Post on 01-Apr-2015
Neurodynamic project
Hvidovre Hospital 7. October 2010
PT, MHSc, PhD student Jakob Lorentzen
Department of Physiotherapy, Hvidovre Hospital, Department of Neurorehabilitation TBI UNIT, Copenhagen University Hospital, Glostrup.
Baggrund ND
• The lack of mobility of the peripheral nerves in relation to the surrounding structures (so called “mechanical stresses”) is suggested (Shacklock, 1995) to be caused by variations in blood flow, axonal transport and impulse traffic.
• The primary treatment objective for ND is thus to ´restore the natural movement of the neural tissue and surrounding mechanical tissue’ and thereby’ reduce the intrinsic pressure on the neural tissue to regain natural physiological function’ (Butler, 2000; Shacklock, 1995).
• Often used treatment in physiotherapy.
• BUT – no evidence for it’s efficacy
Formål
• In this study we investigate the effect of ND in relation to change in muscle tone and ROM by a hand-held device in traumatic brain injury (TBI) patients with spasticity defined as “velocity-dependent increase in tonic stretch reflexes to phasic stretch, in the absence of voluntary activity” (Lance, 1980).
Method
• 10 TBI patients with spasticity in knee flexors
• Design: Blinded(single) , randomized, controlled, cross over design
• Intervention: single session treatment ND / RPM
• Three raters (two blinded and one non blinded to the intervention)
Outcome
– Objective measures:• Hand-held dynamometer
– Subjective measures?• Modified Ashworth Score (MAS)• Range of motion (ROM) (R1 og R2)• Change in muscle tone (VAS)
Objective stiffness measurements
MAS - blindet
MAS – ikke blindet
ROM (R1 og R2)
Subjectively perceived reduction in tone
Conclusion
ND seems not to be effective in reducing spasticity when evaluated objectively, but may increase ROM in the knee flexors with the same effect as random passive movements.
Thanks for your attention!
-and to the co-authors: Dorte Nielsen, Susanne Baagøe, Karl Holm, Michael J Grey, Jens B Nielsen
MAS reliabilitetAll three raters Two blinded raters
Absolute
agreement
(%)
Agreement +/- 1
(%)
Absolute
agreement (%)
Absolute
agreement +/-1
(%)
kappa (SE)
Knee flex pre ND 30 70 50 80 0.18 (0.26)
Knee flex post ND 10 100 40 100 0.19 (0.23)
Knee flex pre
RPM
10 60 40 100 0.14 (0.32)
Knee flex post
RPM
30 100 80 100 0.69 (0.19)
Knee ext pre ND 30 70 40 70 0.12 (0.22)
Knee ext post ND 40 80 60 80 0.39 (0.20)
Knee ext pre
RPM
20 90 70 90 0.14 (0.32)
Knee ext post
RPM
20 80 60 80 0.39 (0.18)
Median
Mean (SD)
25
23.8 (10.6)
80
81.3 (14.6)
55
55.0 (15.1)
85
87.5(11.7)
0.42 (0.1)*