The Relationship between Brain Abnormalities Based on MRI-parameters and Motor Control in ...

53 Pages·2016·1.95 MB·English

by  Lore Vandenbossche

Rehabilitation Sciences and Physiotherapy
Academic Year 2015-2016

The Relationship between Brain Abnormalities
Based on MRI-parameters and Motor Control in
Chronic Low Back Pain Patients

Thesis submitted in fulfillment of the requirements for the degree of
Master of Science in Rehabilitation and Physiotherapy

Yasmine Dammak
Lore Vandenbossche

Promotor: Prof. Dr. Barbara Cagnie
Copromotor: Drs. Jeroen Kregel

Faculteit Geneeskunde en Gezondheidswetenschappen – Revalidatiewetenschappen en Kinesitherapie
Campus Heymans, 2B3, De Pintelaan, 185, BE-9000 Gent
tel. [phone], fax [phone]
www.REVAKI.UGent.be
www.UGent.be

Rehabilitation Sciences and Physiotherapy
Academic Year 2015-2016

The Relationship between Brain Abnormalities
Based on MRI-parameters and Motor Control in
Chronic Low Back Pain Patients

Thesis submitted in fulfillment of the requirements for the degree of
Master of Science in Rehabilitation and Physiotherapy

Yasmine Dammak
Lore Vandenbossche

Promotor: Prof. Dr. Barbara Cagnie
Copromotor: Drs. Jeroen Kregel
1. ACKNOWLEDGEMENTS
This thesis is made possible thanks to the support and the help of a few people. Therefore we
like to thank those people. Firs and of all we would like to thank our promoter prof. dr. Barbara
Cagnie, and our copromotor drs. Jeroen Kregel for the close cooperation and the availability for
feedback, advice and motivation. We also like to mention the Ghent University and the
department of Rehabilitation Sciences and Physiotherapy. The five years of study helped us
shape in who we are now and gave us an idea of who we want to be. We also like to thank the
people close to us for the unconditional support we needed to complete this thesis.

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2. TABLE OF CONTENTS
1. Acknowledgements ............................................................................................................ 4
2. Table of Contents ............................................................................................................... 5
3. List of Figures and Tables .................................................................................................. 6
4. List of Abbreviations and Acronyms ................................................................................... 7
5. Experimental study ............................................................................................................ 8
ABSTRACT IN ENGLISH ................................................................................................................................... 8
ABSTRACT IN DUTCH ..................................................................................................................................... 9
KEYWORDS ................................................................................................................................................ 10
INTRODUCTION .......................................................................................................................................... 11
MATERIALS AND METHODS .......................................................................................................................... 13
Study Design .................................................................................................................................... 13
Participants ....................................................................................................................................... 15
Procedure ......................................................................................................................................... 15
Outcome Measurements and Analysis ........................................................................................ 15
RESULTS .................................................................................................................................................... 22
Distribution of the Data ................................................................................................................... 23
Correlation ........................................................................................................................................ 24
DISCUSSION AND CONCLUSION ..................................................................................................................... 31
Regions of Interest .......................................................................................................................... 31
General Remarks ............................................................................................................................ 31
Summary of Evidence .................................................................................................................... 32
Limitations ........................................................................................................................................ 37
Conclusion ........................................................................................................................................ 38
REFERENCES .............................................................................................................................................. 39
6. Abstract in Dutch Layman's Terms ................................................................................... 44
7. Prove of Submission of the Ethics Committee .................................................................. 45
8. Appendix .......................................................................................................................... 50

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3. LIST OF FIGURES AND TABLES

Figure 1: Flowchart Patient Selection Process. ........................................................................... 14
Figure 2: Correlation LH Postcentral Thickness and Total Lumbar Repositioning Sitting, Female
Group. ......................................................................................................................................... 25
Figure 3: Correlation RH Postcentral Thickness and Total Lumbopelvic Control Standing,
Female Group. ............................................................................................................................ 25
Figure 4: Correlation LH Mean Thickness and Total Movement Control, Male Group. ................ 26
Figure 5: Correlation RH Mean Thickness and Total Lumbar Repositioning Sitting, Male Group. 26
Figure 6: Correlation RH Mean Thickness and Total Path, Female Group. ................................. 27
Figure 7: Correlation LH Postcentral Thickness and Anteroposterior Sway, Female Group. ....... 27
Figure 8: Correlation Left Thalamus and Total Lumbar Repositioning Standing, Female Group. . 28
Figure 9: Correlation Left Putamen and Total Neuromuscular Control TAM, Male Group. ........... 29
Figure 10: Correlation Left Putamen and Total Neuromuscular Control MM, Male Group. .......... 29
Figure 11: Correlation Left Thalamus and Anteroposterior Sway, Female Group. ....................... 29

Table 1: Movement Control Tests of the Low Back: Scoring Criteria [56]. ..................................... 17
Table 2: Interpretation of the Correlation Coefficient [69] ............................................................... 22
Table 3: Participant Demographics ............................................................................................. 23
Table 4: Differences between the Female and the Male Data. .................................................... 24
Table 5: Significant Female Group Correlations .......................................................................... 30
Table 6: Significant Male Group Correlations .............................................................................. 31
Table 7: Distribution of the Data .................................................................................................. 50
Table 8: Correlations in the Female Group .................................................................................. 51
Table 9: Correlations in the Male Group ...................................................................................... 52

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4. LIST OF ABBREVIATIONS AND ACRONYMS

BMI: body mass index; N: number;
C: control group; NRS: numeric rating scale;
cc: correlation coefficient; O: outcome;
cLBP: chronic low back pain; p: level of statistical significance;
cLRP: chronische lage rugpijn; P: patient(s);
cm: centimetre(s); PDI: pain disability index;
CoP: center of pressure; PM: premotor cortex;
DTI: diffusion tensor imaging; RCT: randomized controlled trial;
e.g.: for example; RH: right hemisphere;
FA: fractional anisotropy; ROI: regions of interest;
I: intervention; s: second(s);
i.e.: that is; S1: primary somatosensory cortex;
k.: kappa index; SD: standard deviation;
LH: left hemisphere; SIAS: spina iliaca anterior superior;
m: month(s); sign.: significant;
M1: primary motor cortex; SIPS: spina iliaca posterior superior;
MA: mean age; SMA: supplementary motor area;
MET: metabolic equivalent of task; TAM: transverse abdominis muscle;
mm: millimetre(s); VAS: visual analogue scale;
MM: multifidus muscle; VBM: voxel-based morphometry;
MRI: magnetic resonance imaging; Vs: versus.

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5. EXPERIMENTAL STUDY
ABSTRACT IN ENGLISH
Context: Chronic pain is a common, worldwide public health problem and a major cause of
disability. The aetiology of chronic low back pain (cLBP) is heterogeneous what makes it
difficult to diagnose and manage. To develop effective treatments, it is crucial to understand
the underlying neurobiology of the brain e.g. by brain imaging. Motor control is a complex
sensorimotor task that requires an intact network of white matter connections and sufficient
gray matter. White and gray matter changes can be associated to chronic pain, what
confirms the link between brain plasticity and motor deficits. Regarding sexual dimorphisms,
evidence of gender differences in brain structure as well as function is provided. Still very
little research is done about these topics.
Objective: The first aim of this cross-sectional study was to examine the relation between
brain gray matter structure and (dysfunctional) motor control in cLBP patients. The second
aim was to examine the gender differences in previous relation.
Study Design: Cross-sectional study.
Methods: The study included 45 participants (18 male, 27 female) with cLBP, recruited in
the Ghent University Hospital, Brussels University Hospital, primary care practices and via
social media. The measurement procedure consisted of the Pain Disability Index (PDI), a
brain MRI-scan and a standardized order of multiple motor control tests. The primary
outcome measures included brain gray matter structure (precentral cortex, postcentral
cortex, cerebellum, basal ganglia and thalamus), sensorimotor control (movement control of
the lumbar spine; proprioception; lumbopelvic control; neuromuscular control) and postural
steadiness. The PDI was the secondary outcome measure.
Results: Correlations, varying between negligible and moderate, were found for cortical,
cerebellar and subcortical structures with motor control performance. But most correlations
were negligible and thus non-significant. In the female group more significant results were
found than in the male group, although in the male group more moderate correlations were
found than in the female group. The main significant results in the female group were left
hemisphere (LH) postcentral thickness with total lumbar reposition standing (correlation
coefficient (cc)= ,525; p= ,005) and right hemisphere (RH) mean thickness with total lumbar
reposition standing (cc= ,521; p= ,005). In the male group, the main significant results were
LH mean thickness with total movement control (cc= -,563; p= ,015), RH mean thickness
with total lumbar reposition sitting (cc= ,566; p= ,014), left putamen volume with total
neuromuscular control transverse abdominis muscle (cc= ,526; p= ,025) and with total
neuromuscular control multifidus muscle (cc= ,607; p= ,008).
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Conclusions: The findings of this study support the evidence that gray matter changes,
linked to cLBP, may influence motor control. This study found only few moderate correlations
in the gender based groups concerning the correlation of gray matter with motor or postural
control. Also, amongst the groups, the results often differ. This perspective concerning gray
matter modifications, motor control and gender differences in cLBP may lead to new
physiotherapeutic approaches and techniques based on motor control training or exercise
therapy. Still, more research about the relation of gray matter quantity and motor or postural
control in cLBP patients and the expected gender differences is necessary to give a
conclusive answer.
ABSTRACT IN DUTCH
Context: Chronische pijn is een vaak voorkomend, wereldwijd gezondheidsprobleem en een
grote oorzaak van fysieke ongeschiktheid. De etiologie van chronische lage rugpijn (cLRP) is
heterogeen, daardoor is het diagnosticeren en de aanpak ervan moeilijk. Om effectieve
behandelingen te ontwikkelen is het cruciaal om de onderliggende neurobiologie van de
hersenen te begrijpen met behulp van bijvoorbeeld hersenscans. Motorische controle is een
complexe sensorimotorische taak, die een intact netwerk van witte stof en voldoende grijze
stof vereist. Veranderingen in witte en grijze stof kunnen gekoppeld worden aan chronische
pijn, wat de link tussen plasticiteit van de hersenen en motorische deficiëntie bevestigd.
Betreffende geslachtsverschillen, bewijzen zijn geleverd in verband met geslachtsverschillen
in hersenstructuur en -functie. Toch is nog steeds zeer weinig onderzoek gedaan over deze
onderwerpen.
Objectief: Het eerste doel van deze cross-sectionele studie was om de relatie tussen grijze
stof structuur en (disfunctionele) motorische controle in chronische lage rugpijn patiënten te
onderzoeken. Het tweede doel was om de geslachtsverschillen in voorgaande relatie te
onderzoeken.
Onderzoeksdesign: Cross-sectionele studie.
Methode: De studie includeerde 45 deelnemers (18 mannen, 27 vrouwen) met cLRP,
aangebracht door het Universitair Ziekenhuis Gent, Universitair Ziekenhuis Brussel,
huisartsen en via sociale media. De onderzoeksprocedure omvatte de Pain Disability Index
(PDI) een hersenscan en een gestandaardiseerde volgorde van meerdere motorische
controle testen. De primaire uitkomstmaten waren de grijze stof structuur (precentrale
cortex, postcentrale cortex; cerebellum, basale ganglia en thalamus), sensorimotorische
controle (bewegingscontrole van de lumbale wervelzuil; proprioceptie; lumboplevische
controle; neuromusculaire controle) en posturale controle. De PDI was de secundaire
uitkomstmaat.
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Resultaten: Correlaties, variërend tussen verwaarloosbaar en matig, werden gevonden voor
corticale, cerbellaire en subcorticale structuren met motorische controle prestatie. Maar de
meeste correlaties waren verwaarloosbaar en dus niet significant. In de vrouwelijke groep
werden meer significante resultaten gevonden dan in de mannelijke groep, toch werden in
de mannelijke groep meer matige correlaties gevonden dan in de vrouwelijke. De
belangrijkste resultaten in de vrouwelijke groep waren linker hemisfeer (LH) postcentrale
dikte met totale lumbale repositie in stand (cc= ,525; p= ,005) en rechter hemisfeer (RH)
gemiddelde dikte met totale lumbale repositie in stand (correlatie coëfficiënt (cc)= ,521; p=
,005). In de mannelijke groep, de belangrijkste significante resultaten ware LH gemiddelde
dikte met totale bewegingscontrole (cc= -,563; p= ,015), RH gemiddelde dikte met totale
lumbale repositie in zit (cc= ,566; p= ,014), linker putamen volume met totale
neuromusculaire controle transversus abdominis (cc= ,526; p= ,025) en met totale
neuromusculaire controle multifidus (cc= ,607; p= ,008).
Conclusies: De bevindingen van deze studie ondersteunen de evidentie dat veranderingen
in grijze stof, gelinkt aan cLRP, de motorische controle kunnen beïnvloeden. Deze studie
vond weinig matige correlaties in de gender gebaseerde groepen betreffende de correlatie
van grijze stof met motorische of posturale controle. Ook tussen de groepen verschillen de
resultaten. Dit perspectief met betrekking tot grijze stof veranderingen, motorische controle
en geslachtsverschillen in cLRP kan leiden tot nieuwe kinesitherapeutische benaderingen en
technieken gebaseerd op motorische controle training of oefentherapie. Toch is nog meer
onderzoek nodig over de relatie van grijze stof en motorische of posturale controle in cLRP
patiënten en de verwachte geslachtsverschillen nodig om een definitief antwoord te kunnen
geven.
KEYWORDS
Brain Imaging, Chronic Low Back Pain, Gray Matter, Motor Control, Neuroscience

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