Effect of Neurodynamics Nerve Flossing on Femoral Neuropathy in Haemophilic Patients

Study Overview
=================
Brief Summary
-----------------
To investigate the effect of Neurodynamics Nerve flossing on femoral neuropathy in patients with haemophilia Background: heamophilia is one of the serious chronic disorders in children and adolescents which results in less physical activities and restlessness hours than their peer. HYPOTHESES: This study will hypnotize that: Neurodynamics Nerve flossing will have a significant effect on femoral neuropathy in patients with haemophilia RESEARCH QUESTION: will the Neurodynamics Nerve flossing has an effect on femoral neuropathy in patients with haemophilia?

Detailed Description
-----------------
Haemophilic patients with Femoral Neuropathy will be randomly divided in two equal groups control group which will receive conventional selected exercise program and study group will receive the same exercise training program in addition to Neurodynamics Nerve flossing three times per week for three successive months. The Evaluation will done pre and post interventions included: femoral nerve motor conduction velocity, muscle test For Iliopsoas and Quadriceps muscles and Pain visual analogue scale.

Official Title
-----------------
Effect of Neurodynamics Nerve Flossing on Femoral Neuropathy in Haemophilic Patients

Conditions
-----------------
Femoral Neuropathy in Haemophilic Patients

Intervention / Treatment
-----------------
* Other: Neurodynamics Nerve flossing
* Other: conventional selected exercise program


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: hemophilia A or B, all the patients positive femoral nerve tension test the Manual muscle test for iliopsoas and quadriceps muscles in all patients not less than grade 2 according to the oxford scale the age ranging from (12:16) years all the participants will be able to communicate verbally ,obey commands and instructions and co-operate with testing and training protocols Exclusion Criteria: any participants have auditory, visual and sever cardiac disorders Patients who have mild degree of hemophilia Patients who have joint, muscle bleeding or pain in the lower limb in the preceding 3 weeks patients with any other neurological disorders or musculoskeletal disorders or deformities of the lower limb.

Ages Eligible for Study
-----------------
Minimum Age: 12 Years
Maximum Age: 16 Years

Sexes Eligible for Study
-----------------
Male

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: control group which received conventional selected exercise program in form of Ultrasound therapy The flexibility exercises for iliopsoas & quadriceps The iliopsoas & quadriceps muscles strength exercise and study group received the same exercise training program in addition to Neurodynamics Nerve flossing three times per week for three successive months
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: study group<br>received conventional selected exercise program and in addition to Neurodynamics Nerve flossing for femoral nerve | Other: Neurodynamics Nerve flossing<br>* Neurodynamics Nerve flossing for femoral nerve that includes two techniques inform of: slider technique and the second is the tensioner technique<br>Other: conventional selected exercise program<br>* Ultrasound therapy The flexibility exercises for iliopsoas & quadriceps The iliopsoas & quadriceps muscles strength exercise<br>|
| Experimental: control group<br>received conventional selected exercise program in form of: Ultrasound therapy The flexibility exercises for iliopsoas & quadriceps in heamophilic patient The iliopsoas & quadriceps muscles strength exercise | Other: conventional selected exercise program<br>* Ultrasound therapy The flexibility exercises for iliopsoas & quadriceps The iliopsoas & quadriceps muscles strength exercise<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Electromyography Nerve conduction study | Femoral Nerve motor conduction velocity (m/sec.) , via the Neuropack S1 MEB9004 EMG device | 12 weeks | 
| Femoral Nerve Tension Test, for femoral nerve injury | Femoral Nerve Tension Test is a neural tension test used to stress the femoral nerve A positive test was be reproduction of the patient's symptoms as burning discomfort in the groin or anterior thigh occurred if there was femoral nerve involvement. | 12 weeks | 
| Manual muscle test, Oxford five grades of muscle power assessment | The group Manual muscle test was used for testing the strength of iliopsoas and quadriceps muscles, according to the Oxford Scale as the Muscle strength is often rated on a scale of 0/5 as follow: (0/5) no contraction of muscle, (1/5) muscle flicker contraction, but no movement (2/5) movement possible, but not against gravity (test the joint in its horizontal plane), (3/5) movement possible against gravity, but not against resistance by the therapist, (4/5) movement possible against some resistance by the examiner and (5/5) normal strength | 12 weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Neurodynamics,, Nerve flossing;, femoral neuropathy, , haemophilia,