Comparative Effects of the Neurodynamic Slider and Tensioner Mobilisation Techniques on Sympathetic Nervous System Function: A Randomised Controlled Trial

Study Overview
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Brief Summary
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In accordance with an independently matched group design methodology, 90 healthy volunteers (aged 18 to 40) were enlisted and randomly assigned to one of three experimental groups (sliding, tension, or control groups). The participants' group assignment was concealed from them. Using the Biopac MP36 electrodermal amplifier, constant skin conductors (SC) levels were captured for 20 minutes. A blind data collector used the Biopac software to gather the data. A pre and post-treatment measurement was taken with the thermal-camera and an ambulatory blood pressure monitor.

Detailed Description
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Ninety healthy volunteer participants were randomly allocated to three groups (sliding neurodynamic techniques (NDT), tension NDT, and control) using the hypothetico-deductive method of theory testing that allows the comparison within the variables. Additionally, a double-blind experimental research strategy was used in this study. The study's participants were not informed on their allocation to the groups in an effort to reduce the likelihood of expectation bias. It is crucial to note that the researcher maintained his or her blindness throughout the data selection process in order to safeguard the study's internal validity. Two people carried out the experiment in order to accomplish this: the therapist who applied the NDT and the data collector in charge of documenting the outcomes of the intervention. Any changes in the Sympathetic Nervous System (SNS) were noted and recorded using three valuable outcome measure tools: the Biopac Galvanic skin response 100B electrodermal activity amplifier (MP36 Biopac Systems Incorporation), a thermo-camera © and an ambulatory blood pressure monitor. The practical room was set up during the experiment so that neither the therapist nor the subjects came in contact with the apparatus. In order to ensure blinding from the results as the experiment was running, the plinth (treatment area) was separated from the data collection table with the computer and equipment (Biopac, blood pressure monitor, environmental thermometer, and thermo-camera) by a screen. Only the data collector has access to the Biopac software, blood pressure monitor, environmental thermometer, and thermo-camera in order to blind the therapist to the results of the experiment completely. Throughout the whole experiment, the therapist stayed hidden behind the screen. The therapist begins standardising the equipment when the subjects are seated on the plinth. The thermo-camera has to be positioned correctly, pointing at the participant's hold body in the first stage. Second, the therapist placed the blood pressure monitor's cuff on the participant's left arm. The ideal placement of the skin electrodes was the next step. Each participant's second and third toes on both legs received skin electrodes. When the participant finally assumed their position, the therapist asked the data collector to quickly verify SC activity using the thermo-camera, ambulatory blood pressure monitor, and graph readings from the Biopac acquisition programme. The experiment comprised three phases: (1) Pre-Intervention Phase, (2) Intervention Phase, and (3) Post-Intervention Phase. The experiment started with an 8-minute stabilisation phase aiming to achieve a physiological resting state, followed by the baseline recording period, which lasted 2 minutes. During this phase, the therapist took the body temperature and the blood pressure of each participant, using the blood pressure monitor and the thermo-camera ©. Following, three phases of 1-minute interventions were applied on the 'intervention leg', each separated by a 1-minute rest period. Finally, the experiment concluded with a 5-minute resting period. The SC was recorded through the Biopac software the whole time, and the whole experiment lasted 20 minutes. Throughout the experiment, the data collector indicated the time frame for each phase with the verbal cue 'Intervention Phase 1 or 2 or 3'. Moreover, the data collector placed markers on the Biopac graph to demonstrate the start and end of each intervention phase. Finally, when the experiment passed into the Post-Intervention Phase, the therapist took the body temperature and the blood pressure from each participant. It must be noted that NDT manoeuvres during the experiment were performed on the participants as described by Shacklock (2005).

Official Title
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Comparative Effects of the Neurodynamic Slider and Tensioner Mobilisation Technique on Sympathetic Nervous System Function: A Randomised Controlled Trial

Conditions
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Health Care Acceptor

Intervention / Treatment
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* Other: Neurodynamic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged between 18 and 40 years Body Mass Index less than 30 Exclusion Criteria: Previous History of Lower Back Pain Skin Disorders Previous Experience of Spinal Manual Therapy Treatment Previous Lower Limb Injuries or Trauma Food, Caffeine, Nicotine, or Alcohol consumed 3 hours before the experiment strenuous Activity done 3 hours before the experiment Chronic Systemic Health Conditions (for example, diabetes) Psychiatric Illnesses or Anxiety Disorders Medication that may have an affect on the SNS (for example, anti-depressants, anti-nausea medication, beta-blockers, muscle relaxants)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sliding Technique Group<br>When the participants achieved the final sympathetic slump position , the therapist will move the foot of the participant into full plantar flexion as they moved their head into maximal flexion. | Other: Neurodynamic<br>* Neurodynamic Slider and Tensioner Technique<br>|
| Experimental: Tension Technique Group<br>When the participants achieved the final sympathetic slump position , the therapist will move the foot of the participant into full plantar flexion as they moved their head into maximal extension. | Other: Neurodynamic<br>* Neurodynamic Slider and Tensioner Technique<br>|
| No Intervention: Control Group<br>In this group the participants will be requested to position themselves on the plinth in supine line position. All participants in this group will not receive any intervention and they will be instructed to remain in this position for 20 minutes. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Biopac Galvanic skin response 100B electrodermal activity amplifier (MP36 Biopac Systems Incorporation) | The skin electrodes were placed on the 2nd and 3rd toes on both legs of each participant. Aiming to be sure of the maximum contact of the pads sticking on the skin, the ventral surfaces on the 2nd and 3rd toes were initially cleaned with an isopropyl alcohol tissue before the pads were placed. They remained for a few seconds to dry, aiming to remove any sweat residue or unwanted skin that might influence the data reading process. | 7 min continuously monitoring will take place during the intervention (7 min following the start of the experiment). | 
| Thermo-Camera | Skin temperature will be measured using a thermo-camera (ThermaCam SC2000©, FLIR, Danderyd, Sweden) pre-post intervention. The thermo-camera will be positioned, pointing at the participant's entire body and monitoring the body temperature in degrees Celsius. | Monitoring will start when participants will take the final sympathetic slump position on the plinth before the intervention (4 min following the starting of the experiment) and following the intervention (20 min following the start of the experiment). | 
| Ambulatory blood pressure monitoring | Therapist placed the cuff of an ambulatory blood pressure monitor (Omron© HEM-9210T Healthcare, Co, Ltd, Kyoto, Japan) on the left arm of the participant. The monitor was used to monitor pre and post-intervention systolic and diastolic blood pressure. | Monitoring will start when participants will take the final sympathetic slump position on the plinth before the intervension (3 min following the starting of the experiment) and following the intevension (18 min following the start of the experiment). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neurodynamic, Neuromobilisation, Tensioner Neurodynamic Technique, Slider Neurodynamic Technique, Slump Test