Proprioceptive Deficits in Degenerative Cervical Myelopathy

Study Overview
=================
Brief Summary
-----------------
Proprioceptive deficits in degenerative cervical myelopathy (DCM) is a progressive neurological deficits in somatosensory and motor function which affects the body balance and motor control. DCM usually presents with body incoordination, hand clumsiness and gait disturbance associated with proprioceptive dysfunction that hinders the physical performance and functions. In this study, a non-invasive assessment protocol on proprioception will be developed for detecting subtle proprioceptive deficits at the early stage of disease through simple Physical Performance Tests for population older than 45. By adopting the physical performance tests as the diagnostic predictors of DCM, we aim to avoid the development of devastating consequences and disabilities.

Detailed Description
-----------------
DCM is a chronic insidious disease, one of the most disabling orthopaedic conditions, which involves compression of the spinal cord by the surrounding structures in cervical spinal region. It characterizes with progressive neurological deficits in body coordination, hand clumsiness and gait disturbance as the preliminary symptom which may cause by proprioceptive dysfunction . Physical performance and function hinder patients' hand clumsiness, gait disturbance and body imbalance. The incoordination between body, upper limbs and lower limbs will be resulted from proprioceptive deficits caused by spinal cord compression. By adopting the Proprioceptive Functional Analysis System (PFAS), proprioceptive deficits over the core body joints and peripheral joints could be tested during Activity of Daily Living (ADL) with reference to normal subjects' performance. All subjects will be tested by the PFAS and Physical Performance Tests. The idea of regional proprioceptive deficit will be incorporated in the assessment protocol for DCM to facilitates a breakthrough from the traditional DCM functional evaluation. In developing a non-invasive assessment protocol to assess proprioceptive deficit, we aim to detect subtle proprioceptive deficit from the tests, especially at the very early stage of disease. We target to demonstrate the validity of Physical Performance Tests are evenly high as that of the advanced technology, PFAS. Consequently, by adopting the valid Physical Performance Tests in health screening scheme for population older than 45 within the community can serve as an early diagnostic parameter of DCM and avoid delayed treatment leading to devastating consequences and disabilities.

Official Title
-----------------
Early Detection of Proprioceptive Dysfunction in Degenerative Cervical Myelopathy by Proprioceptive Functional Analysis in Activities of Daily Living

Conditions
-----------------
Cervical Myelopathy

Intervention / Treatment
-----------------
* Other: Proprioceptive Functional Analysis System


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Chinese Aged 40 or above With radiological evidence of degenerative cervical myelopathy, both symptomatic and asymptomatic Nurick grade less than 3 Exclusion Criteria: Non-Chinese ethnicity Aged under 40 without any radiological proof of cervical myelopathy Active problems of tuberculosis spine, lumbar spinal diseases and other problem causing pain or deformities over the limbs that may affect their balance and movement Presents with extra-pyramidal or other disorders involving the cerebellum or frontal lobe of cerebrum leading to poor balance and gait disturbance Previous spinal operation with residual disturbance in balance or gait Non-communicable patients with insufficient cognitive ability in expressing their own symptoms clearly Non-walker Blind or deaf

Ages Eligible for Study
-----------------
Minimum Age: 40 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| (1) Degenerative Cervical Myelopathy<br>Chinese subjects aged 40 or above who have radiological evidences of Degenerative Cervical Myelopathy, both symptomatic and asymptomatic with Nurick Grade less than 3 will be included. | Other: Proprioceptive Functional Analysis System<br>* Proprioceptive testing and Physical Performance Tests<br>|
| (2) Healthy Controls<br>Chinese healthy controls aged 40 or above who have no myelopathic sign of Degenerative Cervical Myelopathy with Nurick Grade less than 3 will be included. | Other: Proprioceptive Functional Analysis System<br>* Proprioceptive testing and Physical Performance Tests<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Japanese Orthopaedics Association Scoring System for Cervical Myelopathy (mJOA) | mJOA is a self-reported functional questionnaire on disease severity through assessing 4 domains: Upper Limb Function Lower Limb Function Sensory Function Bladder Function mJOA has a total score of 17 and it categories DCM patient into different severity as below: Mild >= 15 Moderate = 12-14 Severe < 12 | 15 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proprioceptive Deficits - Speed Test | Proprioceptive deficits hinder the limb coordination, especially the fine finger dexterity, reciprocal walking and stepping. Thus, incoordination over the lower and upper limbs will then be resulted and which alters the speed and integrity of the performance in the Physical Performance Tests validated for DCM. In the physical performance tests, it has divided into 2 separate sections, the Speed Test will be recorded for in terms of the Time required to complete the standardized test process in seconds | 15 years | 
| Proprioceptive Deficits - Time Limited Test | Time Limited Test of physical performance test will be assessed and data will be recorded in terms of Total number of repetitions completed within strictly fixed time frame | 15 years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Degenerative Cervical Myelopathy, Proprioceptive Deficits