Manual Therapy with Neural Mobilization: Immediate Effect on the Vocal Quality of Women with Dysphonia.

OBJECTIVE: To evaluate the immediate effect of neural mobilization on the voice quality, self-perceived phonatory effort, and laryngeal muscles of women with behavioral dysphonia. METHOD: This is an intrasubject comparative study. The research included 21 women aged 18 to 59 years with vocal complaints. Therefore, the selection of this sample excluded the lower limit of the voice change period and the upper limit of presbyphonia. The participants were assessed by voice acoustic and auditory-perceptual analysis, self-reported vocal effort, and laryngeal palpation performed at three moments: at baseline, after 10 minutes of vocal resting, and after manual therapy. The participants were divided into two groups: the group with 10 minutes of vocal resting (G1) and the group with intervention (G2). The patients in the intervention group underwent manual therapy using neural mobilization in the laryngeal region. For the statistical analysis, a descriptive analysis of the data was performed first with measures of central tendency and dispersion. Subsequently, the Anderson-Darling test was used to verify sample normality. To analyze the difference between three groups were used the parametric One-Way ANOVA or the non-parametric Friedman's test. The McNemar's or chi-squared tests were used to compare categorical variables and to compare an ordinal variable a non-parametric Wilcoxon test was used. The Gwet's AC1 test was used to assess intra-rater agreement in the auditory-perceptual analysis response. RESULTS: Neural mobilization in the laryngeal region showed no positive effects on the acoustic voice parameters and voice quality of women with dysphonia. Phonatory effort improved after neural mobilization in the laryngeal region (p = 0.004). There was no significant change in supralaryngeal resistance, lateral laryngeal resistance, and laryngeal position after neural mobilization in the laryngeal region. CONCLUSION: Neural mobilization improved phonatory comfort but did have any effect on the voice quality and laryngeal musculature of women with dysphonia.

Effects of neural mobilization in patients after lumbar microdiscectomy due to intervertebral disc lesion.

BACKGROUND: Neural mobilization (NM) techniques have been shown to improve the neural tissue's viscoelastic properties that may lead to recover of the function of the nerve after lumbar spine surgery. This study aimed to determine the effects of NM in addition to standard rehabilitation on lumbar and sciatic pain intensity, disability level, and quality of life in patients after receiving a microdiscectomy of the intervertebral lumbar disc (IVD). METHODS: Twenty-four participants (age 41.3 ± 8.3 years old) within 3-4 weeks of a microdiscectomy of an IVD were randomly allocated to control (CTRL; n = 12) or NM group (n = 12). The CTRL group received ten standard rehabilitation sessions. The NM group received the same rehabilitation sessions with the addition of NM techniques. The intensity of lumbar and sciatic pain (visual analogue scale), disability level (Oswestry disability index), and health-related quality of life (SF-36 questionnaire) were measured before and after the intervention. RESULTS: Within-group analysis revealed a significant reduction in lumbar (p < 0.05) and sciatic pain intensity (p < 0.001), disability level (p < 0.001), and improvement in the physical function and problems, vitality, emotional well-being, and pain SF-36 items (p < 0.05) in both groups. There were no statistical differences between groups in all outcomes. CONCLUSION: A standard rehabilitation protocol alone or in combination with NM techniques are equally effective in reducing pain and disability level, as well as improving quality of life in patients after a microdiscectomy due to intervertebral lumbar disc lesion.

Neurodynamic treatment for patients with nerve-related leg pain: Protocol for a randomized controlled trial.

OBJECTIVES: To investigate if neurodynamic treatment is more effective than advice to remain active in patients with nerve-related leg pain. DESIGN: Parallel-group randomized controlled trial blinded to the outcome assessor conducted in Porto Alegre, Brazil. PARTICIPANTS: Sixty patients recruited from the community and private practices. INTERVENTION: Patients will be randomly assigned to receive four sessions of neurodynamic treatment over two weeks comprising passive lumbar foramen opening and neurodynamic sliders plus home exercises or advice to remain active. MAIN OUTCOME MEASURES: Leg pain intensity, disability, low back pain intensity, functional ability, symptoms distribution and global impression of recovery will be assessed at two and four weeks after randomization. ANALYSIS: A linear mixed model will be employed for each outcome following intention to treat principles.

Neural mobilization promotes nerve regeneration by nerve growth factor and myelin protein zero increased after sciatic nerve injury.

Neurotrophins are crucial in relation to axonal regrowth and remyelination following injury; and neural mobilization (NM) is a noninvasive therapy that clinically is effective in neuropathic pain treatment, but its mechanisms remains unclear. We examined the effects of NM on the regeneration of sciatic nerve after chronic constriction injury (CCI) in rats. The CCI was performed on adult male rats, submitted to 10 sessions of NM, starting 14 days after CCI. Then, the nerves were analyzed using transmission electron microscopy and western blot for neural growth factor (NGF) and myelin protein zero (MPZ). We observed an increase of NGF and MPZ after CCI and NM. Electron microscopy revealed that CCI-NM samples had high numbers of axons possessing myelin sheaths of normal thickness and less inter-axonal fibrosis than the CCI. These data suggest that NM is effective in facilitating nerve regeneration and NGF and MPZ are involved in this effect.

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.