Motor Learning in the Presence of Chronic Musculoskeletal Pain
[Thesis]
Brown, Michael R.
Langan, Jeanne
State University of New York at Buffalo
2020
186
Ph.D.
State University of New York at Buffalo
2020
In response to the growing chronic pain epidemic, a greater emphasis has been placed on finding conservative interventions to manage patients with chronic musculoskeletal pain. More recently, exercise strategies using motor learning principles are increasingly being promoted by rehabilitation specialists like physical therapists to improve movement impairments in patients with chronic musculoskeletal pain. However, our understanding of the process of motor learning in the presence of chronic musculoskeletal pain is underdeveloped. Few studies suggest individuals with chronic musculoskeletal pain may present with an impaired ability to motor learn, which could negatively impact the effectiveness of the prescribed exercise. This study takes a comprehensive look at explicit and implicit motor learning, as well as, cognitive and sensorimotor characteristics of the participants to better understand motor learning abilities in a population with a chronic neck pain. Using a cross-sectional study design, we aimed to investigate whether participants with chronic neck pain (n = 17), present with impaired explicit or implicit motor learning compared to age matched controls without a history of chronic neck pain (n = 21). During a single session, participants in both groups performed a repetitive upper limb reaching task, reaching outward to a circle of peripheral targets and inward towards a central target. The repetitive task was broken up into three conditions: an explicit condition where participants received instructions about the order of targets, an implicit condition with targets appearing in a sequential order but instructions about the order of targets was withheld, and a pseudo-random condition where participants could not anticipate the next location of a target. A 30-minute delay was also included to examine short-term retention of the sequence of targets acquired during the implicit motor learning condition. Additionally, participants completed demographic questionnaires, cognitive assessments (attention, working memory, and verbal working memory), and clinical examination measures (range of motion, left/right discrimination, touch localization, and pressure pain threshold) in an effort to better describe the participants with chronic neck pain. Results from the analysis indicated that there was no difference in cognitive function or physical measures for participants with chronic neck pain compared to the control group. As for the primary aim of the study, results indicated that participants with CNP explicitly and implicitly motor learned the repetitive upper limb reaching task similar to the control group. Following a 30-minute delay, both groups retained the ability to perform the upper limb reaching task. Findings from this study may have the potential to inform how rehabilitation specialists develop and prescribe interventions to improve motor skills in patients with chronic musculoskeletal pain.