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Lövgren, A., Österlund, C., Lampa, E., Ilgunas, A. & Hellström, F. (2018). A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students. Acta Odontologica Scandinavica
Open this publication in new window or tab >>A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students
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2018 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850Article in journal (Other academic) Epub ahead of print
Abstract [en]

Objective: Dental students have been identified as a group with high risks of developing both temporomandibular disorders (TMD) and psychosocial conditions. Our primary aim was to evaluate the cross-sectional prevalence of TMD diagnoses, as defined in the Diagnostic Criteria (DC)/TMD, among dental students. The secondary aim was to evaluate the prevalence and association of behavioural and psychosocial factors in relation to DC/TMD diagnoses.

Materials and methods: The study was conducted among undergraduate dental students during the second semester of their third year at the Department of Odontology, Medical Faculty, Umeå University, Sweden. Three consecutive cohorts were recruited during August in 2013, 2014, 2015. In total, 54 students were included and examined according the DC/TMD procedure.

Results and conclusions: The prevalence of any DC/TMD diagnosis was 30%. The most prevalent TMD diagnosis was myalgia. Individuals with a TMD-pain diagnosis (i.e. myalgia or arthralgia) reported significantly higher pain intensity levels according to the Graded Chronic Pain Scale (GCPS) as compared to individuals without TMD-pain (Fisher’s exact test p < .001, two-sided). In addition, individuals with any TMD scored significantly higher jaw functional limitations according to the Jaw Functional Limitation Scale 20 (JFLS-20, p < .001) and oral parafunctions according to the Oral Behavior Checklist (OBC, p = .005) as compared to individuals without TMD. The psychosocial factors evaluated did not differ between individual with or without a TMD diagnosis. The majority of the dental students reported symptoms that are already identified as risk factors for developing TMD and pain conditions. However, longitudinal data are needed to evaluate how this evolves over time.

Keyword
Temporomandibular disorders, diagnostic criteria for temporomandibular disorders, psychosocial assessment, dental students
National Category
Dentistry
Identifiers
urn:nbn:se:hig:diva-25619 (URN)10.1080/00016357.2018.1440322 (DOI)29457522 (PubMedID)
Available from: 2017-11-28 Created: 2017-11-28 Last updated: 2018-04-03Bibliographically approved
Gold, J., Hallman, D., Hellström, F., Björklund, M., Crenshaw, A. G., Mathiassen, S. E., . . . Ali, S. (2017). Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders. BMC Musculoskeletal Disorders, 18, Article ID 395.
Open this publication in new window or tab >>Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders
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2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 395Article, review/survey (Refereed) Published
Abstract [en]

Background

This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs?

Methods

PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies.

Results

Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity.

Conclusions

Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided.

Keyword
MRI, MSD, near-infrared spectroscopy, overuse, pain, PET/CT, thermography
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-20784 (URN)10.1186/s12891-017-1694-y (DOI)000410323900001 ()10.1186/s12891-017-1694-y (PubMedID)2-s2.0-85029322406 (Scopus ID)
Projects
ImagingBiorev
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1761NIH (National Institute of Health), AR056019
Available from: 2015-12-04 Created: 2015-12-04 Last updated: 2018-03-13Bibliographically approved
Hellström, F., Gouveia-Figueira, S., Nording, M., Björklund, M. & Fowler, C. J. (2016). Association between plasma concentrations of linoleic acid-derived oxylipins and the perceived pain scores in an exploratory study in women with chronic neck pain. BMC Musculoskeletal Disorders, 17(1), Article ID 103.
Open this publication in new window or tab >>Association between plasma concentrations of linoleic acid-derived oxylipins and the perceived pain scores in an exploratory study in women with chronic neck pain
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2016 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 1, article id 103Article in journal (Refereed) Published
Abstract [en]

Background: Chronic musculoskeletal pain may be associated with changes in the balance of algogenic and anti-nociceptive compounds, and that such changes may be visible in plasma samples. We have undertaken an exploratory study to measure the levels of endocannabinoids, related N-acylethanolamines and oxylipins (primarily those derived from linoleic acid) in plasma samples from women with chronic neck pain (NP) and chronic widespread pain (CWP), and to investigate whether the observed levels are associated with the pain experienced by these women.

Methods: Blood samples from 35 women with NP, 15 with CWP and 27 age-matched controls were analysed for the lipids using an ultra performance liquid chromatography coupled to tandem mass spectrometry method. Current pain ("NRSday") and the average pain during the last week ("NRSweek") were rated by the participants using a numerical rating scale.

Results: There were no significant differences in the plasma concentrations of the fifteen lipids investigated between the pain subjects and the controls. However, significant correlations were seen for the NP group between the NRSday scores and the plasma concentrations of the linoleic acid derivatives 9- and 13- hydroxy-10E,12Zoctadecadienoic acid (Spearman's rho values 0.51 [P=0.0016]) and 0.53 [P=0.0011], respectively).

Conclusions: The data obtained in this exploratory study are consistent with a model whereby the underlying inflammatory nature of the musculoskeletal disorders leads both to an increase in the NRSday scores and the hydroxy-10E,12Z-octadecadienoic acid levels, and these increases further influence the perceived pain of in the NP subjects.

Keyword
musculoskeletal disorders, chronic neck pain, chronic widespread pain, endocannabinoids, N-acylethanolamines oxylipins, 9-hydroxy-10E, 12Z-octadecadienoic acid, 13-hydroxy-9Z, 11E-octadecadienoic acid
National Category
Other Medical Biotechnology
Identifiers
urn:nbn:se:hig:diva-20434 (URN)10.1186/s12891-016-0951-9 (DOI)000370919700001 ()26916287 (PubMedID)2-s2.0-84975778633 (Scopus ID)
Funder
AFA Insurance, 090288Swedish Research Council, 12158Swedish Research Council Formas
Available from: 2015-10-16 Created: 2015-10-16 Last updated: 2018-03-13Bibliographically approved
Gold, J., Hallman, D., Hellström, F., Björklund, M., Mathiassen, S. E., Piligian, G. & Barbe, M. F. (2016). Biochemical biomarkers for MSDs: systematic review results. In: : . Paper presented at Ninth International Conference on the Prevention of Work-Related Musculoskeletal Disorders (PREMUS), June 20-23, 2016, Toronto, Canada.
Open this publication in new window or tab >>Biochemical biomarkers for MSDs: systematic review results
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2016 (English)Conference paper, Published paper (Refereed)
Abstract [en]

Background. Although the potential for musculoskeletal disorder (MSD) biomarkers to detect subclinical disease and monitor MSD severity was discussed more than 20 years ago, only one review on biochemical biomarkers exclusive to humans has been published (Saxton 2000). The aim of this study was to systematically summarize biochemical biomarker research in neck and upper extremity MSDs that could appear in a work-related context. Two research questions guided the review: (1) Are there biochemical markers associated with neck and upper extremity MSDs? (2) Are there biochemical markers associated with the severity of neck and upper extremity MSDs?

Methods: A literature search was conducted in PubMed and SCOPUS. 87 studies met primary inclusion criteria. Following a quality screen, data were extracted from 44 sufficient-quality articles.

Results. Most of the 87 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. A response rate was explicitly stated in only 11 (13%) studies. Less than half of the studies controlled for potential confounding through restriction or in the analysis. Most sufficient-quality studies were conducted in older populations (mean age in one or more analysis group > 50 yrs). In sufficient-quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. Evidence suggested that: (a) the collagen repair marker TIMP-1 is decreased in fibroproliferative disorders, (b) 5-HT (serotonin) is increased in trapezius myalgia, and (c) triglycerides are increased in a variety of MSDs. Only five studies showed an association between a biochemical marker and MSD severity.

Discussion. While some MSD biomarkers were identified, limitations in the articles examined included possible selection bias, confounding, spectrum effect (potentially heterogeneous biomarker associations in populations according to symptom severity or duration) and insufficient attention to co-morbid conditions. A list of recommendations for future studies is provided.

National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-21912 (URN)
Conference
Ninth International Conference on the Prevention of Work-Related Musculoskeletal Disorders (PREMUS), June 20-23, 2016, Toronto, Canada
Available from: 2016-06-23 Created: 2016-06-23 Last updated: 2018-03-13Bibliographically approved
Wiesinger, B., Häggman-Henrikson, B., Hellström, F., Englund, E. & Wänman, A. (2016). Does induced masseter muscle pain affect integrated jaw-neck movements similarly in men and women?. European Journal of Oral Sciences, 124(6), 546-553
Open this publication in new window or tab >>Does induced masseter muscle pain affect integrated jaw-neck movements similarly in men and women?
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2016 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 124, no 6, p. 546-553Article in journal (Refereed) Published
Abstract [en]

Normal jaw opening-closing involves simultaneous jaw and head-neck movements. We previously showed that, in men, integrated jaw-neck movements during jaw function are altered by induced masseter muscle pain. The aim of this study was to investigate possible sex-related differences in integrated jaw-neck movements following experimental masseter muscle pain. We evaluated head-neck and jaw movements in 22 healthy women and 16 healthy men in a jaw opening-closing task. The participants performed one control trial and one trial with masseter muscle pain induced by injection of hypertonic saline. Jaw and head movements were registered using a three-dimensional optoelectronic recording system. There were no significant sex-related differences in jaw and head movement amplitudes. Head movement amplitudes were significantly greater in the pain trials for both men and women. The proportional involvement of the neck motor system during jaw movements increased in pain trials for 13 of 16 men and for 18 of 22 women. Thus, acute pain may alter integrated jaw-neck movements, although, given the similarities between men and women, this interaction between acute pain and motor behaviour does not explain sex differences in musculoskeletal pain in the jaw and neck regions.

Keyword
head movements; jaw; masseter muscle; neck; pain
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-22724 (URN)10.1111/eos.12315 (DOI)000387755000005 ()27781338 (PubMedID)2-s2.0-84995482173 (Scopus ID)
Note

Funding agencies: Department of Research and Development, Vasternorrland County Council; Swedish Dental Society; Sigurd and Elsa Golje Memorial Foundation 

Available from: 2016-11-10 Created: 2016-11-10 Last updated: 2018-03-13Bibliographically approved
Hadrévi, J., Turkina, M., Carlsson, A., Gerdle, B., Larsson, B., Hellström, F. & Ghafouri, B. (2016). Myosin light chain and calcium regulating protein differences in chronic musculoskeletal neck and shoulder pain. Journal of Integrated OMICS, 6(1), 1-8, Article ID 191.
Open this publication in new window or tab >>Myosin light chain and calcium regulating protein differences in chronic musculoskeletal neck and shoulder pain
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2016 (English)In: Journal of Integrated OMICS, ISSN 2182-0287, Vol. 6, no 1, p. 1-8, article id 191Article in journal (Refereed) Published
Abstract [en]

Proteomic screening analysis has detected myosin light chain (MLC) as a protein implied to be involved in chronic musculoskeletal neck and shoulder pain. Several analyses of MLC proteins have stated a difference in phosphorylation being the determining factor for protein activation hence altered contrability of the muscle in i.e. senescence. In continuation of a previous publication, this study is an attempt to analyze the different MLC isoforms by mass spectrometry and immune-analyses in myalgic and healthy trapezius muscle. In the present study no differences in phosphorylation level between the corresponding individual proteins were detected using LC-MSMS and immunoblotting; instead we assigned different isoforms of regulatory MLCs. To further elucidate the contrability: calcium (Ca2+) regulatory proteins, sarco(endo)plasmic reticulum Ca2+ ATPase 1 (SERCA-1) and calsequestrine (CSQ) were analyzed by western blot. The analysis revealed a significantly increased abundance of SERCA-1 protein in the myalgic muscle and a significantly increased abundance of CSQ in healthy muscle. Myalgic muscle contraction patterns have in previous studies shown to differ from healthy muscle which may be connected to the Ca2+ availability in the muscle. Here we present the proteomic characterization of differences in Ca2+ regulating proteins and particularly regulatory MLCs in trapezius muscle of women with chronic musculoskeletal neck and shoulder pain.

Keyword
calcium, mass spectrometry, phosphorylation, muscle pain, myosin light chain, trapezius
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-20858 (URN)10.5584/jiomics.v6i1.191 (DOI)2-s2.0-85020454420 (Scopus ID)
Available from: 2015-12-14 Created: 2015-12-14 Last updated: 2018-03-22Bibliographically approved
Borg, T., Björklund, M., Djupsjöbacka, M., Wänman, A. & Hellström, F. (2016). Perceived muscular tension in healthy subjects: a cross-sectional study. In: PREMUS2016: Book of abstracts. Paper presented at 9th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders, Toronto, June 20-23, 2016. (pp. 411-411).
Open this publication in new window or tab >>Perceived muscular tension in healthy subjects: a cross-sectional study
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2016 (English)In: PREMUS2016: Book of abstracts, 2016, p. 411-411Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background. Perceived muscular tension (PMT) has been suggested to predict development of neck/shoulder pain. It has been hypothesized to be an early sign of musculoskeletal disorder and a possible mediator of stress on symptoms. However, the content of the concept of PMT is not clear. This study examined the association between PMT and physical and psychosocial factors and physical activity in a group of healthy students.

Methods. This cross-sectional study was conducted on the baseline measurements of an ongoing longitudinal case-control study. A total of 63 healthy university students without complaints of neck/shoulder pain were included (21 males, 42 females, mean age 24 years). PMT was measured by asking the question “Have you, during the past month, experienced muscular tension (for example, wrinkled your forehead, ground your teeth, raised your shoulders)?” with the following response options: never, a few times, a few times per week, or one or several times per day. Self-reports on symptoms in the neck, anxiety, depression, stress, mental health, physical health, sleep and physical activity were collected with questionnaires, as well as by tenderness on palpation of neck muscles and trapezius pressure pain threshold. This produced a total of 15 variables. The relationship between these variables and PMT were analyzed using Spearman’s rank correlation coefficient.

Results. Positive correlations were found between PMT and temporomandibular complaints (rho= .34, p < .001), neck crepitus (rho= .33, p < .001), anxiety (rho= .33, p < .001), depression (rho= .31, p < .05), tenderness on palpation (rho= .25, p < .05). There was a negative correlation between PMT and mental health (rho= -.26, p < .05). Frequent experience of PMT had weak to moderate correlations with frequency of symptoms and higher psychosocial strain, but not with stress. This suggests some covariance between PMT and both physical and psychosocial factors.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hig:diva-22353 (URN)978-0-9699726-7-9 (ISBN)
Conference
9th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders, Toronto, June 20-23, 2016.
Available from: 2017-01-09 Created: 2016-09-06 Last updated: 2018-03-13Bibliographically approved
Gold, J. E., Hallman, D., Hellström, F., Björklund, M., Crenshaw, A. G., Djupsjöbacka, M., . . . Barbe, M. F. (2016). Systematic review of biochemical biomarkers for neck and upper-extremity musculoskeletal disorders. Scandinavian Journal of Work, Environment and Health, 42(2), 103-124
Open this publication in new window or tab >>Systematic review of biochemical biomarkers for neck and upper-extremity musculoskeletal disorders
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2016 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, no 2, p. 103-124Article, review/survey (Refereed) Published
Abstract [en]

Objective:  This study systematically summarizes biochemical biomarker research in non-traumatic musculoskeletal disorders (MSDs).  Two research questions guided the review:  1) Are there biochemical markers associated with neck and upper extremity MSDs? and, 2) Are there biochemical markers associated with the severity of neck and upper extremity MSDs? 

Methods:  A literature search was conducted in PubMed and SCOPUS.  Eighty-seven studies met primary inclusion criteria.  Following a quality screen, data were extracted from 44 sufficient quality articles.

Results:  Most of the 87 studies were cross-sectional and utilized convenience samples of patients as both cases and controls.  A response rate was explicitly stated in only 11 (13%) studies.  Less than half of the studies controlled for potential confounding through restriction or in the analysis.  Most sufficient quality studies were conducted in older populations (mean age in one or more analysis group > 50 yrs).

In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied.  Evidence suggested that: a) the collagen repair marker TIMP-1 is decreased in fibroproliferative disorders, b) 5-HT (serotonin) is increased in trapezius myalgia, and c) triglycerides are increased in a variety of MSDs.  Only five studies showed an association between a biochemical marker and MSD severity.

Conclusion: While some MSD biomarkers were identified, limitations in the articles examined included possible selection bias, confounding, spectrum effect (potentially heterogeneous biomarker associations in populations according to symptom severity or duration) and insufficient attention to co-morbid conditions. A list of recommendations for future studies is provided.

Keyword
collagen degradation and repair, inflammation, lipids, muscle injury, muscle metabolites, pain, serotonin, tendon injury, triglycerides
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-19271 (URN)10.5271/sjweh.3533 (DOI)000371449500002 ()26599377 (PubMedID)2-s2.0-84959483922 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1761
Available from: 2015-05-02 Created: 2015-05-02 Last updated: 2018-03-13Bibliographically approved
Hadrévi, J., Björklund, M., Kosek, E., Hällgren, S., Antti, H., Fahlström, M. & Hellström, F. (2015). Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls. Scientific Reports, 5, Article ID 15925.
Open this publication in new window or tab >>Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls
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2015 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, article id 15925Article in journal (Refereed) Published
Abstract [en]

Chronic musculoskeletal pain exists either as localised to a single region or as widespread to multiple sites in several quadrants of the body. Prospective studies indicate that widespread pain could act as a far end of a continuum of musculoskeletal pain that started with chronic localised pain. The mechanism by which the transition from localised pain to widespread occurs is not clear, although many studies suggest it to be an altered metabolism. In this study, systemic metabolic differences between women with chronic localised neck-shoulder pain (NP), women with chronic widespread pain (CWP) and women who were healthy (CON) were assessed. Blood samples were analysed taking a metabolomics approach using gas chromatography mass spectrometry (GC-MS) and orthogonal partial least square discriminant analysis (OPLS-DA). The metabolomics analysis showed a clear systematic difference in the metabolic profiles between the subjects with NP and the CON but only a weak systematic difference between the subjects with CWP and the CON. This most likely reflects a difference in the portion of the metabolome influenced by the two pain conditions. In the NP group, the overall metabolic profile suggests that processes related to energy utilisation and lipid metabolism could be central aspects of mechanisms maintaining disorder.

Keyword
Neck pain, Musculoskeletal pain, Chronic musculoskeletal pain, Chronic pain, Microdialysis
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-19016 (URN)10.1038/srep15925 (DOI)000363874800001 ()26522699 (PubMedID)2-s2.0-84946215069 (Scopus ID)
Funder
AFA Insurance, 090288Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1403Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1761Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-1259
Available from: 2015-02-16 Created: 2015-02-16 Last updated: 2018-03-13Bibliographically approved
Wiesinger, B., Häggman-Henriksson, B., Wänman, A., Lindqvist, M. & Hellström, F. (2014). Jaw-opening accuracy is not affected by masseter muscle vibration in healthy men. Experimental Brain Research, 232(11), 3501-3508
Open this publication in new window or tab >>Jaw-opening accuracy is not affected by masseter muscle vibration in healthy men
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2014 (English)In: Experimental Brain Research, ISSN 0014-4819, E-ISSN 1432-1106, Vol. 232, no 11, p. 3501-3508Article in journal (Refereed) Published
Abstract [en]

There is a functional integration between the jaw and neck regions with head extension–flexion movements during jaw-opening/closing tasks. We recently reported that trigeminal nociceptive input by injection of hypertonic saline into the masseter muscle altered this integrated jaw–neck function during jaw-opening/closing tasks. Thus, in jaw-opening to a predefined position, the head–neck component increased during pain. Previous studies have indicated that muscle spindle stimulation by vibration of the masseter muscle may influence jaw movement amplitudes, but the possible effect on the integrated jaw–neck function is unknown. The aim of this study was to investigate the effect of masseter muscle vibration on jaw–head movements during a continuous jaw-opening/closing task to a target position. Sixteen healthy men performed two trials without vibration (Control) and two trials with bilateral masseter muscle vibration (Vibration). Movements of the mandible and the head were registered with a wireless three-dimensional optoelectronic recording system. Differences in jaw-opening and head movement amplitudes between Control and Vibration, as well as achievement of the predefined jaw-opening target position, were analysed with Wilcoxon’s matched pairs test. No significant group effects from vibration were found for jaw or head movement amplitudes, or in the achievement of the target jaw-opening position. A covariation between the jaw and head movement amplitudes was observed. The results imply a high stability for the jaw motor system in a target jaw-opening task and that this task was achieved with the head–neck and jaw working as an integrated system.

Keyword
Integrated jaw–neck function, Masseter muscle vibration, Proprioception, Jaw-opening accuracy, Motor strategy
National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:hig:diva-16418 (URN)10.1007/s00221-014-4037-3 (DOI)000343916400012 ()25059909 (PubMedID)2-s2.0-84919875564 (Scopus ID)
Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2018-03-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4556-2846

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