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Title: The effect of cervical spine manipulation on laterality judgement ability in participants with persistent neck pain
Authors: Bradford, Benjamin 
Keywords: Cervical spine manipulation;Persistent neck pain;Laterality judgement ability
Issue Date: 29-Sep-2022
Neck pain is among the top twenty most burdensome chronic health conditions
worldwide. The severity of neck pain among patients varies, but it has been found that
about 50% of episodes tend to become chronic. Previous research has used the accuracy
with which the laterality of body parts can be identified as a proxy for cortical body schema
accuracy and integrity. Treatments aimed at addressing such cortical maladaptations to
pain have been effective in reducing pain and dysfunction in a number of conditions. More
specifically, spinal manipulation (SM) has been shown to improve the laterality judgement
reaction time (LJRT) of participants regarding alphabetical characters. However, the
effect of SM on laterality judgment accuracy (LJA) regarding body parts has not been
determined. Moreover, it has been shown that the neurological mechanisms by which the
brain determines the laterality of letters and objects (allocentric mechanisms) are distinct
from those involved in laterality judgements of body parts (egocentric mechanisms). This
study investigated the effects of cervical spinal manipulation on LJA using Neck and Hand
images as well as the ‘R’ alphabetical character to determine whether SM was able to
address distortions in cortical body schema mapping that may have contribute to
persistent neck pain.
The overarching aim of the study was to determine the immediate effect of cervical spinal
manipulation on laterality judgement reaction time (LJRT) and laterality judgement
accuracy (LJA) in participants with persistent neck pain.
The study adopted a quantitative paradigm and was a pre-test, post-test experimental
trial. People between the ages of 18 and 55 with a current history of non-traumatic neck
pain for 4 weeks or more were invited to participate in the study. The selected participants
were randomly allocated to either the intervention or the control group. Further screening was conducted by means of a telephonic interview, the elicitation of a medical history, a
full physical examination, and a cervical regional examination to ensure that there were
no contraindications to their participation in the study. Applicants were excluded if they
had received any treatment for their neck pain in the foregoing three months. A total of
58 participants was formally included and randomly allocated to either the intervention or
control group. Each participant was then submitted to a pre-intervention/control test for
laterality judgment ability in terms of the letter ‘R’ and Hand and Neck images using the
commercially available Recognize application. Following the application of the respective
interventions (i.e., spinal manipulation and a set up for spinal manipulation without thrust),
post-test measurements were taken as before. Each participant also completed a Central
Sensitization Inventory (CSI) at the time of participation.
The paired t-tests was used to compare paired means within groups from pre- to posttreatment. Repeated ANOVA measures were used to compare the changes over time
between the two treatment groups, while profile plots were used to assess the direction
and trend of the effect of the intervention. Correlations between changes in the scores of
the alphabetical character ‘R’, Hand, and Neck were assessed using Pearson’s
correlation analysis. The same was used to assess the correlation between changes in
Laterality judgement performance and CSI scores. These correlations were done for the
entire sample regardless of treatment group.
Ethical approval (IREC 013/20) for the study was obtained from the relevant institution’s
research ethics committee prior to commencement (Appendix A).
Both groups showed significant improvements over time between the pre- and postintervention tests, but improvements in the intervention group were statistically
indistinguishable from those of the control group. Additionally, there was no correlation
between measures of allocentric and egocentric laterality judgement ability. No relationship was found between CSI scores and laterality judgement performance or
improvement over time.
Thesis submitted in fulfillment of the requirements for a Master’s degree in
Chiropractic Technology, Durban University of Technology, Durban, South Africa, 2022.
Appears in Collections:Theses and dissertations (Health Sciences)

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