Presentation on theme: "Neurodynamic project Hvidovre Hospital 7. October 2010 PT, MHSc, PhD student Jakob Lorentzen Department of Physiotherapy, Hvidovre Hospital, Department."— Presentation transcript:
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 reliabilitet All three ratersTwo blinded raters Absolute agreement (%) Agreement +/- 1 (%) Absolute agreement (%) Absolute agreement +/-1 (%) kappa (SE) Knee flex pre ND (0.26) Knee flex post ND (0.23) Knee flex pre RPM (0.32) Knee flex post RPM (0.19) Knee ext pre ND (0.22) Knee ext post ND (0.20) Knee ext pre RPM (0.32) Knee ext post RPM (0.18) Median Mean (SD) (10.6) (14.6) (15.1) (11.7) 0.42 (0.1)*