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)*