Impact of Order of Movement on Nerve Root Function

NCT ID: NCT05813002

Last Updated: 2023-04-14

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 75 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-04-30
• Study Completion Date: 2023-05-31

Brief Summary

the main objective of this study is to investigate if different neurodynamic test sequencing of the median nerve has a different impact on median nerve root function. We hypothesized that the order of median nerve neurodynamic movements would influence peak-to-peak amplitude and latency.

Detailed Description

Neurodynamic concept is used clinically to normalize nerve mobility. It has been manifested in previous studies that neurodynamics have increased mobility by floss like movement of the nerve. Whereas in other studies it has been concluded that neurodynamic techniques has an effect in decreasing fibrous and adhesions between neural tissues and the surrounding tissues therefore giving an outcome of improved infrafasicular gliding.

The upper limb neurodynamic test has an effect to alter the mechanical loads on the nerve by changing its dimensions. For neurodynamic to be more effective, it requires a certain sequence.

The different order of movements will induce different duration of tension in which it will influence the nerve root function, which is needed to be investigated to check for the effectiveness. A previous study has found that the difference of sequence on median nerve, had caused a change on the distribution of the sensory response on the asymptomatic participants. The sensory responses were more prevalent during the neurodynamic of the median nerve when it was applied from a distal to proximal sequence . One of the main purposes of the order of sequences is to add more strain to the nerve segment to increase the sensitivity of the test.

Clinically it has been assumed that the different order of movements could possibly influence the level of strain on a certain nerve segment. When the standard sequence was compared with the distal-to-proximal sequence for the median nerve, there was no physiological difference obtained at the end of the test. In comparison, there was a larger strain in the distal-to-proximal sequence in comparison to the proximal-to-distal sequence observed. However, the longitudinal excursion collected data indicated that the start and end positions for all the three sequences were alike.

In terms of neurophysiological outcomes, in this study we will use the dermatomal somatosensory evoked potential as a primary outcome due to its reliability in comparison with other physiological outcomes. There is a literature gap in regard to the effect of the order of sequence on the median nerve on the nerve root function and this is what the study will focus on. We hypothesized that the order of movements of the median nerve neurodynamic will influence the peak-to-peak amplitude and the latency.

Conditions

Physical and Rehabilitation Medicine

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: SINGLE

Study Groups

standard neurodynamic sequence

Participants in the first group will receive the standard neurodynamic sequence. The starting position for this sequence will be shoulder in extension with lateral rotation, elbow in full flexion and wrist in neutral position. Passively the shoulder is abducted till 90 degrees followed by wrist extension then ended by elbow extension. Ipsilateral movement of the head bending till 45 degrees with movement of the wrist towards the body for 10 repetitions

Group Type: ACTIVE_COMPARATOR

standard neural mobilization

Intervention Type: OTHER

is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system.

Distal to proximal neurodynamic sequence

The second group participants will receive the distal to proximal neurodynamic sequence. For this sequence the starting position will be shoulder in full extension with lateral rotation, elbow fully extended and wrist in neutral position. the sequence will start with wrist extension, going to elbow extension, and ending with shoulder abduction. Ipsilateral movement of the head bending till 45 degrees with movement of the wrist towards the body for 10 repetitions

Group Type: ACTIVE_COMPARATOR

Distal to proximal neural mobilization

Intervention Type: OTHER

is a distal to proximal movement-based intervention aimed at restoring the homeostasis in and around the nervous system.

proximal to distal neurodynamic sequence

The participants in the third experimental group will receive the proximal to distal sequence which will start with shoulder abduction, elbow extension and then wrist extension. The starting position is shoulder in extension and laterally rotated, elbow in full flexion, and wrist in neutral position. The shoulder will be passively mobilized to 90 degrees of abduction, elbow into full extension and wrist in full extension. Ipsilateral movement of the head bending till 45 degrees with movement of the wrist towards the body for 10 repetitions

Group Type: ACTIVE_COMPARATOR

proximal to distal neural mobilization

Intervention Type: OTHER

is a proximal to distal movement-based intervention aimed at restoring the homeostasis in and around the nervous system.

Interventions

standard neural mobilization

is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system.

Intervention Type: OTHER

Distal to proximal neural mobilization

is a distal to proximal movement-based intervention aimed at restoring the homeostasis in and around the nervous system.

Intervention Type: OTHER

proximal to distal neural mobilization

is a proximal to distal movement-based intervention aimed at restoring the homeostasis in and around the nervous system.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• not currently experiencing any neck or dominant upper extremity symptoms.
• do not have a history significant for a chronic painful condition.
• do not using pain relievers.

Exclusion Criteria

• inflammatory joint disease or other systemic pathologies.
• prior history of overt injury and surgery relating to the musculoskeletal system.
• disorder related to the spine and extremities.
• musculoskeletal pain in the last three months

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Sharjah

OTHER

Sponsor Role: lead

Responsible Party

Ibrahim Moustafa

Professor-chair of Physiotherapy Department

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Ibrahim M moustafa, Professor

Role: PRINCIPAL_INVESTIGATOR

University of Sharjah

Central Contacts

Ibrahim M [imoustafa], Professor

Role: CONTACT

iabuamr@sharjah.ac.ae

+971502180024 ext. 7513

Other Identifiers

REC-22-06-04-S

Identifier Type: -

Identifier Source: org_study_id