{"id":4382,"date":"2015-10-25T07:16:07","date_gmt":"2015-10-25T07:16:07","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=4382"},"modified":"2017-01-07T06:39:08","modified_gmt":"2017-01-07T06:39:08","slug":"the-effect-of-dual-tasking-on-timed-up-and-go-performance-in-subjects-with-chronic-nonspecific-neck-pain","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol8octoberspledition\/the-effect-of-dual-tasking-on-timed-up-and-go-performance-in-subjects-with-chronic-nonspecific-neck-pain\/","title":{"rendered":"The Effect of Dual-Tasking on \u2018Timed up and go\u2019 Performance in Subjects with Chronic Nonspecific Neck Pain"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Neck pain is known as the second common musculoskeletal problem in general people in worldwide which mainly caused by non-specific reason. Non-specific neck pain is the most common type of neck pain that refereed to physical therapy clinic in which is absence of definitive diagnosis or abnormal anatomical structure \u00a0(1, 2).<\/p>\n

The loss of motion, stiffness in one or both sides, reducing the accuracy of position\u00a0 and movement sense, decreased muscle strength and disturbance in balance and gait, account as\u00a0 problems of these patients were mentioned in clinical studies (3-6).<\/p>\n

The potential cause of impaired balance and gait \u00a0is due to impaired cervical sensory information\u00a0 and\u00a0 mismatching \u00a0this information with the visual and the vestibular systems \u00a0(7).In everyday activities, adult usually need to \u00a0maintain postural stability while they perform other task simultaneously such as walking and talking so assessment of postural control concurrent other task is important (8), In addition, recent approaches indicated postural control is not automatic and needs some degree of \u00a0attention(9).<\/p>\n

Dual task methodology has been used to evaluate the effect \u00a0of a secondary cognitive task on balance control which is\u00a0 similar to functional activities (10). In this method, according to the theory\u00a0 limited capacity of attention, resources of attention\u00a0 for processing are limit\u00a0 and \u00a0performance of one or both task may be deteriorated (11, 12).<\/p>\n

Also decrease of cognitive function have been reported in patients with chronic neck pain (13, 14). Individuals with nonspecific neck pain may have problem when they perform secondary task in walking relative to healthy age-matched due to both postural control and cognitive impairments. However, no research has been surveyed the effect of cognitive task on locomotion in\u00a0 patient \u00a0with chronic non-specific neck pain.<\/p>\n

Timed up and go (TUG) is a reliable and valid test which measured balance and mobility performance in single and dual-task condition(15).<\/p>\n

Previous research have been reported increased the time needed to complete TUG test under dual-task condition in stroke ,elderly and Parkinson subjects((16)17,18,19)<\/p>\n

However, effect of secondary tasks on TUG test in individuals with neck pain has not been investigated. Therefore, objective this study is assessment of \u00a0TUG performance in single and dual tasks \u00a0condition in subjects with chronic non-specific neck pain.<\/p>\n

Method<\/strong><\/p>\n

Participants<\/strong><\/p>\n

24 people with nonspecific chronic neck pain and 24 control subjects were enrolled in this study. They were matched according to age, height and body mass index (Table1). This study was performed in at the School of Rehabilitation Jundishapur University of Medical Science. Inclusion criteria for these subjects were neck pain without any special pathology, analogue scale pain less than grade 2 (VAS) (17, 18), 10 to 50 percent of neck disability\u00a0 index (6, 7, 19), corrected- to- normal visual acuity and detect color (20). Patients with\u00a0 previous traumatic injury, sever osteoarthritis, neck surgery, certain history of vestibular, neurological or cognitive disorder, diabetes, rheumatoid arthritis ,structural deformities in the spine and lower extremities ,musculoskeletal pain experience except in the neck over the past three months were\u00a0 excluded (6, 7, 19, 21).<\/p>\n

Procedure<\/strong><\/p>\n

First, the subjects were informed about the main rationale and aims of the study, and provided written informed consent approved by the ethics committee of Joundishapor University of Medical Sciences then they completed Neck Disability Index questionnaire for evaluation the amount of disability of\u00a0patients with neck Pain. After this, Subjects were asked to put on comfortable and right size footwear (the same footwear with different sizes were provided for all subjects) and sit down on a chair with 45 cm in the height without handle for 5 minute before starting the test. \u00a0A three meter path was signposted with tapes and a conical object was placed in the half of path that subjects turn the road. Individuals were instructed to stand up as soon as they hear start word by examiner and walk the three-meter path and sit down on the chair. In this experiment the walking speed was optional and \u00a0subjects could walk in their usual speed (22, 23) . This test was performed in 3 levels of cognitive difficulty without cognitive trial, with easy and difficult cognitive task. Each condition was performed 3 times randomly with a rest period of five minute. Performance of the test in each condition was calculated time from the moment they stand up to when they sit back in seconds by stopwatch.<\/p>\n

Cognitive test used in the present study was Stroop test. This test has 4 main colors; green, red, blue, yellow and three levels of difficulty which in this study the level one and three were applied (25). For easy level, different colors in squares were displayed on the screen which is located in front of subject and the subject should say the name of every single color respectively. For difficult level, color of the words was different from the real meaning of the word. for example, the word yellow was shown in red and individuals were asked to recount the color without reading the word. The evidences express processing \u00a0in the first level is automatic while difficult level\u00a0 requires considerable\u00a0 controlled processing and more attention (24, 25). For each Stroop task, the number of errors was recorded to monitor performance of the cognitive task(24).<\/p>\n

Data analysis<\/strong><\/p>\n

Data were analyzed using SPSS (version 16). Data are expressed as mean \u00b1 standard deviation(S.D). Descriptive statistic and frequency were determined for appropriate demographic variables.\u00a0 Performance of TUG after calculating mean of 3 trials was analysisd<\/u> using 2 (group)\u00d73 (cognitive difficulty) a mixed model analysis of variance (ANOVA). For multiple comparisons, the Bonferroni adjustment method was used. A value of P< 0.05 was considered as statistically significant.<\/p>\n

Results<\/strong><\/p>\n

Mean and SD of time taken to complete of TUG for both groups in different conditions of cognitive difficulty has been shown in Table 2. Also, results of mixed ANOVAs for time taken complete of TUG revealed main effect group and cognitive difficulty were significant. This means subjects with chronic non-specific neck pain have increase in time of TUG than control group in all of condition. Interaction of group by cognitive difficulty was not significant and two groups have increase time in dual-task condition (Table 3). Because the mean number of uncorrected Stroop errors in all conditions never exceeded one ,we ignore it.<\/p>\n

 <\/p>\n

 <\/p>\n

Discussion<\/strong><\/p>\n

The results show patients with nonspecific chronic neck pain performed the experiment in longer period of time compared to healthy subjects. This may imply that in the performing of functional task, the patients group more likely act in a different way than the healthy individuals. It can be explained by walking consist of consecutive periods of balance and imbalance and during this process before the imbalance period that it led to falling, the patient must reach stability phase by taking another step and \u00a0a new reaching surface substitute to prevent falling. It seems that slowing down of substitution may be a reason of increased timing period in TUG test in patients. Our findings are consistent with other studies which have reported \u00a0gait problems in patients suffering from chronic neck pain (6). Also, greater difficulty by performance TUG test in patients this study\u00a0 Parkinson, multiple sclerosis patients and elderly subjects(23, 26-28).<\/p>\n

Of other results of this study were increasing the amount of time of TUG test with increasing difficulty of cognitive task in two groups. This phenomena may be explained by allocating more attentional resource to difficult cognitive task than easy and no cognitive task and according to capacity sharing modal attention capacity is limit(11) and therefore persons need to reduce his or her speed for finding new surface to avert from falling.<\/p>\n

There was no considerable difference in the performance of TUG test in dual-task condition in two groups. This is against to other studies in adults with parkinson \u00a0and stroke patients that they were slower under dual-task condition(16, 29, 30) .It is recommended that for more orientation in this field more precise assessment by force plate is utilized<\/p>\n

In overall trend, The results of this study suggest that chronic \u00a0neck pain lead to disturbance in TUG test and so it is suggested \u00a0that functional mobility assessment and treatment \u00a0this patients is\u00a0 considered in\u00a0 clinic and \u00a0on based results of this study ,TUG is a simple clinical tools for assessment functional mobility subjects with neck pain that can be used. However, since addition the cognitive task did not affect functional mobility this patients, dual-task\u00a0\u00a0 assessment of mobility by more difficult cognitive task\u00a0 is considered in future research.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, et al. The burden and determinants of neck pain in the general population. European Spine Journal. 2008;17(1):39-51.<\/li>\n
  2. Tsakitzidis G, Remmen R, Dankaerts W, Van Royen P. Non-specific neck pain and evidence-based practice. European Scientific Journal. 2013;9(3).<\/li>\n
  3. Johnston V, Jull G, Darnell R, Jimmieson N, Souvlis T. Alterations in cervical muscle activity in functional and stressful tasks in female office workers with neck pain. European journal of applied physiology. 2008;103(3):253-64.<\/li>\n
  4. Johnston V, Jull G, Souvlis T, Jimmieson NL. Neck movement and muscle activity characteristics in female office workers with neck pain. Spine. 2008;33(5):555-63.<\/li>\n
  5. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual therapy. 2008;13(1):2-11.<\/li>\n
  6. Poole E, Treleaven J, Jull G. The influence of neck pain on balance and gait parameters in community-dwelling elders. Manual therapy. 2008;13(4):317-24.<\/li>\n
  7. Karlberg M, Persson L, Magnusson M. Reduced postural control in patients with chronic cervicobrachial pain syndrome. Gait & Posture. 1995;3(4):241-9.<\/li>\n
  8. Huxhold O, Li S-C, Schmiedek F, Lindenberger U. Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention. Brain research bulletin. 2006;69(3):294-305.<\/li>\n
  9. Fraizer E, Mitra S. Methodological and interpretive issues in posture-cognition dual-tasking in upright stance. Gait & posture. 2008;27(2):271-9.<\/li>\n
  10. Huang H-J, Mercer VS. Dual-task methodology: applications in studies of cognitive and motor performance in adults and children. Pediatric Physical Therapy. 2001;13(3):133-40.<\/li>\n
  11. Huang HJ, Mercer VS. Dual-task methodology: applications in studies of cognitive and motor performance in adults and children. Pediatric Physical Therapy. 2001;13(3):133-40.<\/li>\n
  12. Pellecchia GL. Postural sway increases with attentional demands of concurrent cognitive task. Gait & posture. 2003;18(1):29-34.<\/li>\n
  13. Snider BS, Asmundson GJ, Wiese KC. Automatic and strategic processing of threat cues in patients with chronic pain: A modified Stroop evaluation. The Clinical journal of pain. 2000;16(2):144-54.<\/li>\n
  14. Hart RP, Wade JB, Martelli MF. Cognitive impairment in patients with chronic pain: the significance of stress. Current pain and headache reports. 2003;7(2):116-26.<\/li>\n
  15. Condron JE, Hill KD, Physio GD. Reliability and Validity of a Dual\u2010Task Force Platform Assessment of Balance Performance: Effect of Age, Balance Impairment, and Cognitive Task. Journal of the American Geriatrics Society. 2002;50(1):157-62.<\/li>\n
  16. Campbell CM, Rowse JL, Ciol MA, Shumway-Cook A. The effect of cognitive demand on Timed Up and Go performance in older adults with and without Parkinson disease. Journal of Neurologic Physical Therapy. 2003;27(1):2-7.<\/li>\n
  17. Negahban H, Hadian MR, Salavati M, Mazaheri M, Talebian S, Jafari AH, et al. The effects of dual-tasking on postural control in people with unilateral anterior cruciate ligament injury. Gait & Posture. 2009;30(4):477-81.<\/li>\n
  18. Salavati M, Mazaheri M, Negahban H, Ebrahimi I, Jafari AH, Kazemnejad A, et al. Effect of dual-tasking on postural control in subjects with nonspecific low back pain. Spine. 2009;34(13):1415-21.<\/li>\n
  19. Michaelson P, Michaelson M, Jaric S, Latash M, Sjolander P, Djupsjobacka M. Vertical posture and head stability in patients with chronic neck pain. Journal of rehabilitation medicine. 2003;35(5):229-35.<\/li>\n
  20. Dault MC, Geurts ACH, Mulder TW, Duysens J. Postural control and cognitive task performance in healthy participants while balancing on different support-surface configurations. Gait & Posture. 2001;14(3):248-55.<\/li>\n
  21. Rahnama L, Salavati M, Akhbari B, Mazaheri M. Attentional demands and postural control in athletes with and without functional ankle instability. J Orthop Sports Phys Ther.40(3):180-7.<\/li>\n
  22. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice: Lippincott Williams & Wilkins; 2006.<\/li>\n
  23. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical Therapy. 2000;80(9):896-903.<\/li>\n
  24. Kertzman S, Lowengrub K, Aizer A, Nahum ZB, Kotler M, Dannon PN. Stroop performance in pathological gamblers. Psychiatry research. 2006;142(1):1-10.<\/li>\n
  25. Cohen JD, Dunbar K, McClelland JL. On the control of automatic processes: a parallel distributed processing account of the Stroop effect. Psychological review. 1990;97(3):332.<\/li>\n
  26. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Physical Therapy. 2002;82(2):128-37.<\/li>\n
  27. Campbell CM, Rowse JL, Ciol MA, Shumway-Cook A. The effect of cognitive demand on Timed Up and Go performance in older adults with and without Parkinson disease. Journal of Neurologic Physical Therapy. 2003;27(1):2.<\/li>\n
  28. Nilsagard Y, Lundholm C, Gunnarsson LG, Denison E. Clinical relevance using timed walk tests and \u00e2\u20ac\u02dctimed up and go\u00e2\u20ac\u2122testing in persons with multiple sclerosis. Physiotherapy Research International. 2007;12(2):105-14.<\/li>\n
  29. Manaf H, Justine M, Omar M. Functional Balance and Motor Impairment Correlations with Gait Parameters during Timed Up and Go Test across Three Attentional Loading Conditions in Stroke Survivors. Stroke research and treatment. 2014;2014.<\/li>\n
  30. Christofoletti G, de Andrade LP, Beinotti F, Borges G. Cognition and dual-task performance in older adults with Parkinson\u2019s and Alzheimer\u2019s disease. International journal of general medicine. 2014;7:383.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction Neck pain is known as the second common musculoskeletal […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-4382","post","type-post","status-publish","format-standard","hentry","category-vol8octoberspledition"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/4382","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=4382"}],"version-history":[{"count":3,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/4382\/revisions"}],"predecessor-version":[{"id":4871,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/4382\/revisions\/4871"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=4382"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=4382"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=4382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}