Exercise Program Based on Motor Learning and Forward Head Posture Correction

January 8, 2019 updated by: Eleni Kapreli

The Efficacy of Exercise Program Based on Motor Learning Principles in Correction of Forward Head Posture

The aim of this study is to investigate the efficiency of an exercise program based on principles of motor learning in correction of Forward Head Position (FHP) in asymptomatic patients.

Study Overview

Detailed Description

Epidemiological studies have shown that bad posture and poor body control occurs at puberty, with forward head posture (FHP) and rounded shoulders being the most common biomechanical deviations in sagittal plane. The FHP is defined as an anterior displacement of the head with hyperextension of the cervical spine and this is associated with a reduction in the length of the upper portion of the trapezius, posterior portion of the cervical extensor muscles, the sternocleidomastoid and the levator scapulae. FHP can be evaluated by measuring craniovertebral angle (CVA) which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7.

CVA, smaller than 50 degrees, constitute a criterion of abnormal posture of cervical spine, suggesting FHP. People with FHP present incomplete balance control, thereby affecting the position of the center of gravity and motor control of the body. The establishment of altered motor control strategies could lead to balance disorders, neck muscle imbalances, chronic neck pain and even respiratory dysfunction.

Despite the efforts of researchers to create effective treatment programs based on strength training and stretching exercises, positive long-term results have been a problem in FHP correction. For this reason, re-education of posture and body alignment, through exercise programs based on motor learning, with cognitive elements (attention, motivation, feedback, reasoning), could be proved a more effective therapeutic strategy.

Study Type

Interventional

Enrollment (Actual)

52

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years to 24 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Students at Technological Educational Institute of Sterea Ellada,
  • Aged 18-26 years old
  • Males and females
  • Craniocervical angle < 50 degrees (statical Forward Head Posture in standing position)

Exclusion Criteria:

  • Injury or surgery in cervical spine
  • Accompanying neurologic, musculoskeletal or mental problems
  • Any medical administration
  • Intense continuous or intermittent neck pain
  • BMI >25
  • Participation in any rehabilitation or physiotherapy sessions considering neck dysfunction the last 6 months
  • Change in physical activities during the research period of 6 weeks

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control
The control group will not participate in any exercise program. However, at the end, home based exercises and special advice will be given to the participants.
Experimental: Intervention
The intervention group will participate in an exercise program based on motor learning principles for 4 weeks/3 sessions per week, for a total of 12 sessions of 30-45 minutes each.
The exercise program will include simple activities exposing volunteers in various environmental conditions with a view to adjust their head posture in such conditions. The progressiveness of exercises will be based on the two-dimensional classification system of Gentile (1987). Furthermore, external attentional focus will be used.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Static Forward Head Posture (sFHP)
Time Frame: Change from Baseline sFHP at 4 weeks and Change from Baseline sFHP at 6 weeks
The sFHP will be assessed by calculating the craniovertebral angle through lateral photographs in standing. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle on the photographs will be carried out using AutoCAD software. A performance curve will be developed using the measurements during the 4 weeks practice and 2 weeks after the end of protocol (retension test).
Change from Baseline sFHP at 4 weeks and Change from Baseline sFHP at 6 weeks
Change of Dynamic Forward Head Posture (dFHP)
Time Frame: Change from Baseline dFHP t at 4 weeks and Change from Baseline dFHP at 6 weeks
The dFHP will be assessed by calculating the craniovertebral angle through video motion during walking. The craniovertebral angle is the angle between the line extending from the tragus of the ear to the 7th cervical vertebra (C7) spinous process and the horizontal line through C7. The calculation of the angle The calculation of the angle will be carried out using Kinovea and AutoCAD softwares. dFHP will be regarded as a transfer test. Transfer tests are tests involving some novel situation, so that people must adapt the skill they have been practicing to the characteristics of this new situation.
Change from Baseline dFHP t at 4 weeks and Change from Baseline dFHP at 6 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall self-esteem
Time Frame: Baseline; week 4; week 6
Sorensen self-esteem test will be used which has been translated into Greek and has been tested for its reliability and validity.
Baseline; week 4; week 6
Mood
Time Frame: Baseline; week 4; week 6
A ten point Visual Analogue Scale (VAS) will be used
Baseline; week 4; week 6
Overall physical fatigue
Time Frame: Baseline; week 4; week 6
A ten point VAS scale will be used
Baseline; week 4; week 6
Overall mental fatigue
Time Frame: Baseline; week 4; week 6
A ten point VAS scale will be used
Baseline; week 4; week 6
Attention-concentration
Time Frame: Baseline; week 4; week 6
Attention- concentration questionnaire will be used. It has been developed in Greek language and has been tested for its reliability and validity.
Baseline; week 4; week 6
Verbal Comprehension index
Time Frame: Baseline
The Wechsler Adult Intelligence Scale (WAIS-IV) (similarities) will be used. Participants will be given a number of pairs of words or concepts and have to describe how they are similar.
Baseline
Perceptual Organization Index
Time Frame: Baseline
The WAIS-IV (Matrix Reasoning) will be used. Participants will be given pictures of sets of drawings and have to choose the correct drawing that is missing from each set.
Baseline
Change in Deep neck flexors endurance
Time Frame: Change from Baseline Deep neck flexors endurance at 4 weeks and Change from Baseline Deep neck flexors endurance at 6 weeks
The first stage of the test allows for the quantification of the performance of craniocervical flexion action, while the second stage examines the isometric endurance of deep neck flexors, during which the participant adopts the crook lying position. The air chamber of a pressure biofeedback device is positioned under the cervical area and the participant is asked to perform a head nod action at five different pressure levels (22, 24, 26, 28 and 30 mmHg). The test is initially performed at a pressure level of 22 mmHg and proceeds to the next pressure level if the participant is able to maintain in the position for 10 seconds on three separate occasions. The Chattanooga stabilizer pressure biofeedback will be used.
Change from Baseline Deep neck flexors endurance at 4 weeks and Change from Baseline Deep neck flexors endurance at 6 weeks
Change in Discomfort
Time Frame: Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
The Discomfort will be assessed using a ten point grade VAS scale, where 0 is no pain and 10 worst pain.
Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
Change in Area of Discomfort
Time Frame: Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
The Discomfort (Head, Neck, Shoulders and upper arms, Middle back, Lower back, Forearms and Wrists/hands areas) will be assessed using a body chart
Change from Baseline discomfort at 4 weeks and Change from Baseline discomfort at 6 weeks
Weight
Time Frame: Baseline
Measurement of weight with scale (kilograms)
Baseline
Height
Time Frame: Baseline
Measurement of height (cm)
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Investigators

  • Study Chair: Eleni V Kapreli, MSc, PhD, Technological Educational Institute of Sterea Ellada
  • Principal Investigator: Stefani Argyrou, BSc, Technological Educational Institute of Sterea Ellada

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2017

Primary Completion (Actual)

May 1, 2017

Study Completion (Actual)

December 30, 2017

Study Registration Dates

First Submitted

December 3, 2016

First Submitted That Met QC Criteria

December 29, 2016

First Posted (Estimate)

December 30, 2016

Study Record Updates

Last Update Posted (Actual)

January 9, 2019

Last Update Submitted That Met QC Criteria

January 8, 2019

Last Verified

January 1, 2019

More Information

Terms related to this study

Other Study ID Numbers

  • PHYSMSC1

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Undecided

IPD Plan Description

Individual Participant Data (IPD) are to be shared with other researchers, when it will be available

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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