Dynamic Neural Mobilization Versus Proprioceptive Neuromuscular Facilitation On Grip Strength And Upper Limb Function In Sub-Acute Stroke Subjects

Authors

  • Angel Caralin Selvaraj Clinical Physiotherapist and Research Assistant, CMC Ludhiana Hospital, Ludhiana
  • Sudheera Kunduru Professor, Padmashree Institute of Physiotherapy, Bangalore, Karnataka, India.

DOI:

https://doi.org/10.37506/73wxjw35

Keywords:

Subacute stroke, Dynamic Neural Mobilization, Proprioceptive Neuromuscular Facilitation, Neurodynamics, Upper Limb Function, Grip Strength

Abstract

Background: Neural mobilization helps to reduce spasticity, improve muscle flexibility and balance thereby improving mobility and elasticity of the nervous system in stroke subjects.

Objectives: The objective of the study was to compare the effect of Dynamic Neural Mobilization and Proprioceptive Neuromuscular Facilitation on grip strength and upper limb function in sub-acute stroke subjects.

Materials and methods: 30 post-stroke subjects were recruited for the study based on the inclusion and exclusion criteria and were randomly divided into two groups. 15 subjects in Group A received Dynamic Neural Mobilization while 15 subjects in Group B received Proprioceptive Neuromuscular Facilitation. The treatment sessions were scheduled for 30 minutes per day, 5 times per week, for 4 weeks. Subjects were assessed for the upper limb function and grip strength prior to- and post-intervention using Fugl Meyer Assessment –Upper Extremity (FMA-UE) subscale and Hand Held Dynamometer.

Results: The pre-test score of FMA-UE and grip strength were 33.60±7.13 and 2.92±1.07 in Group A and 32.60±9.85 and 1.70±0.68 in Group B respectively. The post-test scores of FMA-UE and grip strength were 41.00±7.07 and 5.12±203 in Group A and 34.13±10.40 and 3.32±0.82 in Group B. Within group comparison showed significant improvement in Group A and in grip strength of Group B subjects. FMA-UE in Group B did not show significant results compared to pre-test scores. Between groups comparison showed statistically significant improvement in Group A in both the outcomes.

Conclusion: Based on the results, it can be concluded that Dynamic Neural Mobilization was more effective than Proprioceptive Neuromuscular Facilitation in improving grip strength and upper limb function in subacute stroke subjects.

Downloads

Download data is not yet available.

References

Allison R, Shenton L, Bamforth K, Kilbride C, Richards D. Incidence, time course and predictors of impairments relating to caring for the profoundly affected arm after stroke: a systematic review. Physiotherapy Research International. 2016 Dec;21(4):210-27.

Batool S, Soomro N, Amjad F, Fauz R. To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke. Pakistan journal of medical sciences. 2015 Sep;31(5):1167.

Kim WS, Cho S, Baek D, Bang H, Paik NJ. Upper extremity functional evaluation by Fugl-Meyer assessment scoring using depth-sensing camera in hemiplegic stroke patients. PloS one. 2016 Jul 1;11(7):e0158640.

Bailey RR, Klaesner JW, Lang CE. Quantifying real-world upper-limb activity in nondisabled adults and adults with chronic stroke. Neurorehabilitation and neural repair. 2015 Nov;29(10):969-78.

Langhorne P, Bernhardt J, Kwakkel G. Stroke Rehabilitation. The Lancet. 2011 May 14;377(9778):1693-702.

Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane database of systematic reviews. 2018(7).

Al Baradie RS. Neurodynamics and mobilization in Stroke Rehabilitation A Systematic Review. Majmaah Journal of Health Sciences. 2020 Mar 3;5(2):99-.

Ellis R, Hing W, Dilley A, McNair P. Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique. Ultrasound in medicine & biology. 2008 Aug 1;34(8):1209-16.

Godoi J, Kerppers II, Rossi LP, Corrêa FI, Costa RV, Corrêa JC, Oliveira CS. Electromyographic analysis of biceps brachii muscle following neural mobilization in patients with stroke. Electromyography and clinical neurophysiology. 2010 Jan 1;50(1):55-60.

Coppieters MW, Butler DS. Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual therapy. 2008 Jun 1;13(3):213-21.

Nee RJ, Vicenzino B, Jull GA, Cleland JA, Coppieters MW. Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve-related neck and arm pain: a randomised trial. Journal of physiotherapy. 2012 Mar 1;58(1):23-31.

Knoflach M, Matosevic B, Rücker M, Furtner M, Mair A, Wille G, Zangerle A, Werner P, Ferrari J, Schmidauer C, Seyfang L. Functional recovery after ischemic stroke—a matter of age: data from the Austrian Stroke Unit Registry. Neurology. 2012 Jan 24;78(4):279-85.

Boyd BS, Wanek L, Gray AT, Topp KS. Mechanosensitivity during lower extremity neurodynamic testing is diminished in individuals with Type 2 Diabetes Mellitus and peripheral neuropathy: a cross sectional study. BMC neurology. 2010 Dec;10:1-4.

Dobkin BH. Rehabilitation after stroke. New England Journal of Medicine. 2005 Apr 21;352(16):1677-84.

Nakamura R, Kosaka K. Effect of proprioceptive neuromuscular facilitation on EEG activation induced by facilitating position in patients with spinocerebellar degeneration. The Tohoku Journal of Experimental Medicine. 1986;148(2):159-61.

Stinear C, Ackerley S, Byblow W. Rehabilitation is initiated early after stroke, but most motor rehabilitation trials are not: a systematic review. Stroke. 2013 Jul;44(7):2039-45.

Voss DE. Proprioceptive neuromuscular facilitation. American Journal of Physical Medicine & Rehabilitation. 1967 Feb 1;46(1):838-98.

Shimura K, Kasai T. Effects of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potentials in upper limb muscles. Human movement science. 2002 Apr 1;21(1):101-13.

Kang JI, Moon YJ, Jeong DK, Choi H, Park JS, Choi HH, Song YK. Effects of dynamic neural mobilization on cerebral cortical activity in patients with stroke. Journal of Physical Therapy Science. 2018;30(7):906-9.

Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, Krakauer JW, Boyd LA, Carmichael ST, Corbett D, Cramer SC. Agreed definitions and a shared vision for new standards in stroke recovery research: the stroke recovery and rehabilitation roundtable taskforce. International Journal of Stroke. 2017 Jul;12(5):444-50.

Patten SB, Fick GH. Clinical interpretation of the mini-mental state. General hospital psychiatry. 1993 Jul 1;15(4):254-9.

Woytowicz EJ, Rietschel JC, Goodman RN, Conroy SS, Sorkin JD, Whitall J, Waller SM. Determining levels of upper extremity movement impairment by applying a cluster analysis to the Fugl-Meyer assessment of the upper extremity in chronic stroke. Archives of physical medicine and rehabilitation. 2017 Mar 1;98(3):456-62.

Chen ZJ, He C, Xia N, Gu MH, Li YA, Xiong CH, Xu J, Huang XL. Association between finger-to-nose kinematics and upper extremity motor function in subacute stroke: a principal component analysis. Frontiers in bioengineering and biotechnology. 2021 Apr 12;9:660015.

Amano S, Umeji A, Takebayashi T, Takahashi K, Uchiyama Y, Domen K. Clinimetric properties of the shortened Fugl-Meyer Assessment for the assessment of arm motor function in hemiparetic patients after stroke. Topics in Stroke Rehabilitation. 2020 May 18;27(4):290-5.

Singer B, Garcia-Vega J. The Fugl-Meyer upper extremity scale. Journal of physiotherapy. 2017 Jan 1;63(1):53.

Page SJ, Levine P, Hade E. Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke. Archives of physical medicine and rehabilitation. 2012 Dec 1;93(12):2373-6.

Aguiar LT, Martins JC, Lara EM, Albuquerque JA, Teixeira-Salmela LF, Faria CD. Dynamometry for the measurement of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials. Brazilian journal of physical therapy. 2016 Jul 11;20:395-404.

Faria CD, Aguiar LT, Lara EM, Souza LA, Martins JC, Teixeira-Salmela LF. Dynamometry for the assessment of grip, pinch, and trunk strength in subjects with chronic stroke: reliability and various sources of outcome values. Int J Phys Med Rehabil. 2013;1(8):1-5.

Amin W, Ahmed MM, Mohamed WE, Morsy M, Alfaifi BH, Almalki AH. The effects of mental practice combined with proprioceptive neuromuscular facilitation on muscle strength of upper limb and handgrip. Int J Sci Res. 2019;20(9):34843-8.

Tomić TJ, Savić AM, Vidaković AS, Rodić SZ, Isaković MS, Rodríguez-de-Pablo C, Keller T, Konstantinović LM. ArmAssist robotic system versus matched conventional therapy for poststroke upper limb rehabilitation: a randomized clinical trial. BioMed research international. 2017;2017(1):7659893.

Castilho J, Ferreira LA, Pereira WM, Neto HP, da Silva Morelli JG, Brandalize D, Kerppers II, Oliveira CS. Analysis of electromyographic activity in spastic biceps brachii muscle following neural mobilization. Journal of bodywork and movement therapies. 2012 Jul 1;16(3):364-8.

Santos AC, Goes AC, Lago RM, Petto J. Neural mobilization as a therapeutic option in the treatment of stroke. Manual Therapy, Posturology& Rehabilitation Journal. 2016 Aug 9;14:1-4.

Chaturvedi P, Singh AK, Kulshreshtha D, Tiwari V, Maurya PK, Thacker AK. Effects of early proprioceptive neuromuscular facilitation exercises on sensory-motor recovery of upper extremity and neuroplasticity in the patients with acute stroke. Medico Research Chronicles. 2018 Oct 31;5(5):378-90.

Downloads

Published

2024-12-17

How to Cite

Dynamic Neural Mobilization Versus Proprioceptive Neuromuscular Facilitation On Grip Strength And Upper Limb Function In Sub-Acute Stroke Subjects. (2024). Indian Journal of Physiotherapy and Occupational Therapy - An International Journal, 19(1), 15-20. https://doi.org/10.37506/73wxjw35