Stroke Clinical Trial
Official title:
Effect of Joint Mobilization on Alpha Motoneuron Reflex Excitability in People With Spasticity: Controlled Clinical Trial
Objective: To determine the effect of ankle joint mobilization on the alpha motoneuron
reflex excitability of the soleus muscle in people with spasticity.
Subjects and Methods: A controlled clinical trial with crossover design and simple masking
was conducted in 24 randomized subjects to initiate the control or experimental group.
Traction and rhythmic oscillation were applied for five minutes to the ankle joint. Alpha
motoneuron reflex excitability was assessed by measuring H wave amplitude (Hoffmann reflex -
H reflex), stimulating the tibial nerve at the level of the popliteal fossa and recording in
the soleus muscle. In each subject 12 measurements were taken: basal rate, during and after
mobilization. Changes in alpha motoneuron reflex excitability were calculated in relation to
basal measurement. For each measurement a hypothesis test was performed (Student t test).
Results: In groups of patients with brain injury (BI) and incomplete spinal cord injury
(ISCI), a significant difference was found between measurements of both studies, concerning
variation in alpha motoneuron reflex excitability during the application of joint
mobilization techniques, with a decrease in the experimental group and an increase in the
control group. In contrast, no significant differences were found after mobilization
therapy. Patients with complete spinal cord injury (CSCI) showed no significant differences
in any measurements.
Conclusion: We demonstrate the effectiveness of passive movement in the decrease of muscle
tone during the mobilization maneuver in patients with BI or ISCI, but no residual effect
after completion of the trial. This research project showed no evidence regarding spasticity
reduction in complete spinal cord injuries. This suggests that therapeutic interventions to
decrease muscle tone, based on the passive exercise and stimulation of proprioceptors should
be reconsidered.
n/a
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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