The Effects of Spinal Manipulation on Performance on Neck Pain Patients During a Fitts' Task

Study Overview
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Brief Summary
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The objective of this study is to quantify motor performance, this study will use an eye movement Fitts' task to examine the effects of cervical spine manipulation on participants with chronic neck pain and the subsequent changes to saccade movement time. This study will also include a head movement Fitts' task which has previously reported a reduction in head movement time in chronic neck pain participants after cervical spine manipulation. This is an observational within-subjects design that involves a pre/post cervical spine manipulation intervention on participants (n=20) with chronic neck pain and asymptomatic controls (n=20). All participants will complete an eye movement and head movement Fitts' task before and after cervical spine manipulation to identify any changes in saccade and head movement time, saccade and head peak velocity, and time to peak saccade and head velocity.

Detailed Description
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The purpose of this study is to measure the effects of cervical spine manipulation on the motor performance of participants with and without chronic neck pain. The objective of this pre/post design study is to apply spinal manipulation of the cervical spine to participants with chronic neck pain and participants who are asymptomatic for neck pain, and to measure the subsequent changes of movement time of the eyes during an eye movement Fitts' task using eye-tracker technology. This study will also include a head movement Fitts' task, which has been previously shown to identify a reduction in head movement time in participants after receiving cervical spine manipulation. The head movement task, which has a biomechanical basis, will serve as a comparator to the eye movement task, which has a neurophysiologic basis. Changes in head and eye movement time are both measures of motor performance. The hypothesis for the eye movement Fitts' task, is that the eye movement time will be increase with larger distances between targets and will not be affected by changes in target width. It is anticipated that the eye movement time will reduce in the neck pain group following spinal manipulation in comparison to the asymptomatic group. We hypothesize that during the head movement task, symptomatic participants will experience a decrease in head movement time as compared to the asymptomatic group after spinal manipulation. We further hypothesize that head movement time will be increase with larger target distances and smaller target widths.

Official Title
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Motor Performance of Asymptomatic and Chronic Neck Pain Participants Pre- and Post-spinal Manipulation Using an Eye and Head Movement Fitts' Task

Conditions
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Chronic Neck Pain

Intervention / Treatment
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* Other: High velocity/low amplitude cervical spine manipulation


Participation Criteria
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Eligibility Criteria
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Participants with neck pain: Inclusion criteria Between the ages of 18 and 40 Neck pain for at least 3 months Palpable spinal segmental fixations at C1-7 Neck pain must be reproducible by neck movements and/or provocative Normal or corrected-to-normal vision Exclusion criteria Contraindications to spinal manipulation Can't be calibrated during the eye movement Fitts task (excluded from eye movement test only) Progressive neurologic deficits Cervical spine trauma or surgery Infection, tumor, osteoporosis, inflammatory spondyloarthropathy, spinal fracture, and a history of vestibular/inner ear dysfunction Diagnosed with an autonomic disorder such as Horner's syndrome Any current ocular and/or retinal disease, Diabetes, a history of head trauma Currently using opioids, recreational drugs or have a history of substance abuse Asymptomatic participants: Inclusion criteria Between the ages of 18 and 40 No neck pain for at least 3 months Palpable spinal segmental fixations at C1-7 Normal or corrected-to-normal vision Exclusion criteria Contraindications to spinal manipulation Can't be calibrated during the eye movement Fitts task (excluded from eye movement test only) Progressive neurologic deficits Cervical spine trauma or surgery Infection, tumor, osteoporosis, inflammatory spondyloarthropathy, spinal fracture, and a history of vestibular/inner ear dysfunction Diagnosed with an autonomic disorder such as Horner's syndrome Any current ocular and/or retinal disease, Diabetes, a history of head trauma Currently using opioids, recreational drugs or have a history of substance abuse

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is an observational within-subjects design that involves a pre/post cervical spine manipulation intervention on participants (n=20) with chronic neck pain and asymptomatic controls (n=20). All participants will complete an eye movement and head movement Fitts' task before and after cervical spine manipulation to identify any changes in eye and head movement time, eye and head peak velocity, and time to peak eye and head velocity.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Eye movement Fitts' task<br>High velocity/low amplitude cervical spine manipulation applied to chronic neck pain and asymptomatic participants. | Other: High velocity/low amplitude cervical spine manipulation<br>* The participants will receive a single cervical spine rotary manipulation to the previously identified palpable cervical segmental fixation. During the performance of the manipulation, the supine participant will rest their arms at the sides of their body. Next, the index finger of the chiropractor's contact hand will be placed on the lamina of the restricted cervical segment. The chiropractor will then rotate the participant's head contralaterally until the barrier of the cervical segments volitional end range is reached. The chiropractor's other hand will be placed behind the participant's head to induce gentle neck rotation contralateral to the chiropractor's thrusting hand. The chiropractor will deliver a manual thrust, with the thrust vector directed towards the participant's opposite eye.<br>* Other names: Neck adjustment;|
| Active Comparator: Head movement Fitts' task<br>High velocity/low amplitude cervical spine manipulation applied to chronic neck pain and asymptomatic participants. | Other: High velocity/low amplitude cervical spine manipulation<br>* The participants will receive a single cervical spine rotary manipulation to the previously identified palpable cervical segmental fixation. During the performance of the manipulation, the supine participant will rest their arms at the sides of their body. Next, the index finger of the chiropractor's contact hand will be placed on the lamina of the restricted cervical segment. The chiropractor will then rotate the participant's head contralaterally until the barrier of the cervical segments volitional end range is reached. The chiropractor's other hand will be placed behind the participant's head to induce gentle neck rotation contralateral to the chiropractor's thrusting hand. The chiropractor will deliver a manual thrust, with the thrust vector directed towards the participant's opposite eye.<br>* Other names: Neck adjustment;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in eye (saccade) movement time | Eye (saccade) movement time (milliseconds), which is the time between saccade onset and offset while moving from central circle to the target. | Change from baseline saccade movement time immediately following cervical spine manipulation. | 
| Change in head movement time | Head movement time (milliseconds) is the time required to move the cursor from the central circle to the target. | Change from baseline head movement time immediately following cervical spine manipulation. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in saccade peak velocity | Peak of the velocity amplitude (meters/second) in the horizontal movement direction | Change from baseline saccade peak velocity immediately following cervical spine manipulation. | 
| Change in time to peak saccade velocity | Measured as the time (milliseconds) from the onset of velocity to its peak amplitude | Change from baseline time to peak velocity immediately following cervical spine manipulation. | 
| Change in head peak velocity | Measured as the peak of the velocity amplitude (meters/second) of the cursor moving in the horizontal plane | Change from baseline head peak velocity immediately following cervical spine manipulation. | 
| Change in time to peak head velocity | The time (milliseconds) to peak velocity will be measured as the time from the onset of velocity to its peak amplitude. | Change from baseline time to peak head velocity immediately following cervical spine manipulation. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Manipulation, Spinal, Fitts' Task, Motor Performance