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Al Kassir K.1,2,3, Abdel Nour Lattouf N.2, Akawi R.2, Rima W.1
1Beit Chabab Hospital, Physical Therapy Department, Beit Chabab, Lebanon, 2Saint Joseph University, Faculty of Medicine, Institute of Physical Therapy, Beirut, Lebanon, 3Lebanese University, Faculty of Public Health, Physical Therapy Department, Fanar, Lebanon
Background: Algoneurodystrophy or complex regional pain syndrome (CRPS) of the upper limb is a common complication for stroke or hemiplegic patients. Its clinical presentation associates pain, joint stiffness, vasomotor and trophic disorders for the shoulder and or the hand, and can limit the functional recovery.
This syndrome is considered purely neurological, linked to a dysfunctional coupling between somatic and nociceptive afferents for the peripheral, central and Sympathetic systems and their regulatory abnormal efferent fibers.
The biomechanics of the nervous system allows it to provide a right chemical functionality through neurotransmitters, and electrical functionality through the action potentials.
These biomechanics are represented firstly by the movement of the nerve with respect to the interfaces that it surrounds and called extra neural interface, and secondly by the sliding of the nerve fibers relative to the other and called intra neural interface.
If one of the two components is not working properly, there will be a dysfunction in the efferent and afferent work of the nervous system and the vicious circle of pain, swelling and stiffness will be maintained.
This syndrome is considered purely neurological, linked to a dysfunctional coupling between somatic and nociceptive afferents for the peripheral, central and Sympathetic systems and their regulatory abnormal efferent fibers.
The biomechanics of the nervous system allows it to provide a right chemical functionality through neurotransmitters, and electrical functionality through the action potentials.
These biomechanics are represented firstly by the movement of the nerve with respect to the interfaces that it surrounds and called extra neural interface, and secondly by the sliding of the nerve fibers relative to the other and called intra neural interface.
If one of the two components is not working properly, there will be a dysfunction in the efferent and afferent work of the nervous system and the vicious circle of pain, swelling and stiffness will be maintained.
Purpose: Will the neurodynamics and manual therapy release the intra and extra neural interfaces to increase neural results regarding the reduction of swelling and pain, as well as increasing the range of motion in hemiplegic patients suffering from CRPS in the left upper limb versus conventional physiotherapy?
Methods: A randomized controlled trial was conducted during 2 years at Beit Chabab Hospital on sixty left hemiplegic patients, aged between 60 and 80 years with CRPS since maximum three months.
Ten sessions, two each week, were conducted by two physical therapists, each for one of the two groups. A comparative group is composed of thirty patients undergoing physiotherapy treatment and another identical experimental group who received manual therapy and neurodynamics for the peripheral nerves and the sympathetic system.
Before and after results were tested by another therapist for 25 criteria issued from four variables: range of motion evaluated with an electronic goniometre (11 criteria or movement), edema measured with a tape-meter (8 criteria or point of reference), pain assessed with the Visual Analogue Scale (2 criteria) and the peripheral nervous condition evaluated by the Upper Limb Tension Test (4 criteria).
Results: After using statistical tests "Repeated Measures ANOVA" for quantitative variables, and the "Fisher" for qualitative variables, the experimental group had significant results (pvalue 0.05) on twenty one criteria used to assess the symptoms of CRPS in comparison with the comparative group. Four criteria had non-significant results (pvalue >0.05), which means that the two groups gave the same results with both approaches.
Conclusion(s): We note that neurodynamics and manual therapy have an important action on decreasing symptoms of CRPS, which means that the range of motion, edema, pain and the peripheral nervous condition have been more improved than with conventional physiotherapy treatment.
Implications: There´s a possibility of introducing these techniques in the rehabilitation of the complex regional pain syndrome since its the first study concerning neurodynamics and manual therapy with this neurological syndrome.
Funding acknowledgements: This research was supported by the Physical therapy reaserch center Saint Joseph University and medical committee at Beit Chabab Hospital
Topic: Neurology: stroke
Ethics approval: An informed consent was signed by every patient, and we got the agreement of the hospital medical committee
All authors, affiliations and abstracts have been published as submitted.
