Tactile acuity at the back

Tactile acuity at the back and motor control of the trunk are decreased in people with back pain Lorimer Moseley NHMRC Senior Research Fellow Prince of Wales Medical Research Institute & School of Medical Sciences, University of New South Wales, Sydney, Australia Team leader The GAMFI project University of Oxford, UK © GL Moseley http:// www.bodyinmind.com.au

TPD ver(cal TPD horizontal TPD = two point discrimina(on threshold – a  measure of tac(le acuity. © GL Moseley Luomajoki & Moseley 2009 Br J Sport Med www.BodyInMind.com.au

This shows that tac(le acuity is less in  people with back pain than it is in  those without. This shows voluntary  lumbopelvic control is worse  in people with back pain  than in those without. © GL Moseley Luomajoki & Moseley 2009 Br J Sport Med www.BodyInMind.com.au

This shows voluntary  lumbopelvic control and  tac(le acuity are related. © GL Moseley Luomajoki & Moseley 2009 Br J Sport Med www.BodyInMind.com.au

Can we train tac(le acuity?  © GL Moseley www.BodyInMind.com.au

A. Stimulation B. Condition NO ATTENTION Probes Screen 5 1 2 34 2 mm 11 mm In one condi(on, we just touched the aﬀected hand at these points while the pa(ent read a book.  In the other condi(on,  we did iden(cal touches but now they had to discriminate between them – which point and which probe. Affected part ATTENTION Stimulation sites 5 1 2 4 3 5 5 5 1 2 34 1 2 34 Photograph of affected part, with stimulation sites marked. © GL Moseley Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

This shows that while there was no eﬀect of the s(mula(on alone, there was signiﬁcant improvement in pain, tac(le  acuity and func(on. Improvements were maintained at 3 month follow‐up. NO ATTENTION 8 Pain NRS 4 Screen 5 0 1 2 34 60 TPD mm ATTENTION 30 10 Task-specific NRS 5 5 5 5 1 2 34 1 2 34 0 Wait No Attention Review attention © GL Moseley Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

6 Change 7 in pain 12 9 NRS 3 24 8 11 ATTENTION 3 5 10 1 13 r2 = 0.34 This shows that during  0 P = 0.04 discrimina(on, the change in  tac(le acuity and the change  -0.5 6 0 1 2 in pain were related. Change in TPD 3 Change in pain 4 NRS 7 6 9 8 NO ATTENTION 12 3 0 2 1 13 10 11 5 -0.5 0 1 © GL Moseley Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 Change in TPD www.BodyInMind.com.au

Can we use vision and gaze direction to make it better? Taylor-Clarke et al (2002) Curr Biol 12, 233-6 These (and other) studies show that if you can see skin and look in the direction of a stimulus, our tactile acuity is better and sensory cortex response is bigger. © GL Moseley www.BodyInMind.com.au

In this experiment we used the  same method as the clinical trial  (condi(on E) and then a  condi(on that also captured  visual input of skin (C),  a condi(on that captured gaze  direc(on but not visual input of  skin (D) and a condi(on that captured  both (B).   Each session involved 72 s(muli  randomly to ﬁve points with  either a fat or a skinny probe (A). © GL Moseley Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

This shows that, a]er a single 30  minute discrimina(on training  session, the increase in tac(le  acuity was greatest in the  condi(on that captured both  visual input of skin and gaze  direc(on.  This shows that there was also a  signiﬁcant decrease in pain. © GL Moseley Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

Does the same apply for the back? How do we use vision there?  We should use vision & spa(al a^en(on to  enhance TPD training In CRPS, TPD training can reduce pain © GL Moseley www.BodyInMind.com.au

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Tactile acuity at the back

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Tactile acuity at the back — Presentation Transcript