The Effect of Cervical Mobilization on Balance and Spasticity in Multiple Sclerosis Individuals
Condition: Multiple Sclerosis; Balance; Distorted
MeSH terms: Muscle Spasticity; Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      Taking into consideration the effects of mobilization on muscle tone and balance, it is
      predicted that this method will have effective results in the treatment of individuals with
      MS. Therefore, it is thought that grade A and grade B mobilization applications can be used
      to strengthen the balance control mechanisms of MS individuals and to regulate muscle tone by
      increasing the proprioceptive input. In this study, it was aimed to investigate the
      short-term effects of cervical mobilization on balance and spasticity in MS individuals.
    

Detailed description: 
      Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, and neurodegenerative
      disease of the central nervous system (CNS). The etiology of the disease is not fully known.
      It is thought that both autoimmune and neurodegenerative mechanisms can play a role in MS.
      Genetic and environmental factors are also influenced by the emergence of the disease.
      Although the factors that trigger MS are not fully known, autoreactive T cells and antibodies
      against SSS are thought to have a major pathogenic role in the development of inflammation
      and tissue damage. The same mechanism is held responsible for the progression of neurological
      disorders and functional deficits.

      MS can severely limit the quality of life in patients due to the accumulation of sequelae
      following the attacks or the development of a progressive degenerative process, leading to
      progressive disability.

      The disease has marked clinical heterogeneity. This difference may be in the age of onset,
      onset, frequency, severity and sequelae of exacerbations, worsening prevalence and cumulative
      impairment over time. Although there are differences in clinical and pathologic findings,
      variable clinical features reflect multifocal SSS destruction. In patients, somatosensory
      findings (burning, numbness, tingling, deep and superficial sensory deficits), motor findings
      (spasticity due to corticospinal involvement, muscle strength losses), postural control and
      coordination disorders, bladder-bowel problems, visual, cognitive and psychiatric
      manifestations, fatigue and sleep disorders.

      Spasticity is one of the most common physical disorders in MS. It is known that 60-90% of
      individuals with MS develop spasticity. MS-associated spasticity; generalized, focal (which
      affects a part of the extremity) or multifocal (which affects more than one part of the
      extremities or extremities). Spasticity; due to force imbalance between agonist and
      antagonist muscles, affecting static joint positions and dynamic limb movements, resulting in
      abnormal postural conditions and stiffness. Spasticity is directly related to disease
      progression and muscle weakness leads to secondary fatigue due to increased energy
      expenditure. Depending on the spasticity, structural changes of muscles, tendons and joints
      affect the movements and functions of the extremities.

      Equilibrium losses are one of the other important symptoms seen in MS patients, affecting
      about 75% of patients. Balance; the ability to keep the center of gravity of the body within
      the limits of the support surface. The sensory components of the balance; visual, vestibular
      and somatosensory system information. The feeling of proprioception, which is part of the
      somatosensory system; joints and extremities, which are formed by receptors located in the
      joints and tissues and provided by neural inputs. Proprioceptors are specific receptors that
      are located at different rates in different structures and tissues of the body. It is known
      that the cervical region is very rich in these receptors. In this respect, the neck plays a
      very important role in maintaining the right orientation, balance, and accordingly motor
      coordination of the whole body. For example; In the impaired proprioceptive processes of the
      lower extremities, compensation is provided by proprioceptive inputs from the cervical region
      to maintain body balance. The cervical region is closely related to the vestibular system,
      which is another sensory component of balance. This relationship is extremely important in
      the activity of cervico-colic (CCR) and vestibulo-colic reflexes (VCR). VCR is semicircular
      canal and macular origin. They are effective on the receptors on the inner ear and on the
      muscular extensor muscles. In one study, when vestibular stimulation accompanied the tension
      of the neck muscles, the sagittal VCR in the semispinalis capitis muscle increased about
      three-fold normally. Strengthening of the VCR reflex with tongue proprioceptive afferents is
      the result of summing up of CCR and VCR induced by stretching of the neck muscles. The
      interaction between the two reflexes showed that not only the vestibular stimulation but also
      the length of the neck muscles were important in the normal movement of the head over the
      neck.

      In the treatment of spasticity and balance disorders, which are very common and difficult to
      manage in MS patients, drug therapies, botulinum toxin treatments, surgical treatments and
      physiotherapy and rehabilitation approaches are included.Physiotherapy applications; sensory,
      walking parameters, extremity functions, muscle tone, body and standing balance are known to
      have positive effects. The use of somatosensory strategies, balance exercises, coordination
      training, spinal stabilization exercises and activity based exercises are the physiotherapy
      approaches used in balance training. Mobilization techniques, which are another physiotherapy
      application, restoration of joint motion with the application of different forms of active
      and passive exercise. Mobilization is a repetitive passive motion within the limits of normal
      joint motion, without exceeding this limit, at different amplitudes at low speeds. The
      neurophysiological effects of mobilization are to improve the proprioception sensation by
      stimulating receptor nerve endings in different periarticular structures, changing the range
      of motion, pain, muscle tone, motor control and spinal stability. Inserted stretching and
      pushing stimulates Type III joint receptors and golgi tendon organs. In this case relaxation
      occurs with temporary inhibition in the muscles. This causes an increase in joint motion and
      prepares the joint for more stretching and mobilization. Thus, pain and protective muscle
      spasm are reduced. Neurophysiological effects of mobilization; decreased pain and muscle
      tone, postural control and balance effects.

      Mobilization techniques are classified into 3 groups according to severity and degree. These;
      grade A (mobilization), grade B (mobilization) and grade C (manipulation). Grade (mobility);
      active, or active assisted movements within painless range of motion. Grade B (mobility); is
      a special continuous stretching technique which causes the prolongation of the connector
      touch. At the spinal joints, the joint is applied at the end of the range of motion. Grade C
      (manipulation); passive movement in the form of a minimal amplitude, high velocity push
      applied between the physiological boundary and the anatomical boundary.

      Taking into consideration the effects of mobilization on muscle tone and balance, it is
      predicted that this method will have effective results in the treatment of individuals with
      MS. Therefore, it is thought that grade A and grade B mobilization applications can be used
      to strengthen the balance control mechanisms of MS individuals and to regulate muscle tone by
      increasing the proprioceptive input. In this study, it was aimed to investigate the
      short-term effects of cervical mobilization on balance and spasticity in MS individuals.
    

Intervention name(s): cervical mobilisation
Intervention type(s): Other
Intervention description(s): manual therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: multiple sclerosis; cervical region; balance; spasticity; mobilisation