Neurodynamics on Spasticity in Upper Extremity of Stroke Patients.
Condition: Stroke
MeSH terms: Muscle Spasticity; Stroke
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Experimental group; Control group
Intervention type(s): Other; Other
Intervention description(s): Neurodynamics with conventional treatment. Intervention will be applied for 6 weeks (10 reps per set, 1 set per day, 3 days per week) for 30 minutes; Conventional treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Neurodynamics; Spasticity; Stroke