1. 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.

2. 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).

3. Often used treatment in physiotherapy. BUT – no evidence for it’s efficacy

4. 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).

5. 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)

6. Outcome – Objective measures: Hand-held dynamometer – Subjective measures? Modified Ashworth Score (MAS) Range of motion (ROM) (R1 og R2) Change in muscle tone (VAS)

7. Objective stiffness measurements

8. MAS - blindet

9. MAS – ikke blindet

10. ROM (R1 og R2)

11. Subjectively perceived reduction in tone

12. 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

13. MAS reliabilitet All three ratersTwo blinded raters Absolute agreement (%) Agreement +/- 1 (%) Absolute agreement (%) Absolute agreement +/-1 (%) kappa (SE) Knee flex pre ND307050 80 0.18 (0.26) Knee flex post ND1010040100 0.19 (0.23) Knee flex pre RPM 106040100 0.14 (0.32) Knee flex post RPM 3010080100 0.69 (0.19) Knee ext pre ND307040 70 0.12 (0.22) Knee ext post ND408060 80 0.39 (0.20) Knee ext pre RPM 209070 90 0.14 (0.32) Knee ext post RPM 208060 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)*