학술논문
Linking Pain and Motor Control: Conceptualization of Movement Deficits in Patients With Painful Conditions.
Document Type
Academic Journal
Author
Kantak SS; Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA.; Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA.; Johnson T; Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA.; Zarzycki R; Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA.
Source
Publisher: Oxford University Press Country of Publication: United States NLM ID: 0022623 Publication Model: Print Cited Medium: Internet ISSN: 1538-6724 (Electronic) Linking ISSN: 00319023 NLM ISO Abbreviation: Phys Ther Subsets: MEDLINE
Subject
Language
English
Abstract
When people experience or expect pain, they move differently. Pain-altered movement strategies, collectively described here as pain-related movement dysfunction (PRMD), may persist well after pain resolves and, ultimately, may result in altered kinematics and kinetics, future reinjury, and disability. Although PRMD may manifest as abnormal movements that are often evident in clinical assessment, the underlying mechanisms are complex, engaging sensory-perceptual, cognitive, psychological, and motor processes. Motor control theories provide a conceptual framework to determine, assess, and target processes that contribute to normal and abnormal movement and thus are important for physical therapy and rehabilitation practice. Contemporary understanding of motor control has evolved from reflex-based understanding to a more complex task-dependent interaction between cognitive and motor systems, each with distinct neuroanatomic substrates. Though experts have recognized the importance of motor control in the management of painful conditions, there is no comprehensive framework that explicates the processes engaged in the control of goal-directed actions, particularly in the presence of pain. This Perspective outlines sensory-perceptual, cognitive, psychological, and motor processes in the contemporary model of motor control, describing the neural substrates underlying each process and highlighting how pain and anticipation of pain influence motor control processes and consequently contribute to PRMD. Finally, potential lines of future inquiry-grounded in the contemporary model of motor control-are outlined to advance understanding and improve the assessment and treatment of PRMD.
Impact: This Perspective proposes that approaching PRMD from a contemporary motor control perspective will uncover key mechanisms, identify treatment targets, inform assessments, and innovate treatments across sensory-perceptual, cognitive, and motor domains, all of which have the potential to improve movement and functional outcomes in patients with painful conditions.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Impact: This Perspective proposes that approaching PRMD from a contemporary motor control perspective will uncover key mechanisms, identify treatment targets, inform assessments, and innovate treatments across sensory-perceptual, cognitive, and motor domains, all of which have the potential to improve movement and functional outcomes in patients with painful conditions.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)