Altered visuomotor integration in complex regional pain syndrome

Bultitude, Janet; Petrini, Karin

doi:10.1016/j.bbr.2020.112922

Cited by 7 publications

(15 citation statements)

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“…(Brun et al, 2018a;Brun et al, 2020). In a study involving CRPS and HC participants, both groups performed similarly in a target location task, despite differences in sensorimotor integration for the CRPS participants compared to HC (Bultitude and Petrini, 2021). Moreover, a recent study involving visuomotor conflicts in FM vs. HC demonstrated that while people with FM are more perceptually sensitive to visuomotor conflicts (i.e.…”

Section: Discussionmentioning

confidence: 99%

Virtual Reality in Fibromyalgia: Does Altering Visual Feedback Impact on Pain and Movement During Reaching?

Dagenais

Brun

Ohayon

et al. 2021

Front. Virtual Real.

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People with fibromyalgia (FM) have movement-related fear impacting on daily activities. While virtual reality has been used as a distractor to promote exercise, it can be used to manipulate visual feedback (VF) about movement, potentially influencing pain and movement. Objectives: A. To determine whether altered VF modulates pain during movement; B. To compare adaptation to an altered VF between FM participants and healthy controls (HC); C. To explore relationships between adaptation, limb position sense, kinesiophobia and pain. 20 FM participants and 20 HC performed a reaching task during two sessions in a KINARM exoskeleton including a virtual reality interface allowing to replace their arm with a virtual arm. In one session, VF was altered to show GREATER movements while in the other it showed SMALLER movements (randomized order). Pain was assessed periodically using a numerical rating scale. Movement amplitude was assessed during exposure to altered VF (adaptation) and pre-/post-exposure (without VF; after-effects). Limb position sense was assessed with a KINARM task, and kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-11). Pain intensity increased slightly with movement repetitions (p < 0.001), but did not differ between the VF conditions (GREATER vs. SMALLER). Both groups exhibited visuomotor adaptation, as shown by VF-dependent changes in movement amplitude and speed during exposure to altered VF, and by the presence of VF-dependent after-effects (p < 0.001 for all variables). However, no differences were observed across groups for any of these variables, despite the fact that FM had significantly more difficulty to correctly detect VF conditions than HC (p = 0.046). No clear limb position sense deficits were observed in FM participants, and no significant relationships were found between TSK-11 scores and changes in pain intensity during exposure to altered VF. Altering VF did not influence pain during a reaching task in the FM group. Surprisingly, both groups adapted similarly to altered VF. Visuomotor adaptation is therefore preserved in FM, despite impairments in sensory perception and the poor ability to detect VF alterations in the present study. Further research is warranted to clarify the relationship between sensory perceptions and motor control in FM.

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Section: Discussionmentioning

confidence: 99%

Virtual Reality in Fibromyalgia: Does Altering Visual Feedback Impact on Pain and Movement During Reaching?

Dagenais

Brun

Ohayon

et al. 2021

Front. Virtual Real.

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“…Interestingly, this increase in errors was not explained by isolated deficits in visual or proprioceptive processing, but rather by a difficulty to integrate both sources of information during movement (Verfaille et al, 2020). However, Bultitude and Petrini found that people with CRPS can optimally integrate visual and self-motion cues under some conditions, but use different strategies to controls (Bultitude and Petrini, 2021). Overall, it appears that sensory perturbations arising from sensorimotor integration problems in CRPS do not necessarily result in deficits in motor performance, a result that was also found in fibromyalgia (Brun et al, 2020) and in healthy individuals with experimental pain (Brun et al, 2017), potentially due to adaptations in motor strategies employed.…”

Section: Discussionmentioning

confidence: 94%

“…The uncertainty of results for deficits in sensorimotor integration in CRPS is well summarized in Bultitude and Petrini's study (Bultitude and Petrini, 2021). As noted by the authors, while alteration in body perception (Förderreuther et al, 2004;Lewis et al, 2007;Lewis and Schweinhardt, 2012) and motor performance (Maihöfner et al, 2003;Bank et al, 2014) are frequently observed in this population, some studies have failed to demonstrate deficits in sensorimotor integration (Turton et al, 2007;Reinersmann et al, 2013;Wang et al, 2019).…”

Section: Discussionmentioning

confidence: 94%

“…In addition to these sensory perturbations, altered gait biomechanics (stance and swing) was observed during these alterations of auditory feedback, but this effect appeared to be similar for CRPS and healthy individuals (Tajadura-Jiménez et al, 2015;Tajadura-Jiménez et al, 2017). Two other studies investigated sensorimotor integration during active movements with measures of motor performance in CRPS participants compared to controls (Verfaille et al, 2020;Bultitude and Petrini, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…However, these studies did not require active movements from the participants, which is a strong limitation to study sensorimotor integration. A very few studies have investigated sensorimotor integration during active movements in CRPS and focus either on sensory perception (Brun et al, 2018b;Brun et al, 2018c), motor performance (Verfaille et al, 2020;Bultitude and Petrini, 2021) or both (Tajadura-Jiménez et al, 2017). Results of these studies have consistently shown alterations in perception, while alterations in motor performance are inconsistent across studies.…”

Section: Discussionmentioning

confidence: 99%

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Virtual Reality-Induced Sensorimotor Conflict Evokes Limb-Specific Sensory Disturbances in Complex Regional Pain Syndrome

Brun

Pinard

McCabe

et al. 2021

Front. Virtual Real.

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The origin of sensory disturbances in complex regional pain syndrome (CRPS) remains unclear. It has been hypothesized that such disturbances are due to attentional effects and/or sensorimotor integration deficits. If sensory disturbances are explained by sensorimotor integration deficits, they would be expected to be specific in terms of the category of sensation evoked and in terms of localization. Objective 1: To test whether sensory disturbances evoked by a unilateral sensorimotor conflict are specific to the painful limb and differ according to the category of sensory disturbances in individuals with a unilateral CRPS compared to healthy controls (HC). Objective 2: To assess the association between clinical characteristics and conflict-induced sensory disturbances. Objective 3: To assess conflict-induced motor disturbances. Ten adults with upper limb (UL) CRPS and 23 HC were recruited. Sensorimotor conflict was elicited with a KINARM exoskeleton interfaced with a 2D virtual environment allowing the projection of a virtual UL that was moving in either a congruent or incongruent manner relative to the actual UL movement. Participants rated sensory disturbances from 0 (no change) to 3 (high change) on a 8-item questionnaire. Items were classified into two Categories (Category 1: pain, discomfort, the feeling of losing a limb, change in weight and temperature; Category 2: feelings of peculiarity, the impression of gaining a limb and losing control). Motor disturbances were quantified as mediolateral drift and changes in amplitude of UL movement. Clinical characteristics included the intensity and duration of pain, proprioception, and body perception. CRPS participants report higher Category 1 than Category 2 disturbances for the Affected limb (while the reverse was observed for HC and for the Unaffected limb). In addition, no difference was observed between the Unaffected limb in CRPS and the Dominant limb in HC for Category 2 disturbances, while higher conflict sensitivity was observed for Category 1 disturbances. Conflict sensitivity was only related to higher pain for Category 1 disturbances in the Affected limb. Finally, no effect on motor disturbances was observed. While they do not completely rule out the attentional hypothesis, these results support the hypothesis of sensorimotor integration deficits.

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