair were used for all subjects. The height of the table and screen, and the distance of the keyboard from the subject were adjusted according to their familiar and comfortable position. |
| Measure | Description | Time Frame |
|---|---|---|
| Neurophysiological measures - Active motor threshold | Active motor threshold (AMT) will be described with the percentage (%) of maximum stimulator output (MSO). | Change from baseline AMT after 30-minute computer typing task or 30-minute rest |
| Neurophysiological measures - Motor evoked potential | Motor evoked potential (MEP) will be described with millivolt (mV). | Change from baseline MEP after 30-minute computer typing task or 30-minute rest |
| Neurophysiological measures - Cortical silent period | Cortical silent period (CSP) will be measured with millisecond (ms) | Change from baseline CSP after 30-minute computer typing task or 30-minute rest |
| Neurophysiological measures - Short interval cortical inhibition | Short interval cortical inhibition (SICI) will be defined as percentage (%) of conditioning responses vs testing responses while the inter-stimulus interval is below 5 ms | Change from baseline SICI after 30-minute computer typing task or 30-minute rest |
| Neurophysiological measures - Short interval cortical facilitation | Short interval cortical facilitation (SICF) will be defined as percentage (%) of conditioning responses vs testing responses while the inter-stimulus interval is above 5 ms | Change from baseline SICF after 30-minute computer typing task or 30-minute rest |
| Neurophysiological measures - Area of cortical mapping | Area of cortical mapping will be described with square millimeter (mm2) |
| Measure | Description | Time Frame |
|---|---|---|
| Scapular kinematics during arm elevation | Scapular kinematics, including anterior/posterior tilt, upward/downward rotation, and internal/external rotation in scapula plane elevation at 30°, 60°, 90°, and 120°, and will be described with degree (°). | Before 30-minute computer typing task |
| Scapular kinematics during performing the computer task |
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Inclusion Criteria of Patients with Non-specific Chronic Neck Pain
Ages ranges from 20-40 years old
Work with the computer at least 25 hours per week
Neck pain of idiopathic origin ≥ 6 months during the past year
Minimum of 3/10 on the numerical rating scale (NRS) in past 7 days
No structural abnormalities which are confirmed by neck X-ray or negative results of all the following special tests
Specific head movements or maintaining the fixed posture for a long time reproduced neck pain
Inclusion Criteria of Healthy Subjects in the control group
Inclusion Criteria of Healthy subjects in the Pilot Study
Exclusion Criteria of Patients with Non-specific Chronic Neck Pain and All Healthy Subjects)
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| Name | Affiliation | Role |
|---|---|---|
| Yin-Liang Lin, PhD | National Yang Ming Chiao Tung University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Yang-Ming University | Taipei | 112 | Taiwan |
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| 30-minute rest | Other | Rest for 30 minutes |
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| Before 30-minute computer typing task |
| Neurophysiological measures - Volume of cortical mapping | Volume of cortical mapping will be calculated with multiplying summation of motor evoke potentials on the map (mV) by the area of the map (mm2) with the unit of mV*mm2 | Before 30-minute computer typing task |
| Neurophysiological measures - Center of gravity of cortical mapping | Center of gravity of cortical mapping will be described in a x-y coordinate system (mm). | Before 30-minute computer typing task |
| Neurophysiological measures - Area of cortical mapping | Area of cortical mapping will be described with square millimeter (mm2) | Change from baseline area of cortical mapping after 30-minute rest (pilot subjects) |
| Neurophysiological measures - Volume of cortical mapping | Volume of cortical mapping will be calculated with multiplying summation of motor evoke potentials on the map (mV) by the area of the map (mm2) with the unit of mV*mm2 | Change from baseline volume of cortical mapping after 30-minute rest (pilot subjects) |
| Neurophysiological measures - Center of gravity of cortical mapping | Center of gravity of cortical mapping will be described in a x-y coordinate system (mm). | Change from baseline center of gravity of cortical mapping of cortical mapping after 30-minute rest (pilot subjects) |
The average of scapular kinematics, including anterior/posterior tilt, upward/downward rotation, and internal/external rotation will be calculated with a window of 10 seconds and will be described with degree (°). |
| Change from baseline during the 30-minute computer typing task at 5, 10, 15, 20, 25, 30 minutes of the task |
| Scapular muscles activation during arm elevation | The root mean square of electromyography (EMG) data of the upper trapezius, lower trapezius, and serratus anterior will be normalized by the maximum voluntary contraction amplitude (percentage of maximal voluntary contraction, %) and calculated over three 30° increments of motion during arm elevation from 30° to 120°, including 30° - 60°, 60° - 90°, and 90° - 120°. | Before 30-minute computer typing task |
| Scapular muscles activation during performing the computer task | The root mean square of electromyography (EMG) data of the upper trapezius, lower trapezius, and serratus anterior will be calculated with a window of 10 seconds and will be normalized by the maximum voluntary contraction amplitude (percentage of maximal voluntary contraction, %). | Change from baseline during the 30-minute computer typing task at 5, 10, 15, 20, 25, 30 minutes of the task |
| Craniovertebral angle | Craniovertebral angle will be measured as the included angle between the tragus, C7 spinous process and the horizontal line and will be described with degree (°) | Before 30-minute computer typing task |
| Craniovertebral angle | Craniovertebral angle will be measured as the included angle between the tragus, C7 spinous process and the horizontal line and will be described with degree (°) | Change from baseline during the 30-minute computer typing task at 5, 10, 15, 20, 25, 30 minutes of the task |
| Scapular kinematics during arm elevation | Scapular kinematics, including anterior/posterior tilt, upward/downward rotation, and internal/external rotation in scapula plane elevation at 30°, 60°, 90°, and 120°, and will be described with degree (°). | Change from baseline scapular kinematics after 30-minute rest (pilot subjects) |
| Scapular muscles activation during arm elevation | The root mean square of electromyography (EMG) data of the upper trapezius, lower trapezius, and serratus anterior will be normalized by the maximum voluntary contraction amplitude (percentage of maximal voluntary contraction, %) and calculated over three 30° increments of motion during arm elevation from 30° to 120°, including 30° - 60°, 60° - 90°, and 90° - 120°. | Change from baseline scapular muscles activation after 30-minute rest (pilot subjects) |
| Craniovertebral angle | Craniovertebral angle will be measured as the included angle between the tragus, C7 spinous process and the horizontal line and will be described with degree (°) | Change from baseline craniovertebral angle after 30-minute rest (pilot subjects) |
| ID | Term |
|---|---|
| C092779 | RE1-silencing transcription factor |
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