Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia / 中国康复理论与实践

ObjectiveTo observe the effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia. MethodsFrom January, 2020 to November, 2021, 43 patients with hemiplegia after stroke in the Second People's Hospital of Nantong were randomly divided into control group (n = 21) and treatment group (n = 22). The control group received shoulder control training, while the treatment group received neural mobilization in addition. Before and after four weeks of treatment, they were evaluated with the Numeric Rating Scale (NRS) of pain and Fugl-Meyer Assessment-Upper Extremities (FMA-UE). ResultsOne case dropped off in the control group and two cases dropped off in the treatment group. After treatment, the NRS score and FMA-UE score improved in both groups (|t| >7.898, P < 0.001), and they were better in the treatment group than in the control group (|t| >2.337, P < 0.05). ConclusionNeural mobilization based on shoulder control training can significantly alleviate shoulder pain and improve upper limb motor function in stroke patients with hemiplegia.

The Effectiveness of Early Investigative Tools for Neural Lesions in Leprosy: An Observational Cohort Study

Leprosy can cause different lesions in peripheral nerves and inervatory structures. This study aims to analyze the effectiveness of evaluation protocols used to identify neural lesions in leprosy, such as Degree of Physical Disability (DPD), Simplified Neurological Assessment (SNA) and propose to use Neuro Dynamic Assessment (NDA). A descriptive analytical study was carried out in 27 individuals treated in two outpatient leprosy clinics in São Paulo State, between 2017 and 2019. A control group of age and sex matched 27 people, chosen from the population without a diagnosis of leprosy, was also evaluated. The Mann-Whitney, Multivariate Linear Regression, association between variables, and P<0.05 values were used. The test that most captured the neurological alterations was the SNA, with 22 (81.5%) in the upper limbs (ULs) and 25 (92.6%) in the lower limbs (LLs), followed by the NDA, with 20 (74.1%) in the ULs and 11 (40.7%) in the LLs. The DPD showed handicap in the hands of 16 (59.2%) individuals and in the feet of 17 (62.9%) individuals. The three assessment instruments can and should be used in combination to expand the monitoring of neural lesions in leprosy, as there are changes that are not perceptible with one instrument but can be confirmed by another. If there is an instrument to be chosen, it should be the SNA, because it identifies subtle changes that suggest neural distress.

Effectiveness Of Neural Mobilization In The Management Of Chronic Low Back Pain With Radiculopathy: A Randomized Controlled Trial

Background: Neural mobilization (NM) constitutes the most effective, common method for assessing and treating several neuromuscular disorders. The study at hand aims to determine the effectiveness of the NM technique compared to lumbar stabilization exercise (LSE) and Radial Extracorporeal Shock Wave Therapy (rESWT) in the physical therapy management of chronic low back pain (CLBP) with radiculopathy. Methods: Two groups comprising 30 participants and randomly chosen formed the basis of this investigation: Group A (NM, LSE, and rESWT) and Group B (LSE and rESWT). The period of three to six weeks constituted the time it took to measure the results herein reached baseline. The results of the observations focused on pain assessed by numerical pain rating scale (NPRS), Lumbar flexion range of motion (Lumbar FROM) by Schober’s method, and disability level as measured by the Modified Oswestry Disability Questionnaire (MODQ). Results: In the control group, the mean scores of pain, lumbar FROM, and MODQ at baselines showed a high level of similarity (6.47, 2.87, and 43.71 respectively in the intervention group, and 6.20, 2.93 and 44.66. Both groups showed improvement in their pain scores at three weeks (P<0.05). However, only lumbar FROM and MODQ showed statistically significant improvement in favor of the intervention group at three weeks (P<0.05). By week 6, both groups achieved a statistically significant difference in the values of all variables. Conclusion: NM with LSE and rESWT is more effective than LSE and rESWT in the third week, and was similarly effective in the sixth week of the treatment. NM with LSE and rESWT may be an alternative treatment option in the treatment of CLBP.

Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis

Background: Cervical Spondylitis (CS) is a common term that denotes degenerative changes that develop with of trauma-centre patients, specific age groups, and head injury patients. A study done on Indian population reported 78% of radiological changes of CS at C5-C6 and C6-C7 levels in asymptomatic individuals. These degenerative changes in the cervical spine may remain asymptomatic or can present as pure axial neck pain, cervical radiculopathy, cervical myelopathy, or cervical myeloradiculopathy. So, the aim of the study was to check the effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups ; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group A pre-test measurement with the help of two measures - Northwick Park Neck Pain Questionnaire (NPNPQ) for disability and Visual Analog Scale (VAS) Inclinometer for a range of Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Nazz Sulthan. Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. IAIM, 2018; 5(5): 146-155. Page 147 motion cervical spine movements was done in each group. Subjects in Group-A were given Mulligan Mobilization with Upper Limb Movement for cervical regain for 45 minutes 4 days for one week in four weeks subject were sitting Subjects in Group-B was given McKenzie Exercises with Neural Mobilization for 45 minutes 4 days for one week in four weeks subject were in supine position and remains relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and NPNPQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and NPNPQ. The overall study proved that both Mulligan mobilization with upper limb movement and McKenzie exercises with neural mobilization were effective in improving Pain and decreasing the disability level in cervical radiculopathy subjects. Conclusion: McKenzie exercise with neural mobilization is better than mulligan mobilization with upper limb movements in cervical radiculopathy. Results supported that McKenzie exercise with neural mobilization was more effective than mulligan mobilization to improve pain and disability in a patient with cervical radiculopathy.

Treatment of Occipital Neuralgia by Electroacupuncture Combined with Neural Mobilization / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) combined with neural mobilization (NM) in the treatment of occipital neuralgia. METHODS: A total of 62 occipital neuralgia patients were randomized into EA group (19 cases), NM group (22 cases) and EA＋NM group (21 cases). EA was applied at acupoint-pairs as Yuzhen (BL 9)- Tianzhu (BL 10), Fengchi (GB 20)- Wangu (GB 12), etc. NM intervention consisted of occipital muscle group mobilization, C2 spinous process mobilization, cervical joint passive movement management mobilization, etc., was performed at the impaired cervical spine segment. The two methods were used in combination for patients in the EA＋NM group. All the treatment was given once a day for 2 weeks. Before and after treatment, the visual analogue scale (VAS) and the 6-point (1－6 points) behavioral rating scale (BRS-6) of headache were used to assess the severity of pain. The therapeutic effect was evaluated according to the "Criteria for Diagnosis and Cure-Improvement of Clinical Conditions" formulated by State Administration of Traditional Chinese Medicine of the People's Republic of China in 1994. RESULTS: After treatment, both VAS and BRS-6 scores were significantly lower than those before treatment in each of the three groups (P<0.05), and were significantly lower in the EA＋NM group than in the simple EA and simple NM groups (P<0.01,P<0.05). The total effective rates were 78.95% (15/19) in the EA group, 68.18% (15/22) in the NM group, and 90.48% (19/21) in the EA＋NM group, with an obviously better therapeutic effect being in the EA＋NM group relevant to each of the other two treatment groups (P<0.05). CONCLUSION: EA, NM and EA combined with NM can improve symptoms of patients with occipital neuralgia, and EA＋NM has a synergic analgesic effect for occipital neuralgia.

Electromyography function, disability degree, and pain in leprosy patients undergoing neural mobilization treatment / Função eletromiográfica, grau de incapacidade e de dor em portadores de hanseníase submetidos à mobilização neural

INTRODUCTION: This study aimed to evaluate the effect of the neural mobilization technique on electromyography function, disability degree, and pain in patients with leprosy. METHODS: A sample of 56 individuals with leprosy was randomized into an experimental group, composed of 29 individuals undergoing treatment with neural mobilization, and a control group of 27 individuals who underwent conventional treatment. In both groups, the lesions in the lower limbs were treated. In the treatment with neural mobilization, the procedure used was mobilization of the lumbosacral roots and sciatic nerve biased to the peroneal nerve that innervates the anterior tibial muscle, which was evaluated in the electromyography. RESULTS: Analysis of the electromyography function showed a significant increase (p<0.05) in the experimental group in both the right (Δ percent=22.1, p=0.013) and the left anterior tibial muscles (Δ percent=27.7, p=0.009), compared with the control group pre- and post-test. Analysis of the strength both in the movement of horizontal extension (Δ percentright=11.7, p=0.003/Δ percentleft=27.4, p=0.002) and in the movement of back flexion (Δ percentright=31.1; p=0.000/Δ percentleft=34.7, p=0.000) showed a significant increase (p<0.05) in both the right and the left segments when comparing the experimental group pre- and post-test. The experimental group showed a significant reduction (p=0.000) in pain perception and disability degree when the pre- and post-test were compared and when compared with the control group in the post-test. CONCLUSIONS: Leprosy patients undergoing the technique of neural mobilization had an improvement in electromyography function and muscle strength, reducing disability degree and pain.

INTRODUÇÃO: Este estudo tem como objetivo avaliar o efeito da técnica de mobilização neural sobre a função eletromiográfica, grau de incapacidade e dor em portadores de hanseníase. MÉTODOS: A amostra de 56 indivíduos portadores de hanseníase foi randomizada em: grupo experimental composto por 29 indivíduos submetidos ao tratamento com mobilização neural e grupo controle composto por 27 indivíduos submetidos ao tratamento convencional. Em ambos os grupos, foram tratadas as lesões nos membros inferiores. No tratamento com mobilização neural, o procedimento utilizado foi a mobilização das raízes lombossacrais e do nervo isquiático com viés para o nervo fibular, que inerva o músculo tibial anterior, o qual foi avaliado na eletromiografia. RESULTADOS: Ao analisar a função eletromiográfica, observou-se aumento significativo (p<0,05) no grupo experimental em ambos os músculos tibiais anteriores, direito (∆ por cento=22,1; p=0,01) e esquerdo (∆ por cento=27,7; p=0,009), comparado ao grupo controle no pré e pós teste. Ao analisar a força no movimento de extensão horizontal (∆ por centodir=11,7; p=0,003/∆ por cento esq=27,4; p=0,002) e no movimento de dorso flexão (∆ por cento dir=31,1; p=0,000/∆ por cento esq=34,7; p=0,000), observou-se aumento significativo (p<0,05) em ambos os segmentos direito e esquerdo ao comparar o grupo experimental no pré e pós teste. O grupo experimental apresentou redução significativa (p=0,000) na percepção de dor e no grau de incapacidade ao comparar o pré e pós teste e na comparação com o grupo controle no pós teste. CONCLUSÕES: Pacientes submetidos à técnica de mobilização neural obtiveram melhora na função eletromiográfica e nos níveis de força muscular reduzindo o grau de incapacidade e dor.

Efeito da mobilização neural na melhora da dor e incapacidade funcional da hérnia de disco lombar subaguda / Effect of neural mobilization on pain relief and improvement of functional incapacity of subacute lumbar disc herniation

A Mobilização Neural é um recurso terapêutico para as diversas disfunções do tecido neural e do sistema musculoesquelético. No entanto, é uma técnica ainda pouco conhecida e explorada pelos profissionais da área da saúde no Brasil. Diante disto resolveu-se realizar este estudo com intuito de avaliar sua eficiência na hérnia de disco lombar em relação à fisioterapia convencional. Participaram do estudo 30 indivíduos com hérnia de disco lombar unilateral,voluntários, selecionados por conveniência, independente de sexo,idade, tempo de acometimento, etnia e atividade profissional, desde que preenchessem os critérios de inclusão e exclusão, que foram divididos em grupo experimental (EXP) e controle (CONT), com15 participantes em cada, que receberam tratamentos distintos. O grupo CONT recebeu tratamento fisioterápico convencional enquanto o grupo EXP foi submetido ao tratamento de Mobilização Neural. A duração do programa foi de quatro semanas, com três sessões semanais. Ao se avaliar o efeito terapêutico em relação à dor ea incapacidade funcional, não se observou diferença estatisticamente significativa no grupo controle (CONT) na comparação intra-grupo(pré x pós). Já no grupo experimental (EXP), esta mesma comparação,pré e pós-tratamento, mostrou diferença estatisticamente significativa em relação à dor e a capacidade funcional, pelo teste de Kruskal Wallis (p = 0,0001). Quando se realizou a comparação inter-grupos ( pós-EXP x pós-CONT), encontrou-se um intervalo de confiança (IC) favorável ao grupo EXP (IC: -46,48/-5,79). Os resultados deste estudo evidenciaram resposta terapêutica satisfatória para regressão da sintomatologia dolorosa e incapacidade funcional,utilizando-se a técnica de Mobilização Neural na hérnia de disco lombar, unilateral, póstero-lateral, subaguda em curto período de tempo.

The Neural Mobilization is a therapeutic resource in many neural tissue and musculoskeletal system dysfunctions. Nevertheless, this technique remains underexploited by the health professionals in Brazil. Thirty individuals with unilateral lumbar disc herniation were selected by convenience, regardless of gender, age, duration of symptoms, ethnical group and professional activity, since they satisfy the inclusion and exclusion criteria. This sample was divided into two groups: experimental (EXP) and control (CONT), with15 participants each group, who received different treatments. The group CONT received conventional physical therapy treatment while the EXP group was submitted to the neural mobilization treatment. The individuals were treated for 4 weeks, with 3 weekly sessions. The control group (CONT), after using the conventional physical therapy techniques, did not show a statistically significant difference in comparison to the intragroup (pretreatment x post--treatment). On the other hand, the experimental group (EXP)showed a statistically significant difference in relation to pain and the functional capacity using the Kruskal Wallis test (p = 0.0001).When the results in the pre and post-treatment were compared intragroup post-EXP x post-CONT, the confidence interval (IC)was in favor of group EXP (IC: -46.48/-5.79). The results, in this study, showed a good therapeutic response, with regression of the painful symptomatology and functional incapacity, using Neural Mobilization technique, in individuals with unilateral, posterolateral,subacute lumbar disc herniation, in a short period.

Avaliação da mobilização neural sobre o ganho de amplitude de movimento / Assessment of neural mobilization over the gain in range of motion

INTRODUÇÃO: A mobilização neural (MN) visa a restaurar o movimento e a elasticidade do SN, e é utilizada como método de diagnóstico e tratamento das disfunções de origem neural. OBJETIVO: Verificar os efeitos imediatos da MN sobre o ganho de amplitude de movimento de extensão do cotovelo (ADMEC) em indivíduos com tensão neural adversa do nervo mediano (TNAm). METODOLOGIA: A amostra foi composta por estudantes universitários, de ambos os sexos, na faixa etária de 17 a 30 anos. Cada indivíduo foi avaliado bilateralmente por meio do teste de tensão do nervo mediano (ULTT1). Nos casos de teste positivo, foi aplicada a MN do nervo mediano e realizada a avaliação goniométrica imediatamente pré e pós-MN. Os dados foram analisados de forma descritiva e inferencial por meio do Teste de Normalidade Kolmogorov-Smirnov, teste t de Student e teste de Wilcoxon, sendo considerado um nível de significância de 5 por cento. RESULTADOS: A amostra foi composta por 60 voluntários, com idade média de 21,25 ± 0,29 anos, estatura média de 1,66 ± 0,11 metros e peso médio de 63,27 ± 1,53 kg. Observou-se ganho estatisticamente significante (p < 0, 001) da ADMEC em ambos os membros superiores após a MN, com valores de 31,57 ± 20,27° e 20,53 ± 15,27°, pré e pós, respectivamente, no membro superior direito, e 28,68 ± 22,43° e 16,57 ± 15,11°, pré e pós, no membro superior esquerdo. CONCLUSÃO: Neste estudo, a MN foi capaz de melhorar, com resultados imediatos, a ADMEC de forma significativa.

INTRODUCTION: The neural mobilization (NM) aims to restore movement and elasticity of the NS, and it is used as a method of diagnosis and treatment of disorders of neural origin. OBJECTIVE: To investigate the immediate effects of NM over the gain in range of motion of elbow extension (ROMEE) in individuals with adverse neural tension (ANT) of the median nerve. METHODOLOGY: The sample composed of college students, of both sexes, aged 17 to 30 years. Each subject was assessed bilaterally using the tension test of the median nerve (ULTT1). In cases of positive result of tests the NM was applied to the median nerve and goniometric evaluation performed immediately before and after NM. The data were analyzed using descriptive and inferential Normality Test f Kolmogorov Smirnov, t Student test and Wilcoxon test, considering a significance level of 5 percent. RESULTS: The sample consisted of 60 volunteers with a mean age of 21.25 ± 0.29 years, mean height of 1.66 ± 0.11 meters and mean weighing of 63.27 ± 1.53 kg. Was observed statistically significant improvement (p < 0.001) of ROMEE in both upper limbs after the NM, with values of 31.57 ± 20.27° and 20.53 ± 15.27°, pre and post, respectively, on the right and 28.68 ± 22.43° and 16.57 ± 15.11°, pre and post in the left upper limb. CONCLUSION: In this study, NM was able to improve, with immediate results, the ROMEE significantly.