Stroke Clinical Trial
Official title:
Effects of Neurodynamics on Spasticity in Upper Extremity of Stroke Patients.
Data will be collected from 40 patients with hemiplegia, caused by stroke from DHQ hospital
Jhelum. its an RCT Neurodynamics with conventional treatment to experimental group and
conventional treatment alone to control group will be applied for 6 weeks.
Simple random sampling will be done and randomization will be done through tossing a coin.
Intervention wil be applied and assesment will be done through fugl-meyer upper extremity
scale, Modified Aashwarth scale,goniometry and action research arm test at zero, 3rd and 6th
week.
Informed consent was taken and patients were assessed for eligibility and patients who meet
the inclusion criteria were randomized through simple random sampling into experimental and
control group. Zero, 3rd and 6th week assessment was done through Action research arm test to
assess upper limb performance, Goniometry to assess range of motion, Fugl-meyer upper
extremity scale FMUE to assess motor functioning, sensation and joint functioning and
modified ashworth scale MAS to assess spasticity. Intervention was applied for 6 weeks. The
intervention in control group (n=23) was conventional treatment which includes stretching
(static stretching for 20 sec) and range of motion exercises (within limit of range) .
Intervention was administered one set per day (12 reps per set) four repetitions for each
movement direction for 3 days a week, over a course of 6 weeks.
The intervention in experimental group (n=23) was conventional treatment which includes
stretching (static stretching for 20 sec) and range of motion exercises (within limit of
range) with neurodynamics (Dynamic neural mobilization technique) which includes median,
ulnar and radial nerve mobilization. Peripheral nerve was stretched for 20 sec with addition
of dynamic movement which was performed after every 2 sec for a total of 20 sec.
Neurodynamics was administered, one set per day (10 rep per set) , for 3 days a week, over a
course of 6 weeks. Normality of data was checked through shapiro wilk test as sample size is
<50 and parametric or non-parametric tests were applied accordingly through SPSS version 21.
Rhythmic neurodynamics accelerated the nerve conduction velocity more than the general
neurodynamics. Positive effect of neurodynamics to reduce tone, increase range and improve
function of stroke patients were determined in 2016. Combination of neural mobilization and
Botulinum toxin-A is effective to reduce pain and increase ranges of motion.Decrease in
anxiety also occurs. Botulinum toxin inhibits release of acetylcholine causing a blockade of
the neuromuscular patches without affecting the antagonist muscles resulting in reduced
spasticity.
Neural mobilization is effective than conventional neural mobilization to increase β-waves
and decrease μ-rhythms in C3 and C4 areas of cerebral cortex (primary motor areas). Neural
mobilization was effective for improving range of motion of shoulder joint in all degree of
freedom by reducing muscle tension and increasing extensibility of neural tissue. Neural
mobilization is effective to reduce spasticity in bicep brachii muscle. Decrease in
myoelectric activity is the mechanism behind reduction of tone in stroke patients.
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