Exploring the participants experience of median nerve mobilization on spasticity and improving upper limb strength in individuals with stroke: A Mixed method study

Background: Spasticity after stroke is common that affect upper limb strength and make activities of daily living difficult. There are many techniques but not any standardized technique for long term effect on reduction of spasticity and improving upper limb strength. This study aimed to explore and understand the effectiveness of neural mobilization on spasticity and upper limb strength in individuals with stroke.
Method: This is mixed method approach of embedded design, multicentric study recruited 7 individuals with stroke as no new themes or codes were emerging (data saturated). Median nerve mobilization was given 20 oscillations per minute for 3 times & repeated 3 times with a pause of 1 minute between each sets for 5times/week for 4weeks. Outcome measures were Modified Ashworth Scale (MAS), Brunnstrom’s grading of hand recovery and Hydraulic hand dynamometer(HHD) for grip and pinch strength. Pre and post outcomes data were collected at baseline and 4weeks after intervention and in depth face to face structured interviews were conducted after 4weeks of intervention to explore the effectiveness of median nerve mobilization on reduction of spasticity and the improvement of upper limb strength.
Results: There was a significant improvement in all the quantitative outcome measures MAS, Brunnstrom grading and HHD with p <0.05 in each outcome. In qualitative, five major themes and 26 subthemes were identified: (1) Spasticity & Mobility, (2) Motor recovery, (3) Enhanced interpersonal interactions, (4) Psychological benefits, (5) Overall well-being. Overall participants described decreased assistance in ADL’s, able to hold and lift the objects, increased usage of affected hand and other 23 subthemes.
Conclusion: This study provides new knowledge about the benefits of more potentiate intervention for reduction of spasticity and improving upper limb strength in individuals with stroke for future implementation in clinical practice.

背景：中风后痉挛是常见的并发症，它会影响上肢的力量，使得日常生活的活动变得困难。尽管存在多种技术，但尚无任何标准化的技术能够长期有效地减少痉挛并提高上肢力量。本研究旨在探索并理解神经松动术对中风患者痉挛和上肢力量有效性的影响。
方法：本研究采用嵌入式设计、多中心研究方法，纳入了7名中风患者，由于没有新的主题或代码出现（数据饱和），因此纳入样本量适中。对正中神经进行松动治疗，每次治疗20次振荡，每天治疗3次，每周治疗5次，每次治疗之间休息1分钟，连续治疗4周。结果评估指标包括改良Ashworth量表（MAS）、Brunnstrom手恢复分级以及液压握力计（HHD）测量握力和捏力。在干预前后，分别在基线和干预4周后收集了结果数据。此外，在干预4周后进行了深入的面对面结构化访谈，以探讨正中神经松动术在减少痉挛和提高上肢力量方面的有效性。
结果：所有定量结果指标MAS、Brunnstrom分级和HHD均显示出显著改善，p值均小于0.05。在定性分析中，识别出五个主要主题和26个子主题：（1）痉挛与活动能力，（2）运动恢复，（3）人际互动增强，（4）心理益处，（5）整体福祉。总体而言，参与者描述了日常生活活动中的辅助需求减少，能够握持和举起物体，受影响手的使用频率增加，以及其他23个子主题。
结论：本研究为中风患者减少痉挛和提高上肢力量的更有效干预措施提供了新的知识，并为未来在临床实践中的应用提供了实施依据。