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Cervical Joint Position Sense in Hypobaric Conditions: A Randomized Double-Blind Controlled Trial.
Mil Med. 2017 09; 182(9):e1969-e1975.MM

Abstract

Well-adapted motor actions require intact and well-integrated information from all of the sensory systems, specifically the visual, vestibular, and somatosensory systems, including proprioception. Proprioception is involved in the sensorimotor control by providing the central nervous system with an updated body schema of the biomechanical and spatial properties of the body parts. With regard to the cervical spine, proprioceptive information from joint and muscle mechanoreceptors is integrated with vestibular and visual feedback to control head position, head orientation, and whole body posture. Postural control is highly complex and proprioception from joints is an important contributor to the system. Altitude has been used as a paradigm to study the mechanisms of postural control. Determining the mechanisms of postural control that are affected by moderate altitude is important as unpressurized aircrafts routinely operate at altitudes where hypoxia may be a concern. Deficits in motor performance arise when the reliance on proprioceptive feedback is abolished either experimentally or because of a disorder. As pilots require good neck motor control to counteract the weight of their head gear and proprioceptive information plays an important role in this process, the aim of this study was to determine if hypoxia at moderate altitudes would impair proprioception measured by joint position sense of the cervical spine in healthy subjects.

METHODS

Thirty-six healthy subjects (Neck Disability Index < 5) volunteered to participate. Neck position sense was evaluated using a three-dimensional motion analyzer. To create the environment, a hypobaric chamber was used to simulate artificial moderate altitude. Head repositioning error was measured by asking the subject to perform a head-to-neutral task after submaximal flexion-extension and right/left rotation movements, and a head-to-target task, in which the subjects had to return to a 30° right and left rotation position.

FINDINGS

Exposure to artificial acute moderate altitude of 7,000 feet had no significant effects on cervical joint position sense measured by head repositioning accuracy in healthy subjects. Discussion/impact/recommendations: Postural control mechanisms are very sensitive to acute mild hypoxia and have been recently investigated. Acute hypobaric hypoxia at moderate and high altitudes has a negative effect on postural control. However, which part of the postural system is affected has not yet been determined and proprioception has been little investigated. The results from this study highlighted that in healthy subjects with good cervical spine proprioception at baseline, artificial hypoxia induced by the simulation of moderate altitude does not increase head repositioning error. Further studies should investigate cervical joint position sense in real aircraft, at different altitudes and in a group of experienced helicopter pilots, to evaluate the impact of moderate altitude on cervical joint position sense in a different population. Conducting the same experiments in a population of pilots and in real flight conditions should be considered, since various factors such as the level of proprioception, head posture, type of movement, head load, muscle fatigue, flight altitude, and the length of flight time might influence the kinesthetic sensitivity.

Authors+Show Affiliations

Center for Musculoskeletal Medicine and Rehabilitation, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium.Center for Musculoskeletal Medicine and Rehabilitation, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium.Center for Musculoskeletal Medicine and Rehabilitation, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium.Center for Musculoskeletal Medicine and Rehabilitation, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium.Center for Aerospace Medicine, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium.Center for Aerospace Medicine, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium.Center for Aerospace Medicine, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium.Université Catholique de Louvain, Institut de recherche clinique (IREC/CARS) Avenue Hippocrate, 55 bte B1.55.02, Woluwe-Saint-Lambert, 1200 Brussels, Belgium.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28885964

Citation

Bagaianu, Diana, et al. "Cervical Joint Position Sense in Hypobaric Conditions: a Randomized Double-Blind Controlled Trial." Military Medicine, vol. 182, no. 9, 2017, pp. e1969-e1975.
Bagaianu D, Van Tiggelen D, Duvigneaud N, et al. Cervical Joint Position Sense in Hypobaric Conditions: A Randomized Double-Blind Controlled Trial. Mil Med. 2017;182(9):e1969-e1975.
Bagaianu, D., Van Tiggelen, D., Duvigneaud, N., Stevens, V., Schroyen, D., Vissenaeken, D., D'Hondt, G., & Pitance, L. (2017). Cervical Joint Position Sense in Hypobaric Conditions: A Randomized Double-Blind Controlled Trial. Military Medicine, 182(9), e1969-e1975. https://doi.org/10.7205/MILMED-D-16-00341
Bagaianu D, et al. Cervical Joint Position Sense in Hypobaric Conditions: a Randomized Double-Blind Controlled Trial. Mil Med. 2017;182(9):e1969-e1975. PubMed PMID: 28885964.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical Joint Position Sense in Hypobaric Conditions: A Randomized Double-Blind Controlled Trial. AU - Bagaianu,Diana, AU - Van Tiggelen,Damien, AU - Duvigneaud,N, AU - Stevens,Veerle, AU - Schroyen,Danny, AU - Vissenaeken,Dirk, AU - D'Hondt,Gino, AU - Pitance,Laurent, PY - 2017/9/9/entrez PY - 2017/9/9/pubmed PY - 2018/5/23/medline SP - e1969 EP - e1975 JF - Military medicine JO - Mil Med VL - 182 IS - 9 N2 - : Well-adapted motor actions require intact and well-integrated information from all of the sensory systems, specifically the visual, vestibular, and somatosensory systems, including proprioception. Proprioception is involved in the sensorimotor control by providing the central nervous system with an updated body schema of the biomechanical and spatial properties of the body parts. With regard to the cervical spine, proprioceptive information from joint and muscle mechanoreceptors is integrated with vestibular and visual feedback to control head position, head orientation, and whole body posture. Postural control is highly complex and proprioception from joints is an important contributor to the system. Altitude has been used as a paradigm to study the mechanisms of postural control. Determining the mechanisms of postural control that are affected by moderate altitude is important as unpressurized aircrafts routinely operate at altitudes where hypoxia may be a concern. Deficits in motor performance arise when the reliance on proprioceptive feedback is abolished either experimentally or because of a disorder. As pilots require good neck motor control to counteract the weight of their head gear and proprioceptive information plays an important role in this process, the aim of this study was to determine if hypoxia at moderate altitudes would impair proprioception measured by joint position sense of the cervical spine in healthy subjects. METHODS: Thirty-six healthy subjects (Neck Disability Index < 5) volunteered to participate. Neck position sense was evaluated using a three-dimensional motion analyzer. To create the environment, a hypobaric chamber was used to simulate artificial moderate altitude. Head repositioning error was measured by asking the subject to perform a head-to-neutral task after submaximal flexion-extension and right/left rotation movements, and a head-to-target task, in which the subjects had to return to a 30° right and left rotation position. FINDINGS: Exposure to artificial acute moderate altitude of 7,000 feet had no significant effects on cervical joint position sense measured by head repositioning accuracy in healthy subjects. Discussion/impact/recommendations: Postural control mechanisms are very sensitive to acute mild hypoxia and have been recently investigated. Acute hypobaric hypoxia at moderate and high altitudes has a negative effect on postural control. However, which part of the postural system is affected has not yet been determined and proprioception has been little investigated. The results from this study highlighted that in healthy subjects with good cervical spine proprioception at baseline, artificial hypoxia induced by the simulation of moderate altitude does not increase head repositioning error. Further studies should investigate cervical joint position sense in real aircraft, at different altitudes and in a group of experienced helicopter pilots, to evaluate the impact of moderate altitude on cervical joint position sense in a different population. Conducting the same experiments in a population of pilots and in real flight conditions should be considered, since various factors such as the level of proprioception, head posture, type of movement, head load, muscle fatigue, flight altitude, and the length of flight time might influence the kinesthetic sensitivity. SN - 1930-613X UR - https://www.unboundmedicine.com/medline/citation/28885964/Cervical_Joint_Position_Sense_in_Hypobaric_Conditions:_A_Randomized_Double_Blind_Controlled_Trial_ DB - PRIME DP - Unbound Medicine ER -