Effectiveness of the Neural Mobilization on Upper Limb Functionality in Patients With Acquired Brain Injury

Study Overview
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Brief Summary
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The main objective: To determine changes in physiological and structural properties of upper limb muscles with spasticity in patients with acquired brain injury after applying neural mobilization improving their functional performance, their participation in society and quality of life. Hypothesis: Peripheral nerve mobilizations performed with neurodynamic techniques in upper limb in patients with acquired brain injury, generate changes at structural and physiological level, favoring the performance of daily life activities and improving the quality of life.

Detailed Description
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Randomized clinical trial with blinding of the subject, the evaluator and the person analyzing the data. In the experimental group will be performed neural mobilitazion technique, while in the sham a technique to mimic neurodynamic. The assessment will be made by a single evaluator.

Official Title
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Effectiveness of the Neural Mobilization on Upper Limb Functionality in Patients With Acquired Brain Injury: Randomized, Controlled, Multi-Centric, Single-Blind Clinical Trial

Conditions
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Hemiplegia and Hemiparesis, Acquired Brain Injury

Intervention / Treatment
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* Other: Neurodynamic
* Other: Mimic group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of acquired brain injury (hemiplegia-hemiparesis) Ages between 25 and 50 years Exclusion Criteria: Unable to understand and respond to verbal instructions Absence of voluntary movement in the upper limb Take medicine for spasticity Botulinum toxin infiltration in the last 6 months

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized Controlled Trial
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>The Upper Limb Neurodynamic Test (ULNT1) technique described by Butler will be performed on the affected limb. This technique consists of performing shoulder depression, 90º shoulder abduction, hand, wrist and forearm in a neutral position, external rotation of the shoulder and extension of the elbow. After positioning the limb in this position, wrist flexion-extension movements will be performed smoothly and rhythmically of 20 movements every minute, for 3 minutes, three times per session with 1 minute of rest between each series. | Other: Neurodynamic<br>* The Upper Limb Neurodynamic Test (ULNT1) technique described by Butler will be performed on the affected limb. This technique consists of performing shoulder depression, 90º shoulder abduction, hand, wrist and forearm in a neutral position, external rotation of the shoulder and extension of the elbow. After positioning the limb in this position, wrist flexion-extension movements will be performed smoothly and rhythmically of 20 movements every minute, for 3 minutes, three times per session with 1 minute of rest between each series.<br>|
| Sham Comparator: Mimic group<br>The protocol used by Beneciuk et al. Will be used. This intervention consists of imitating NM without stressing the nervous system. It will be carried out as follow: a neutral cervical position will be maintained (0º of cervical inclination), 45º of shoulder abduction without depression, 45º of external rotation of the shoulder combined with 45º of elbow flexion with the forearm in pronation. Afterwards, 10 wrist flexion-extension movements will be performed at a rate of 6 seconds per cycle (3 seconds of flexion and 3 seconds of extension). The resistance that you will feel will stabilize when you change motion. Once the 10 cycles of movements have been carried out, a wrist flexion will be maintained for 10 seconds. | Other: Mimic group<br>* The protocol used by Beneciuk et al. Will be used. This intervention consists of imitating NM without stressing the nervous system. It will be carried out as follow: a neutral cervical position will be maintained (0º of cervical inclination), 45º of shoulder abduction without depression, 45º of external rotation of the shoulder combined with 45º of elbow flexion with the forearm in pronation. Afterwards, 10 wrist flexion-extension movements will be performed at a rate of 6 seconds per cycle (3 seconds of flexion and 3 seconds of extension). The resistance that you will feel will stabilize when you change motion. Once the 10 cycles of movements have been carried out, a wrist flexion will be maintained for 10 seconds.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Manual Ability | Abilhand Scale; Score 0(worse outcome)-2(better outcome) | Pre-intervention; Immediately after the intervention; Follow up (1 week after the intervention) | 
| Changes in Muscle Spasticity | MAS (Modified Ashworth Scale) 0 (better outcome) - 4 (worse outcome) | Pre-intervention; Immediately after the intervention; Follow up (1 week after the intervention) | 
| Changes in Muscle Strength | Dynamometer | Pre-intervention; Immediately after the intervention; Follow up (1 week after the intervention) | 
| Changes in Nervous Conduction | Delsys Trigno Avanti (surface eMG for non-invasive assessment of muscles) | Pre-intervention; Immediately after the intervention; Follow up (1 week after the intervention) | 
| Changes in Upper Limb Pain Perception | EVA (Visual Analog Scale) 0 (worse outcome) - 10 (better outcome) | Pre-intervention; Immediately after the intervention; Follow up (1 week after the intervention) | 
| Changes in Upper Limb Pain to Pressure | Algometer | Pre-intervention; Immediately after the intervention; Follow up (1 week after the intervention) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acquired Brain Injury, Hemiplegia, Neural Mobilization, Upper limb