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.