Neural Mobilization for Reduction of Spasticity in Stroke

Effectiveness of Neural Mobilization on Spasticity and Upper Limb Function in Individuals With Stroke

Spasticity after stroke is common that affect upper limb strength and make activities of daily living difficult. There are many techniques but not any standardized technique for long term effect on reduction of spasticity and improving upper limb strength. This study aimed to explore and understand the effectiveness of neural mobilization on reduction of spasticity and improving upper limb strength in individuals with stroke. This is mixed method approach of embedded design, multicentric study recruited 7 individuals with stroke as no new themes or codes were emerging (data saturated). Median nerve mobilization was given 20 oscillations per minute for 3 times & repeated 3 times with a pause of 1 minute between each sets for 5times/week for 4weeks. Outcome measures were Modified Ashworth Scale (MAS), Brunnstrom's grading of hand recovery and Hydraulic hand dynamometer(HHD) for grip and pinch strength. Pre and post outcomes data were collected at baseline and 4weeks after intervention and in depth face to face structured interviews was conducted after 4weeks of intervention to explore the effectiveness of median nerve mobilization on reduction of spasticity and the improvement of upper limb strength.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Other: Median nerve mobilization

Detailed Description

Spasticity after stroke is common that affect upper limb strength and make activities of daily living difficult. There are many techniques but not any standardized technique for long term effect on reduction of spasticity and improving upper limb strength. This study aimed to explore and understand the effectiveness of neural mobilization on reduction of spasticity and improving upper limb strength in individuals with stroke. This is mixed method approach of embedded design, multicentric study recruited 7 individuals with stroke as no new themes or codes were emerging (data saturated). Median nerve mobilization was given 20 oscillations per minute for 3 times & repeated 3 times with a pause of 1 minute between each sets for 5times/week for 4weeks. Primary outcome measure was Modified Ashworth Scale (MAS) to assess elbow and wrist flexors spasticity and secondary outcome measures were Brunnstrom's stages for hand recovery and Hydraulic hand dynamometer(HHD) to measure grip and pinch strength. Pre and post outcomes data were collected at baseline and 4weeks after intervention and in depth face to face structured interviews was conducted after 4weeks of intervention to explore the effectiveness of median nerve mobilization on reduction of spasticity and the improvement of upper limb strength.

• Study Type: Interventional
• Enrollment (Actual): 7
• Phase: Not Applicable

Contacts and Locations

Study Locations

• India
  • Haryana
    • Ambala, Haryana, India, 133207
      • Maharishi Markandeshwar Institute of Physiotherapy & Rehabilitation
    • Hisar, Haryana, India, 125001
      • Healing Hands Physiotherapy & Rehabilitation
    • Kaithal, Haryana, India, 136027
      • Bedi Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Participants with subacute and chronic stroke (1month and above) having upper limb spasticity.
2. Participants with haemorrhagic and ischemic stroke.
3. Participants who tolerate the supine position.
4. Participants who are oriented and alert.
5. Both males and females.
6. Participants older than 18 years.

Exclusion Criteria:

1. Participants with a score greater than 3 on The Modified Ashworth Scale.
2. Participants with affected speech.
3. Participants with upper limb deformity.
4. Participants experiencing dizziness.
5. Any increase in the dosage of anti-spastic medications during the intervention period.
6. General health problems or pathologies that affect the nervous system like uncontrolled diabetes, hypertension and recent surgeries.
7. Recent onset of worsening neurological signs.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Median nerve mobilization; Experimental arm given Median nerve mobilization for 12mins 3sets for 3mins each with 1 minute interval in between for 5times a week for 4weeks	Other: Median nerve mobilization; Median nerve mobilization was given 20 oscillations per minute for 3 times & repeated 3 times with a pause of 1 minute between each sets for 5times/week for 4weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Modified Ashworth Scale (MAS)	For spasticity, Total 4 grades are there. Grade 0 means no increase in muscle tone and grade 4 means affected part rigid in flexion or extension. More grade means more spasticity is there.	Change from baseline and 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brunnstrom's stages for hand recovery	To check recovery of hand functions. Total 7 grades are there. Increase in grade means increase in hand functions.	Change from baseline and 4 weeks
Hydraulic hand dynamometer	For grip and pinch strength	Change from baseline and 4 weeks

Collaborators and Investigators

• Sponsor: Asir John Samuel
• Investigators: Principal Investigator: Rittu Sharma, (MPT), Maharishi Markandeshwar Institute of physiotherapy and Rehabilitation; Study Chair: Asir John Samuel, Ph.D, Maharishi Markandeshwar Institute of physiotherapy and Rehabilitation; Study Director: Akanksha Saxena, (Ph.D), Maharishi Markandeshwar Institute of physiotherapy and Rehabilitation

Study record dates

Study Major Dates

• Study Start (Actual): November 22, 2021
• Primary Completion (Actual): February 19, 2022
• Study Completion (Actual): March 15, 2022

Study Registration Dates

• First Submitted: March 30, 2022
• First Submitted That Met QC Criteria: March 30, 2022
• First Posted (Actual): April 6, 2022

Study Record Updates

• Last Update Posted (Actual): August 17, 2022
• Last Update Submitted That Met QC Criteria: August 16, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: Stroke, spasticity, neural mobilization, Upper limb
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Musculoskeletal Diseases; Muscular Diseases; Neuromuscular Manifestations; Muscle Hypertonia; Stroke; Muscle Spasticity
• Other Study ID Numbers: MMDU/IEC/1935; U1111-1276-6515 (Other Identifier: WHO (UTN))

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No