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Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation are effective in reducing of upper limb sensory in late-stage stroke subjects: a three-group randomized trial [with consumer summary]
Wolny T, Saulicz E, Gnat R, Kokosz M
Clinical Rehabilitation 2010 Sep;24(9):810-821
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

QUESTION: Are Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation and traditional post-stroke therapy more effective in reducing affected upper extremity sensory deficits in late-stage stroke subjects than proprioceptive neuromuscular facilitation combined with traditional therapy or traditional therapy alone? DESIGN: Pretest-posttest three-group randomized clinical experimental design. PARTICIPANTS: A total of 96 late-stage stroke subjects were randomly assigned to three groups. INTERVENTION: The therapeutic programme in the control group was based on traditional post-stroke methods. The second group (experimental 1) received in addition individual therapy based on the proprioceptive neuromuscular facilitation method. The third group (experimental 2) received a combination: traditional therapeutic programme plus individual proprioceptive neuromuscular facilitation exercises plus neuromobilization of the affected upper extremity. All groups received 18 training sessions lasting about 45 minutes each. OUTCOME MEASURES: Assessment of the two-point discriminatory sense (distance between the tips of the compass when the subject indicated two-point sensation), stereognosia (identification up to 10 objects by touch) and thermaesthesia (using hot and cold cylinders on dermatomes C6 to C8) were performed. RESULTS: Analysis of change scores showed that two-point discriminatory sense for experimental group 2 was significantly better than that in the two other groups (p < 0.001). Similar results were registered for thermaesthesia (experimental 2 versus experimental 1 p < 0.01; experimental 2 versus control p < 0.001). For stereognosia the only significant difference was found between experimental group 2 and the control group (p < 0.05). CONCLUSION: In our subjects, application of Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation showed greater effectiveness in reducing sensory deficits than proprioceptive neuromuscular facilitation or traditional therapy alone.

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