KVT2 – 2014

Projektkatalog

Indhold ANVENDELSE AF SEISMOKARDIOGRAFI FOR DIAGNOSTICERING AF KORONARARTERIESYGDOM .. 3

UDVIKLING AF METODE TIL DIAGNOSTICERING AF PERIFER NEUROPATI ...................................... 4

LAUGHING AT PAIN ..................................................................................................................... 5

FORBEDRING AF TEKNOLOGIEN TIL GENOPTRÆNING AF GANG HOS APOPLEKSIPATIENTER ......... 6

NAKKESMERTER OG TRYKSENSITIVITET...................................................................................... 7

KAN ULTRALYDSSCANNING PÅVISE ÆNDRINGER I MUSKULÆR PERFUSION UNDER FORSKELLIGE FORHOLD ..................................................................................................................................... 9

THE ROLE OF TISSUE SENSITIVITY IN PREGNANCY RELATED LUMBOPELVIC PAIN ...................... 11

THE ROLE OF CONDITIONED PAIN MODULATION IN RECURRING PAIN SYNDROMES .................... 13

EXPERIENCE IS THE TEACHER OF ALL THINGS: DOES INTERLIMB COMMUNICATION LEARN? ...... 15

INTERLIMB COMMUNICATION DURING WALKING ....................................................................... 16

ANVENDELSE AF SEISMOKARDIOGRAFI FOR DIAGNOSTICERING AF KORONARARTERIESYGDOM Problemstilling: Koronararteriesygdom, som er forkalkninger i kranspulsårerne, er en af de største dødsårsager i den vestlige verden. På trods af et rigt udbud af ikke-invasive test så som CT, SPECT og arbejdes EKG mangles en billig og præcis diagnosticerings metode. Seismokardiografi (SCG) er blevet forslået som en metode til detektering af koronararteriesygdom. Seismokardiografi er en metode til at estimere hjertets bevægelser ved at måle lavfrekvente accelerationer på brystvæggen. Et typisk Seismokardiogram ses på figuren her under. Et Seismokardiogram indeholder flere referencepunkter som er relateret til forskellige fysiologiske events. Flere af disse ændrer sig i tillefælde af Koronararteriesygdom. Den specifikke fysiologi bag de forskellige events i Seismokardiogrammet er dog ikke velbeskrevet i litteraturen. Formålet med dette projekt er derfor at opnå større forståelse af Seismokardiogrammet ved at beskrive ændringer som forekommer i Seismokardiogrammet mens hjertet udsættes for en stress belasting.

Potentielt projekt indhold:

• Analyser problemstillinger omkring ikke-invasiv diagnostik af koronararteriesygdom. • Planlægge og udføre et studie som inkluderer en cykel stresstest samt optagelse af et

Seismokardiogram. • Dataanalyse:

o Filtrere Seismokardiogrammet ved hjælp af et digitalt filter. o Aflæse referencepunkterer fra Seismokardiogrammet o Beskriv ændringer i referencepunkterne som funktion af kardiologisk

belastning. Forslagsstillere: Samuel Schmidt, sschmidt@hst.aau.dk, C1-204

MC = mitral valve closure; IM = isovolumic movement; AO = aortic valve opening; IC = isotonic contraction; RE = rapid ventricular ejection; AC = aortic valve closure; MO = mitral valve opening; RF = rapid ventricular filling; AS = atrial systole; EMD = electromechanical delay.

I. Korzeniowska-Kubacka et. Al. Usefulness of Seismocardiography for the Diagnosis of Ischemia in Patients with Coronary Artery Annals of Noninvasive Electrocardiology Disease. Annals of Noninvasive Electrocardiology 2005

UDVIKLING AF METODE TIL DIAGNOSTICERING AF PERIFER NEUROPATI Baggrund Neuropatier manifesterer sig blandt andet i form af sensoriske forstyrrelser i periferien. Idag testes dette med en blanding af subjektive vurderinger fra patientens side fx oplevelsen af at ”have en handske på” eller ved kvantitative sensoriske stimulationer som fx varme smerte tærsklen. En potentiel mere specifik og sensitiv test er at bruge elektrisk stimulation af kutane sensoriske nerve fibre med overflade elektroder. Derfor arbejder vi på at undersøge, om elektrisk stimulation kan bruges til at detektere en perifer neuropati. Hvis det er tilfældet vil denne metode kunne bruges til elektrofysiologisk diagnosticering og som markør for effekten af behandling eller progression af neuropatien. Som model for neuropati bruges Lidokain. Topikal applikation af lidokain er godkendt som smertelindrende middel. Liodkain blokerer Natrium kanalerne i nociceptorerne. Da de underliggende metoder for lidokain er kendte er modellen god til at vurdere metodens evne til at beskrive neurale mekanismer. Formålet Formålet med projektet er at undersøge om elektrisk stimulation kan benyttes til at undersøge neuropatiske mekanismer. Dette gøres ved at sammenligne aktiveringstærskler til elektrisk stimulation før og efter anbringelsen med topikal lidokain. Perspektiv: Som studerende vil I lære at udføre neurofysiologiske tests og I vil lære at forstå komplicerede neurofysiologiske mekanismer og deres betydning for klinisk praksis. Yderligere vil I lære hvordan men RCT studier til effektstudier. Studenterprojektet er en del af et projekt i samarbejde med AMBU og Onkologisk afdeling på Aalborg Universitets Hospital. Som studerende skal I også forvente at skulle underskrive en hemmeligholdelses-aftale, da vi er ved at undersøge muligheder for et patent og kommercialisering på en metode der relaterer til projektet. Forslagsstiller: Carsten Dahl Mørch, cdahl@hst.aau.dk, A2-212

LAUGHING AT PAIN Background Pain is a major symptom in many medical conditions and often chronic pain leads to a life with anxiety and a low quality of life. Treatment of chronic pain primarily involves analgesics, anti-depressants, and anticonvulsants which is frequently followed by adverse effects. Non-pharmacological approaches to pain management involves physical therapy and cognitive behavioral therapy. In addition, cognitive techniques such as humor has also been identified as an active component of pain management. Laughter is a coping mechanism that promotes relaxation and healing by the release of endorphins which are natural stress and pain fighters. Aim & Solution The idea behind this project proposal is to develop a protocol using an experimental pain model to test the effects of laughter on pain perception. All tests should be performed on healthy controls where pain perception before, during and after treatment are measured. The treatment (laughter) can be e.g. a 15 minute video clip of a comedian or a cartoon. The effects of laughter/humor on pain perception can possibly be used as a therapeutic tool for many chronic pain conditions. Perspectives for the students The students will gain experience and knowledge of pain pathophysiology and pain mechanisms and the effects of cognition on pain perception. Further, the students will learn to design and perform a randomized controlled trial (RCT) as well as statistical methods to evaluate the results of the study. Forslagsstillere: Line Lindhardt Egsgaard, egsgaard@hst.aau.dk Vejledningen vil foregå på dansk References: 1. Christie W, Moore C (2005) The impact of humor on patients with cancer. Clin J Oncol Nurs 9(2):211–218 2. Weisenberg M, Tepper I, Schwarzwald J (1995) Humor as a cognitive technique for increasing pain tolerance. Pain 63(2):207–212 3. Cogan, R., Cogan, D., Waltz, W., & McCue, M. (1987) Effects of laughter and relaxation on discomfort thresholds. Journal of Behavioral Medicine, 10, 139–144

FORBEDRING AF TEKNOLOGIEN TIL GENOPTRÆNING AF GANG HOS APOPLEKSIPATIENTER Baggrund: I Danmark rammes årligt ca. 10.000 mennesker af apopleksi på grund af blodprop eller blødning i hjernen. Patienterne kan opleve betydelig motoriske funktionsnedsættelser grundet halvsidige lammelser. En apopleksipatients gang er typisk karakteriseret ved problemer med bøjning af hofteledet, når det berørte ben skal svinges fremad samt vanskeligheder med at løfte foden. En måde at støtte benløftet og den fremad svingende bevægelse under ganggenoptræning er at anvende elektriske stimulationer for at aktivere refleksfunktioner i rygmarven og dermed understøtte patienternes egne forsøg på at gennemføre gangbevægelsen. Denne form for terapi går under betegnelsen Funktionel Elektrisk Terapi (FET) og involvere at patienten forsøger at gå med støtte af én eller to fysioterapeuter mens elektriske stimulationer bruges på bestemte tidspunkter i gangcyklen til at udløse en afværgerefleks, der vil hjælpe at bøje hoften og løfte foden. Problemstilling: I et kliniske forsøg med apopleksipatienter i Brønderslev Neurorehabiliteringscenter har vi undersøgt effektiviteten af gangrehabilitering støttet af elektriske stimulationer der udløser refleksresponser (læs mere: Årets danske forskningsresultat). Resultaterne viser en hurtigere og bedre forbedring af gangfunktionen men det viser sig også at systemet var for ressourcekrævende da stimulationerne skulle udløses manuelt af en fysioterapeut. Alternativt kunne patienten udløse stimulationerne men der findes evidens i litteraturen om, at opmærksomheden kan hæmme refleksen, hvilke vil give en uønskede effekt.

Der skal undersøges hvorvidt refleksresponsen ændrer sig når den er udløst af selv forsøgspersonen vs. en forsker. Resultaterne har direkte relevans i forbindelse med udvikling af teknologier til genoptræning af gang hos apopleksipatienter.

Problemløsning:

Der skal undersøges hvordan man kan forbedre refleksstimulation teknikken i forhold til den metode der anvendes til at udløse refleksen. Der skal designes en protokol til afprøvning af metoder til udløsning af refleksen; protokollen skal anvende kvantitative metoder til evaluering af refleksresponset. Derefter skal der registreres data fra raske forsøgspersoner og endelige behandle dataene og præsentere resultaterne. Projektet indeholder derfor teoretiske og praktiske aspekter omkring udvikling/forbedring af en ny teknologi.

Forslagsstiller: Erika G. Spaich, espaich@hst.aau.dk, E1-213

NAKKESMERTER OG TRYKSENSITIVITET Baggrund Nakke smerter er et meget almindeligt problem. Op mod 54% oplever nakkesmerter indenfor en 6 måneders periode og en stor del af disse vil udvikle længerevarende symptomer (1, 2).

En anseelig del af disse gener er associeret med statiske stillinger. En gruppe der har været specielt undersøgt og som føler meget i klinisk praksis, er folk med kontorarbejde. Her har man har fundet, at folk med nakke smerter ofte har en ændret kropsholdning, hvilket menes at bidrage til smerterne(3). Man ved fra studier at folk med idiopatiske nakke smerter har ændret tryksensitivitet (pressure point threshold; PPT)(4, 5) men hvornår i forløbet disse ændringer opstår, er endnu uklart.

Formål/Metode Formålet med projektet er at undersøge om ændret krops/siddestilling under en standardiseret opgave (fx arm bevægelser, skrive på computer mm.) ændre PPT over relevante muskler. Før forsøgets start lave en litteratur søgning for at afdække området med nakkesmerte hos en given fokus gruppe samt der skal overvejes hvilke faktorer der har indvirkning på denne type af gener og efterfølgende laves et forsøg. De studerende skal være med til at lave forsøgs-protokol, -opstilling mm. Til selve forsøget rekrutteres raske personer uden nakke eller skulder gener (rekrutteres internt). Forsøget udføres og data analyseres. Projektet kan udvides med electromyografi (EMG) målinger af relevante muskler for at undersøge ændringer i muskelaktivitet under den standardiserede opgave. Inkluderingen af EMG i forsøget kræver dog at de studerende har kendskab til analyse af EMG signaler (F.eks i matlab) eller kan få hjælp til det andetsteds.

Perspektiv Den studerende vil få en baggrundsviden om et klinisk yderst relevant emne, få erfaring med at lave en protokol og sætte et forsøg op samt analysere og rapportere relevant data efterfølgende. Foreslagsstiller Steffan Christensen, stc@hst.aau.dk Referencer 1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2006;15(6):834-48.

2. Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain. 1998;77(1):1-13. Epub 1998/10/01.

3. Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Applied ergonomics. 2002;33(1):75-84. Epub 2002/02/08.

4. La Touche R, Fernández-de-las-Peñas C, Fernández-Carnero J, Díaz-Parreño S, Paris-Alemany A, Arendt-Nielsen L. Bilateral mechanical-pain sensitivity over the trigeminal region in patients with chronic mechanical neck pain. The Journal of Pain. 2010;11(3):256-63.

5. Scott D, Jull G, Sterling M. Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain. The Clinical journal of pain. 2005;21(2):175.

KAN ULTRALYDSSCANNING PÅVISE ÆNDRINGER I MUSKULÆR PERFUSION UNDER FORSKELLIGE FORHOLD Baggrund At kunne undersøge perfusion i en given muskel er af stor interesse for undersøgelse og diagnosticering af forskellige lidelser med muskuloskeletal påvirkning. Det er bl.a. vist i et tidligere studie at der er nedsat muskulær perfusion hos personer med fibromyalgi sammenlignet med raske kontrol personer, når dette vurderes umiddelbart efter arbejde (1). Denne ændrede perfusion menes at bidrage til muskulær iskæmi som igen menes at kunne være en bidragende faktor i en vedvarende smerte. På nuværende tidspunkt vurderes blodgennemstrømning i en muskel ved mikrodialyse (2), intramuskulær laser Doppler flowmetri (3), muskuloskeletal MR scanninger (mfMRI) (4), eller ultralydsscanning med kontraststof (1, 5). Desværre er disse teknikker invasive, meget dyre, sparsomt tilgængelig og med risiko for bivirkninger, hvorfor et billigere, let tilgængeligt, ikke invasivt og klinisk anvendeligt alternativ vil være at foretrække. Formål/Metode At anvende ultralydsscanning til måling af muskel perfusion uden brug af kontraststof er endnu ikke undersøgt tilstrækkeligt til at kunne vurdere om denne teknik reelt er brugbar. Det formodes at nyere scannere vil være i stand til at kunne detektere forskellen mellem hvile og arbejde, men hvor nuanceret dette ”billede” er, er endnu uvist. I indeværende projekt skal der først laves nogle overvejelser omkring faktorer der kan påvirke den intramuskulær blodgennemstrømning, hvordan dette kan måles, og dernæst skal en af målemetoderne undersøges eksempelvis som følgende: Forsøget er designet som et tværsnitsstudie hvor perfusion måles i en muskel (f.eks. m. tibialis anterior; TA) før, under og efter en dynamisk øvelse en dag og tilsvarende på en dag med eksperimentel muskelømhed (DOMS). Fra denne stilling måles Doppler aktivitet i musklen vha. en lineær ultralyds transducer, placeret på huden midt over TA. Scanneren indstilles med en pre-defineret indstilling og der optages en kort film til yderligere analyse. Perspektiv Den studerende vil få en baggrundsviden om et klinisk yderst relevant emne, få erfaring med at lave en protokol og sætte et forsøg op samt analysere og rapportere relevant data efterfølgende. Foreslagsstiller Steffan Christensen, stc@hst.aau.dk Referencer 1. Elvin A, Siosteen AK, Nilsson A, Kosek E. Decreased muscle blood flow in fibromyalgia patients during standardised muscle exercise: a contrast media enhanced colour Doppler study. European journal of pain (London, England). 2006;10(2):137-44. Epub 2005/11/29.

2. Sjogaard G, Rosendal L, Kristiansen J, Blangsted AK, Skotte J, Larsson B, et al. Muscle oxygenation and glycolysis in females with trapezius myalgia during stress and repetitive work using microdialysis and NIRS. European journal of applied physiology. 2010;108(4):657-69. Epub 2009/11/07.

3. Strom V, Roe C, Knardahl S. Work-induced pain, trapezius blood flux, and muscle activity in workers with chronic shoulder and neck pain. Pain. 2009;144(1-2):147-55. Epub 2009/05/05.

4. Cagnie B, Elliott JM, O'Leary S, D'Hooge R, Dickx N, Danneels LA. Muscle functional MRI as an imaging tool to evaluate muscle activity. The Journal of orthopaedic and sports physical therapy. 2011;41(11):896-903.

5. Sjoberg KA, Rattigan S, Hiscock N, Richter EA, Kiens B. A new method to study changes in microvascular blood volume in muscle and adipose tissue: real-time imaging in humans and rat. American journal of physiology Heart and circulatory physiology. 2011;301(2):H450-8. Epub 2011/05/31.

THE ROLE OF TISSUE SENSITIVITY IN PREGNANCY RELATED LUMBOPELVIC PAIN Background

Musculoskeletal pain is widely prevalent [1, 2] and is the most common cause of non-malignant pain in the general community [3]. It is estimated that between 72-84% of women develop pain in the lumbopelvic region during pregnancy [4-6], with the point prevalence estimated as between 16-20% [7-9]. Previous studies have not been able to identify one single dominant risk factor for developing lumbopelvic pain (LPP) in pregnancy, but a set of physical and psychosocial factors such as history of previous low back pain, trauma of the back or pelvis, multiparity, higher level of stress and low job satisfaction have been linked to the disorder [10]. It is interesting that giving birth once or more (multiparity) increases the risk of developing pain during pregnancy but the mechanisms behind this are currently not known. One potential explanation might be related to an increase in tissue sensitivity which is triggered by the powerful painful stimulus which is involved in the child birth. Further knowledge about the underlying mechanisms of this condition will undoubtedly benefit both the therapist and the person living in pain in terms of treatment and management options which to date are usually only guided towards management of symptoms. One way of assessing this is looking into the tissue sensitivity of structures in the lower back and pelvis of women who have previously given birth. The results from such a study might tell us whether giving birth to a child leads to an increase in tissue sensitivity making the woman more susceptible for developing pain in the area at a later stage.

Possible content of project

The students will gain a sound knowledge of lumbopelvic pain, in general and specific to a pregnant population, risk factors for the development of the symptoms, and they will be introduced to the up-to-date screening and diagnosis of pain in the area. The students will gain knowledge on how to set up a study relevant for this population and be familiarized with relevant statistical methods. The importance of psychometric aspects of the pain condition will be discussed and could also be included into the study design. Vejledningen vil foregå på dansk Project proposer

Thorvaldur Skuli Palsson, tsp@hst.aau.dk, E1-101a

References 1. Picavet, H.S.J. and J.M.W. Hazes, Prevalence of self reported musculoskeletal diseases is high. Annals of the Rheumatic Diseases, 2003. 62(7): p. 644-650.

2. Salaffi, F., R. De Angelis, and W. Grassi, Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clinical and Experimental Rheumatology, 2005. 23(6): p. 819-828.

3. Katz, W.A., Musculoskeletal pain and its socioeconomic implications. Clinical Rheumatology, 2002. 21 Suppl 1: p. S2-4.

4. Bastiaanssen, J., et al., Etiology and prognosis of pregnancy-related pelvic girdle pain; design of a longitudinal study. BMC Public Health, 2005. 5(1): p. 1.

5. Mogren, I.M. and A.I. Pohjanen, Low Back Pain and Pelvic Pain During Pregnancy: Prevalence and Risk Factors. Spine, 2005. 30(8): p. 983-991.

6. To, W.W.K. and M.W.N. Wong, Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. Acta Obstetricia et Gynecologica Scandinavica, 2003. 82(12): p. 1086-1091.

7. Albert, H.B., M. Godskesen, and J.G. Westergaard, Incidence of Four Syndromes of Pregnancy-Related Pelvic Joint Pain. Spine, 2002. 27(24): p. 2831-2834.

8. Larsen, E.C., et al., Symptom-giving pelvic girdle relaxation in pregnancy, I: Prevalence and risk factors. Acta Obstetricia et Gynecologica Scandinavica, 1999. 78(2): p. 105-110.

9. Ostgaard, H., G. Andersson, and K. Karlsson, Prevalence of back pain in pregnancy. Spine, 1991. 16(5): p. 549-552.

10. Albert, H.B., et al., Risk factors in developing pregnancy-related pelvic girdle pain. Acta Obstetricia et Gynecologica Scandinavica, 2006. 85(5): p. 539-544.

THE ROLE OF CONDITIONED PAIN MODULATION IN RECURRING PAIN SYNDROMES Background Musculoskeletal pain is widely prevalent [1, 2] and is the most common cause of non-malignant pain in the general community [3]. The balance in the inbuilt pain modulating mechanisms is today referred to as the conditioned pain modulation (CPM) and this mechanism allows us to reduce and modulate pain signals in the body. This is primarily controlled by supraspinal areas in the central nervous system (e.g. the cerebral cortex, thalamus and brain stem) modulating nociceptive and non-nociceptive input from the periphery. Conditioned pain modulation is in other words a reduction in pain sensitivity away from the original pain area. There is evidence that this mechanism is activated in experimental pain conditions involving healthy, asymptomatic individuals [4-8] and this phenomenon has been investigated extensively through the years in healthy people as well as people living with chronic pain (see van Wijk and Veldhuijzen for review [9]). The reason for acute pain to develop into a chronic condition is not known but it might be related to the lack of ability to dampen a normal, innocuous stimulus indicating a decreased efficiency of the CPM system. Peripheral sensitization and the spread of central sensitization are important components in the transition from acute to chronic pain [10] but any dysfunction in the descending pain modulating systems might play an important role in the spread of central sensitization and thereby contribute to the development of the symptoms seen in people suffering from chronic pain [10-12]. An interesting aspect in relation to recurring pain is to investigate the effectiveness of pain modulation in a sample of people with previous history of a tissue injury which has recovered. This might reveal a deficiency in the system which is normally used to dampen/eliminate innocuous non-damaging stimuli. Possible content of project The students will gain a sound knowledge on how to assess the effectiveness of pain modulation in humans, possibly by including a sample of people with previous history of tissue injury which has recovered. Furthermore, the students will acquire general knowledge on the pain modulating systems, how they are active in daily life and how they can be manipulated for therapeutic purposes. The students will receive guidance on how to set up a study relevant to test the activity of this mechanism and be familiarized with relevant statistical methods for data analysis. Vejledningen vil foregå på dansk Project proposer Thorvaldur Skuli Palsson, tsp@hst.aau.dk, E1-101a

References 1. Picavet, H.S.J. and J.M.W. Hazes, Prevalence of self reported musculoskeletal diseases is high. Annals of the Rheumatic Diseases, 2003. 62(7): p. 644-650.

2. Salaffi, F., R. De Angelis, and W. Grassi, Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clinical and Experimental Rheumatology, 2005. 23(6): p. 819-828.

3. Katz, W.A., Musculoskeletal pain and its socioeconomic implications. Clinical Rheumatology, 2002. 21 Suppl 1: p. S2-4.

4. Palsson, T.S. and T. Graven-Nielsen, Experimental pelvic pain facilitates pain provocation tests and causes regional hyperalgesia. PAIN, 2012. 153(11): p. 2233-2240.

5. Gibson, W., L. Arendt-Nielsen, and T. Graven-Nielsen, Referred pain and hyperalgesia in human tendon and muscle belly tissue. PAIN, 2006. 120(1–2): p. 113-123.

6. Graven-Nielsen, T., et al., Quantification of deep and superficial sensibility in saline-induced muscle pain -- a psychophysical study Somatosensory & motor research 1998. 15(1): p. 46-53.

7. Ge, H., et al., Hypoalgesia to pressure pain in referred pain areas triggered by spatial summation of experimental muscle pain from unilateral or bilateral trapezius muscles. European Journal of Pain 2003. 7(6): p. 531-537.

8. Slater, H., W. Gibson, and T. Graven-Nielsen, Sensory responses to mechanically and chemically induced tendon pain in healthy subjects. European Journal of Pain, 2011. 15(2): p. 146-152.

9. van Wijk, G. and D.S. Veldhuijzen, Perspective on Diffuse Noxious Inhibitory Controls as a Model of Endogenous Pain Modulation in Clinical Pain Syndromes. The Journal of Pain, 2010. 11(5): p. 408-419.

10. Graven-Nielsen, T. and L. Arendt-Nielsen, Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol, 2010. 6(10): p. 599-606.

11. Lemming, D., et al., Widespread pain hypersensitivity and facilitated temporal summation of deep tissue pain in whiplash associated disorder: an explorative study of women. Journal of rehabilitation medicine, 2012. 44(8): p. 648-657.

12. Arendt-Nielsen, L. and D. Yarnitsky, Experimental and Clinical Applications of Quantitative Sensory Testing Applied to Skin, Muscles and Viscera. The Journal of Pain, 2009. 10(6): p. 556-572.

EXPERIENCE IS THE TEACHER OF ALL THINGS: DOES INTERLIMB COMMUNICATION LEARN? Background When we walk, a fine coordination between the two legs is required, in particular when an unexpected change in the over ground surface or the encountering of an obstacle threaten our balance. Even if the structure of the neural networks involved in this coordination is not yet completely known, short-latency muscles responses have recently been observed in muscles of the contralateral leg following nerve stimulation of the ipsilateral leg; this evidence suggests that a direct spinal connection between muscles of the two legs may exist in healthy humans. The existence of these spinal pathways during locomotion represents a promising finding for the rehabilitation of patients presenting a loss of descending drive such as stroke or spinal cord injuries patients. However, there is a lack of knowledge about how experience or training affects these pathways. This information would be relevant order to evaluate the possibility of developing new rehabilitation approaches based on the conditioning of these pathways. Aim & Solution The aim of the present study is to investigate how experience affects interlimb communication. Short-latency crossed responses in lower limb muscles will therefore be elicited and quantified in separate days to evaluate whether adaptation affects these responses. With this attempt, electrical stimulation will be used to elicit crossed responses and EMG signals will be acquired to allow a quantification of these responses. Perspectives Through this research project, students will gain an in-depth understanding of the field of neurophysiology. Students will learn to collect data independently and will get hands-on experience using direct nerve stimulation, muscle activity recordings, acquisition and processing of electromyographic (EMG) signals and will learn how to apply scientific methods, in order to acquire, process, and analyze signals with the aim of interpreting physiologic information. Project proposer Sabata Gervasio, saba@hst.aau.dk, E1-209

INTERLIMB COMMUNICATION DURING WALKING Background During human walking, precise coordination between the two legs is required in order to react promptly to any sudden hazard that could threat stability. Even if the networks involved in this coordination are not yet completely known, evidences suggest that a direct spinal connection between muscles of the two legs may exist in healthy humans. Indeed, short-latency responses have been quantified in muscles (soleus, gastrocnemius) of the contralateral leg following nerve stimulation of the ipsilateral leg. A functional significance of these connections has been proposed since some of these responses showed a phase dependent modulation during locomotion, and a reversal can occur when an opposite reaction is required. Investigating whether short-latency crossed responses exist in other lower leg muscles (tibialis anterior) and how these are modulated during the gait cycle will provide information about the functionality of these responses and how interlimb communication adjusts during walking. This information might be relevant in clinical rehabilitation. Aim & Solution The aim of the present study is to investigate the existence of short-latency crossed responses in lower limb muscles and their modulation during the gait cycle. With this attempt, electrical stimulation will be used to elicit crossed responses and EMG signals will be acquired to allow a quantification of such responses. Perspectives Through this experimental research project students will gain an in-depth understanding of the field of neurophysiology. Students will learn to collect data independently, and how to use advanced techniques such as direct nerve stimulation, biomechanical modelling and muscle activation recordings. Students will have hands-on experience and will learn how to apply scientific methods, in order to acquire, process and analyze signals with the aim of interpreting neurophysiologic information. Project proposer Sabata Gervasio, saba@hst.aau.dk, E1-209