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dc.contributor.authorBreckenridge, John David
dc.date.accessioned2019-03-22
dc.date.available2019-03-22
dc.date.issued2018-08-18
dc.identifier.urihttp://hdl.handle.net/2123/20192
dc.description.abstractShoulder pain is one of the most common musculoskeletal problems for which people seek health care advice and management, and according to the World Health Organisation, musculoskeletal problems disorders are the second largest cause of disability worldwide. Shoulder pain can become persistent and one example of this is frozen shoulder (adhesive capsulitis), a chronic and disabling shoulder problem. The diagnosis of shoulder complaints including frozen shoulder is difficult, and not without controversy, as there are currently no gold standard diagnostic tests. The treatment of shoulder complaints including frozen shoulder is similarly debated in the literature. This lack of consensus in diagnoses and treatment of shoulder complaints implies that new methods of assessment and treatment are required. A large body of work has implicated the role of the brain in chronic pain conditions. Neuroplastic changes associated with chronic pain can be assessed directly, for example, by the neuroimaging of sensory or motor cortex changes. Neuroplastic changes associated with chronic pain can also be inferred indirectly by behavioural experiments. These include motor imagery tasks such as the left/right judgement task, and tactile acuity tasks like the two-point discrimination threshold test. The first part of thesis systematically reviews the literature surrounding the left/right judgement task in chronic pain conditions to determine if motor imagery is affected in people with chronic pain. This revealed a notable gap in the left/right judgement task literature, as no study had yet assessed motor imagery in people with shoulder pain. The second part of this thesis describes the development of a shoulder specific left/right judgement task, its validity and reliability, which was the first step to address this gap in the literature. In the third part of this thesis this new shoulder specific motor imagery test was then applied to a self-selected sample of people with shoulder pain, and then to a clinician confirmed cohort of people with frozen shoulder. Motor imagery was found to be affected in the frozen shoulder group, and one possible explanation for this is that central processes and cortical proprioceptive representations were altered in this group. In a second behavioural experiment, a tactile acuity task – the two point discrimination test – was employed in the frozen shoulder cohort, and the results demonstrated side to side differences in two point discrimination. Again, this could be interpreted as further implication of somatosensory cortical changes in this group. Taken together, these findings of motor imagery impairment and tactile acuity deficits in people with persistent shoulder pain (frozen shoulder) imply sensorimotor cortical alterations in this group. Moreover, these findings raise the possibility that cortically targeted treatments – that have proven successful in other conditions such as complex regional pain syndrome, and shown promise in chronic low back pain – may be beneficial in the management of frozen shoulder.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherSchool of Medical Sciencesen_AU
dc.publisherDiscipline of Biomedical Scienceen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectMotor imageryen_AU
dc.subjectfrozen shoulderen_AU
dc.subjectleft/right judgementen_AU
dc.subjectshoulder painen_AU
dc.subject.otherincludes published articlesen_AU
dc.titlePerceptual Changes in People with Shoulder Pain: Motor Imagery, Left/Right Judgement and Sensory Tactile Thresholdsen_AU
dc.typePhD Doctorateen_AU
dc.type.pubtypeDoctor of Philosophy Ph.D.en_AU
dc.description.disclaimerAccess is restricted to staff and students of the University of Sydney . UniKey credentials are required. Non university access may be obtained by visiting the University of Sydney Library.en_AU


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