The Influence of Manual Therapy Applied to the Cervical Spine in the Prevention of Balance Disorders in the Elderly

Study Overview
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Brief Summary
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Falling is a major trauma that can occur with aging, leading to very significant psychological and physical health effects with financial and societal consequences. It is therefore essential to explore therapeutic treatments that can reduce this risk. Some recognized effective treatments exist, concerning in particular the re-education of the muscles of the lower limbs. However, to our knowledge, none of them focus on the cervical spine although the latter is located at an essential physiological crossroads. Manual therapy, which has already demonstrated its impact on pain and balance parameters in the elderly, could be a painless and non-invasive tool of choice in addressing this problem.

Detailed Description
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The main hypothesis of the present study is therefore that manual therapy applied to the cervical spine may have a beneficial impact on the balance and motor performance of seniors. The study also aims to propose an assessment of the physical parameters of balance, in order to validate the contribution of the cervical spine in compensatory mechanisms. To do so, an interventional study was designed, monocentric, prospective, controlled, randomized double-blind (patient and evaluator performing the measurements). The experiment will take place over three measurement periods on D0, D7 and D21.

Official Title
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The Influence of Manual Therapy Applied to the Cervical Spine (Versus Light Touch) in the Prevention of Balance Disorders in the Elderly: a Randomized Controlled Trial

Conditions
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Balance, Postural, Gait, Elderly

Intervention / Treatment
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* Other: Manual therapy
* Other: Placebo intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 65 years of age or older, of either sex Autonomous, able to walk ten meters alone without walking aid Able to understand instructions necessary for the correct performance of the measurements. Exclusion Criteria: Patients suffering from a locomotor handicap or severe chronic progressive pathologies preventing the protocol from being carried out correctly Patient who has an history of surgery - fracture - dislocation of the cervical spine Patient who has cognitive impairments (Mini Mental Statement <20) Patient who has life expectancy less than 6 months.

Ages Eligible for Study
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Minimum Age: 65 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Sham (ligth touch)<br>Placebo intervention composed of light touch treatment on the cervical spine. | Other: Placebo intervention<br>* The Sham group receives placebo treatment twice (D0 and D7). This placebo treatment also called light touch treatment consists of applying light pressure with broad support from both hands on either side of the joint, in contact with the skin, without equal bone pressure or therapeutic intention, for a duration comparable to that of manual therapy. Outcomes are evaluation before and after placebo intervention. The same schedule will be reproduced at D7. On D21, only one assessment will be done at the beginning of the session and a manual therapy treatment on the cervical spine is provided to balance access to care in the two group<br>|
| Experimental: Manual therapy<br>Manual therapy applied to the cervical spine. | Other: Manual therapy<br>* The manual therapy intervention is performed twice on the experimental group, once on day 0 (D0) and the second time on day 7 (D7). This intervention consists of a manual therapy protocol (base on myofascial release) applied to the cervical spine. Protocol consists of succession of techniques: suboccipital decompression, disengagement of Cervical 0-1-2,vibratory stimulation at C4 level and myofascial release technique of the cervical aponeuroses. Outcomes are evaluated before and after intervention.The same schedule will be reproduced on D7. On D21, only one assessment will be done at the beginning of the session.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change of SPPB (Short Physical Performance Battery test) score at day 0 after 1 intervention | The subject will then be asked to stand up and perform the different steps of the Short Physical Performance Battery test following the instructions of the evaluator, leading to a score between 0 (worse score) and 12 (best score) | at Day 0 before and immediately after intervention in both groups | 
| change of SPPB (Short Physical Performance Battery test) score at day 7 after a second intervention | The subject will then be asked to stand up and perform the different steps of the Short Physical Performance Battery test following the instructions of the evaluator, leading to a score between 0 (worse score) and 12 (best score) | at Day 7 before and immediately after intervention in both groups | 
| SPPB (Short Physical Performance Battery test) score at day 21 | The subject will then be asked to stand up and perform the different steps of the Short Physical Performance Battery test following the instructions of the evaluator, leading to a score between 0 (worse score) and 12 (best score) | at Day 21 in both groups before the intervention for sham group | 
| change of walking speed at day 0 after 1 intervention | The subject will performed a 4m gait measurement | at Day 0 before and immediately after intervention in both groups | 
| change of walking speed at day 7 after a second intervention intervention | The subject will performed a 4m gait measurement | at Day 7 before and immediately after intervention in both groups | 
| walking speed at day 21 | The subject will performed a 4m gait measurement | at Day 21 in both groups, before the intervention for sham group | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in Heart Rate Variability at day 0 after 1 intervention | Participants will be equipped with a heart rate monitor (Polar RS800) and a heart belt to collect HRV. The watch will be placed on the subjects' wrists and the belt on the chest (under the pectoral muscles for men and under the bra for women). The skin under the sensor will be slightly moistened to ensure good electrical contact and to avoid artifacts. The belt must be tight enough to ensure that the sensor is in perfect contact with the skin but must remain comfortable. Thus, a total recording time of 5 minutes, in the supine position and with spontaneous breathing, will be performed on each patient. | at Day 0 before and immediately after intervention in both groups | 
| change in Heart Rate Variability at day 7 after the second intervention | Participants will be equipped with a heart rate monitor (Polar RS800) and a heart belt to collect HRV. The watch will be placed on the subjects' wrists and the belt on the chest (under the pectoral muscles for men and under the bra for women). The skin under the sensor will be slightly moistened to ensure good electrical contact and to avoid artifacts. The belt must be tight enough to ensure that the sensor is in perfect contact with the skin but must remain comfortable. Thus, a total recording time of 5 minutes, in the supine position and with spontaneous breathing, will be performed on each patient. | at Day 7 before and immediately after intervention in both groups | 
| Heart Rate Variability at day 21 | Participants will be equipped with a heart rate monitor (Polar RS800) and a heart belt to collect HRV. The watch will be placed on the subjects' wrists and the belt on the chest (under the pectoral muscles for men and under the bra for women). The skin under the sensor will be slightly moistened to ensure good electrical contact and to avoid artifacts. The belt must be tight enough to ensure that the sensor is in perfect contact with the skin but must remain comfortable. Thus, a total recording time of 5 minutes, in the supine position and with spontaneous breathing, will be performed on each patient. | at Day 21 before the intervention for sham group | 
| change in cervical range of motion at day 0 after 1 intervention | the patients will be seated in a neutral position, with their backs against the back of the chair, and will perform the cervical range of motion tests. For this, the experimenter will use the anatomical points previously identified: ear tragus, chin symphysis, anterior angle of the acromion, sternal incisure. The subject will be asked to perform movements of flexion, extension, right rotation, left rotation, right tilt, and left tilt, returning to the neutral position each time. All movements will be performed 3 times. The measurement will retain the difference between the neutral position and the maximum position of the movement | at Day 0 before and immediately after intervention in both groups | 
| change in cervical range of motion at day 7 after the second intervention | the patients will be seated in a neutral position, with their backs against the back of the chair, and will perform the cervical range of motion tests. For this, the experimenter will use the anatomical points previously identified: ear tragus, chin symphysis, anterior angle of the acromion, sternal incisure. The subject will be asked to perform movements of flexion, extension, right rotation, left rotation, right tilt, and left tilt, returning to the neutral position each time. All movements will be performed 3 times. The measurement will retain the difference between the neutral position and the maximum position of the movement | at Day 7 before and immediately after intervention in both groups | 
| cervical range of motion at day 21 | the patients will be seated in a neutral position, with their backs against the back of the chair, and will perform the cervical range of motion tests. For this, the experimenter will use the anatomical points previously identified: ear tragus, chin symphysis, anterior angle of the acromion, sternal incisure. The subject will be asked to perform movements of flexion, extension, right rotation, left rotation, right tilt, and left tilt, returning to the neutral position each time. All movements will be performed 3 times. The measurement will retain the difference between the neutral position and the maximum position of the movement | at Day 21 before the intervention for sham group | 
| change in cervical muscle strength at day 0 after 1 intervention | the cervical strength tests will be performed seated too, using a manual dynamometer (Micro FET2, Hoggan, Salt Lake City, USA). To obtain the maximum isometric force of the neck muscles in the 6 movements, a make test will be performed: the experimenter will resist the subject's force without trying to exceed it. The subject will be asked to perform progressively and as hard as possible, from the neutral position, a flexion movement (resistance applied under the chin), an extension movement (resistance applied to the back of the occiput), a right and left rotation movement (resistance applied along the horizontal side of the right and left mandibles), and a right and left tilt movement (resistance applied above the right and left ears). | at Day 0 before and immediately after intervention in both groups | 
| change in cervical muscle strength at day 7 after the second intervention | the cervical strength tests will be performed seated too, using a manual dynamometer (Micro FET2, Hoggan, Salt Lake City, USA). To obtain the maximum isometric force of the neck muscles in the 6 movements, a make test will be performed: the experimenter will resist the subject's force without trying to exceed it. The subject will be asked to perform progressively and as hard as possible, from the neutral position, a flexion movement (resistance applied under the chin), an extension movement (resistance applied to the back of the occiput), a right and left rotation movement (resistance applied along the horizontal side of the right and left mandibles), and a right and left tilt movement (resistance applied above the right and left ears). | at Day 7 before and immediately after intervention in both groups | 
| cervical muscle strength at day 21 | the cervical strength tests will be performed seated too, using a manual dynamometer (Micro FET2, Hoggan, Salt Lake City, USA). To obtain the maximum isometric force of the neck muscles in the 6 movements, a make test will be performed: the experimenter will resist the subject's force without trying to exceed it. The subject will be asked to perform progressively and as hard as possible, from the neutral position, a flexion movement (resistance applied under the chin), an extension movement (resistance applied to the back of the occiput), a right and left rotation movement (resistance applied along the horizontal side of the right and left mandibles), and a right and left tilt movement (resistance applied above the right and left ears). | at Day 21 before the intervention for sham group | 
| change in quadriceps strength at day 0 after 1 intervention | to measure the maximal isometric extension force of the dominant quadriceps by applying the dynamometer to the lower tibia and requesting leg extension from a 90° flexion position | At Day 0 before and immediately after intervention in both groups | 
| change in quadriceps strength at day 7 after the second intervention | to measure the maximal isometric extension force of the dominant quadriceps by applying the dynamometer to the lower tibia and requesting leg extension from a 90° flexion position | At Day 7 before and immediately after intervention in both groups | 
| quadriceps strength at day 21 | to measure the maximal isometric extension force of the dominant quadriceps by applying the dynamometer to the lower tibia and requesting leg extension from a 90° flexion position | At Day 21 before the intervention for sham group | 
| change in static posturography at day 0 after 1 intervention | the static posturography test will be performed under standard conditions using the WIN-POSTURO platform (Medicapteur, Balma, France) allowing the measurement of displacements of the center of pressure in a static standing position at a frequency of 40 Hz for 25.6 seconds . The measurement will be repeated 3 times. The data collected will be processed using WIN-POSTURO software (Medicapteur, Balma, France) | At Day 0 before and immediately after intervention in both groups | 
| change in static posturography at day 7 after the second intervention | the static posturography test will be performed under standard conditions using the WIN-POSTURO platform (Medicapteur, Balma, France) allowing the measurement of displacements of the center of pressure in a static standing position at a frequency of 40 Hz for 25.6 seconds . The measurement will be repeated 3 times. The data collected will be processed using WIN-POSTURO software (Medicapteur, Balma, France) | At Day 7 before and immediately after intervention in both groups | 
| static posturography at day 21 | the static posturography test will be performed under standard conditions using the WIN-POSTURO platform (Medicapteur, Balma, France) allowing the measurement of displacements of the center of pressure in a static standing position at a frequency of 40 Hz for 25.6 seconds . The measurement will be repeated 3 times. The data collected will be processed using WIN-POSTURO software (Medicapteur, Balma, France) | At Day 21 before the intervention for sham group | 
| change in plantar support at day 0 after 1 intervention | The subject will perform the 4 m gait measurement part (which will measure walking speed) equipped with W-INSHOE plantar sensors (Medicapteur, Balam, France) which will be analyzed using the software of the same name. The sensors are attached to the skin with hypoallergenic tape | At Day 0 before and immediately after intervention in both groups | 
| change in plantar support at day 7 after the second intervention | The subject will perform the 4 m gait measurement part (which will measure walking speed) equipped with W-INSHOE plantar sensors (Medicapteur, Balam, France) which will be analyzed using the software of the same name. The sensors are attached to the skin with hypoallergenic tape | At Day 7 before and immediately after intervention in both groups | 
| plantar support at day 21 | The subject will perform the 4 m gait measurement part (which will measure walking speed) equipped with W-INSHOE plantar sensors (Medicapteur, Balam, France) which will be analyzed using the software of the same name. The sensors are attached to the skin with hypoallergenic tape | At Day 21 before the intervention for sham group | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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senior;, gait, neck, myofascial release