Neural Mobilization on Multiple Sclerosis

Study Overview
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Brief Summary
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Current treatments for pain in MS patients include the use of non-pharmacological interventions such as electrotherapy and exercise, as well as pharmacological treatments. Neurodynamic mobilization exercises are an intervention that aims to restore homeostasis in and around the nervous system by activating the nervous system itself or the structures surrounding the nervous system. Neurodynamic mobilization facilitates movement between neural structures and their environment through manual techniques and exercise. Human and animal studies reveal that neurodynamic mobilization reduces intraneural edema, improves intraneural fluid distribution, reduces thermal and mechanical hyperalgesia, and reverses increased immune responses following a nerve injury.

Detailed Description
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Multiple Sclerosis (MS) is a chronic neurological disease characterized by local inflammation, gliosis and demyelination in the central nervous system (CNS). It is characterized by demyelinating plaques seen in the brain and medulla spinalis. Many different symptoms can be seen depending on the affected areas in the CNS. One of the common symptoms in these patients is pain. Approximately 50% of patients complain of pain at some point in their lives, and in 20% of them, pain is one of the initial symptoms. Pain may originate from the musculoskeletal system; It may also develop due to inflammation and upper motor neuron damage and may have a neuropathic character. As a result, pain in MS negatively affects patients' physical, emotional functions and quality of life. Current treatments for pain in MS patients include the use of non-pharmacological interventions such as electrotherapy and exercise, as well as pharmacological treatments. Neurodynamic mobilization exercises are an intervention that aims to restore homeostasis in and around the nervous system by activating the nervous system itself or the structures surrounding the nervous system. Neurodynamic mobilization facilitates movement between neural structures and their environment through manual techniques and exercise. Human and animal studies reveal that neurodynamic mobilization reduces intraneural edema, improves intraneural fluid distribution, reduces thermal and mechanical hyperalgesia, and reverses increased immune responses following a nerve injury. As a result of this study, it is thought that the determination of effective treatment methods for pain, which is a common symptom of MS patients, will increase the patient's muscle strength and dexterity. The aim of the study is to examine the effects of neurodynamic mobilization exercises on pain, muscle strength and dexterity in Multiple Sclerosis patients.

Official Title
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Effect of Neurodynamic Mobilization Exercises on Pain, Muscle Strength and Manual Dexterity in Multiple Sclerosis Patients

Conditions
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Multiple Sclerosis

Intervention / Treatment
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* Other: neurodynamic mobilization exercise
* Other: strengthening exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being diagnosed with MS according to McDonald 2010 diagnostic criteria Being between the ages of 18-65 Volunteering to participate in the study Exclusion Criteria: Being under 18 years of age and over 65 years of age Having a history of trauma within the last year Having alcohol and substance addiction Having diabetes mellitus Having another known neurological disease Being pregnant

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Control Group<br>Upper extremity strengthening exercises will be applied 10 repetitions a day, 3 days a week for 6 weeks. | Other: strengthening exercises<br>* upper extremity strengthening exercises will be applied 10 repetitions a day, 3 days a week for 6 weeks<br>|
| Experimental: Study Group<br>Upper extremity neurodynamic mobilization exercises and upper extremity strengthening exercises will be applied 10 repetitions a day, 3 days a week for 6 weeks. | Other: neurodynamic mobilization exercise<br>* Upper extremity neurodynamic mobilization exercises and upper extremity strengthening exercises will be applied 10 repetitions a day, 3 days a week for 6 weeks.<br>Other: strengthening exercises<br>* upper extremity strengthening exercises will be applied 10 repetitions a day, 3 days a week for 6 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale | It is a scale used to determine the severity of pain and to clinically monitor pain. | Baseline and after 6 weeks | 
| Leeds Assessment of Neuropathic Symptoms and Signs Scale | It is a multidimensional scale based on the analysis of short-term survey data that can be applied to the patient at the bedside, especially used to differentiate neuropathic and nociceptive pain. | Baseline and after 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle strength | Upper extremity muscles will be evaluated using a digital dynamometer (Knect). | Baseline and after 6 weeks | 
| Manual Ability Measure-36 | In this survey, in order to evaluate manual dexterity, it is questioned how difficult it is to perform 36 activities determined to represent daily living activities without the use of assistive devices. | Baseline and after 6 weeks | 
| Nine hole peg test | It is a validated test in MS where manual dexterity is measured in seconds based on performance. | Baseline and after 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Multiple Sclerosis, Strength, Neuro mobilization, pain