Diagnostic accuracy of the upper limb neurodynamic test 1 using neurodynamic sequencing in diagnosis of carpal tunnel syndrome

BACKGROUND

The upper limb neurodynamic test 1 is used in the diagnosis of median nerve neuropathies such as carpal tunnel syndrome but its diagnostic validity remains limited. Neurodynamic sequencing has been suggested to increase the specificity of the neurodynamic tests, however, to date, information on the diagnostic accuracy of this variation in neurodynamic testing is required.

OBJECTIVES

The aim of this study was to analyze the diagnostic validity of the local sequence of ULNT1 (LS-ULNT1) (i.e. a sequence that begins at the joint where the problem is (wrist) and progressively moves joints further away from it), in the diagnosis of CTS. A secondary aim was to describe the location of sensory responses to this modified neurodynamic test sequence.

DESIGN

A prospective diagnostic accuracy study was designed.

METHOD

Nerve conduction studies were used as the gold standard. The LS-ULNT1 was performed in 58 consecutive patients (17 men, 44 women) with suspected CTS.

RESULTS

Sensitivity of the LS-ULNT1 was 65.7% (CI 48.0-80.9%) and the specificity was 95.7% (CI 78.1-99.9%). The positive and negative likelihood ratios were >5 and < 0.5, respectively, indicating the ability of the test to generate small but sometimes important changes in post-test probability.

CONCLUSIONS

The overall results of this study showed that the LS-ULNT1 could be useful in confirming the diagnosis of CTS. The test demonstrated high specificity and the +LR indicated the ability of the test to generate changes in posttest probability, especially with a positive LS-ULNT1 result.

A Self-Similarity Logic May Shape the Organization of the Nervous System

From the morphological point of view, the nervous system exhibits a fractal, self-similar geometry at various levels of observations, from single cells up to cell networks. From the functional point of view, it is characterized by a hierarchical organization in which self-similar structures (networks) of different miniaturizations are nested within each other. In particular, neuronal networks, interconnected to form neuronal systems, are formed by neurons, which operate thanks to their molecular networks, mainly having proteins as components that via protein-protein interactions can be assembled in multimeric complexes working as micro-devices. On this basis, the term "self-similarity logic" was introduced to describe a nested organization where, at the various levels, almost the same rules (logic) to perform operations are used. Self-similarity and self-similarity logic both appear to be intimately linked to the biophysical evidence for the nervous system being a pattern-forming system that can flexibly switch from one coherent state to another. Thus, they can represent the key concepts to describe its complexity and its concerted, holistic behavior.

Fractal Neurodynamics

The neuronal ongoing electrical activity in the brain network, the neurodynamics, reflects the structure and functionality of generating neuronal pools. The activity of neurons due to their excitatory and inhibitory projections is associated with specific brain functions. Here, the purpose was to investigate if the local ongoing electrical activity exhibits its characteristic spectral and fractal features in wakefulness and sleep across and within subjects. Moreover, we aimed to show that measures typical of complex systems catch physiological features missed by linear spectral analyses. For this study, we concentrated on the evaluation of the power spectral density (PSD) and Higuchi fractal dimension (HFD) measures. Relevant clinical impact of the specific features of neurodynamics identification stands primarily in the potential of classifying cortical parcels according to their neurodynamics as well as enhancing the effectiveness of neuromodulation interventions to cure symptoms secondary to neuronal activity unbalances.

The sono-elastography evaluation of the immediate effects of neurodynamic mobilization technique on median nerve stiffness in patients with carpal tunnel syndrome

OBJECTIVES

The stiffness of median nerve increases in carpal tunnel syndrome (CTS) even at mild stage of syndrome which could be regarded as a diagnostic criterion. The aim of this study was to evaluate the immediate effects of neurodynamic technique on median nerve stiffness and cross-sectional area (CSA) at wrist and elbow in individuals with CTS.

MATERIAL AND METHODS

It was a quasi-experimental study. Twenty patients were recruited for this study. They were included if aged 18-65 years and diagnosed with CTS based on electrodiagnostic and clinical findings. The exclusion criteria were previous surgeries at wrist or elbow. Patients were assessed by shear wave sono-elastography before and immediately after one session of neurodynamic mobilization technique (NDM). The primary outcome measure was the stiffness of the median nerve at wrist and the secondary outcomes were nerve stiffness at elbow and CSA of nerve at wrist and elbow.

RESULTS

Median nerve stiffness and CSA decreased significantly at wrist immediately after a session of NDM. These parameters also decreased at elbow but were not statistically significant.

CONCLUSION

One session of NDM reduced the stiffness and CSA of median nerve at wrist in patients with CTS as detected by sono-elastography verifying that sono-elastography is able to quickly detect the immediate biomechanical changes of the median nerve.

Neural energy computations based on Hodgkin-Huxley models bridge abnormal neuronal activities and energy consumption patterns of major depressive disorder

Limited by the current experimental techniques and neurodynamical models, the dysregulation mechanisms of decision-making related neural circuits in major depressive disorder (MDD) are still not clear. In this paper, we proposed a neural coding methodology using energy to further investigate it, which has been proven to strongly complement the neurodynamical methodology. We augmented the previous neural energy calculation method, and applied it to our VTA-NAc-mPFC neurodynamical H-H models. We particularly focused on the peak power and energy consumption of abnormal ion channel (ionic) currents under different concentrations of dopamine input, and investigated the abnormal energy consumption patterns for the MDD group. The results revealed that the energy consumption of medium spiny neurons (MSNs) in the NAc region were lower in the MDD group than that of the normal control group despite having the same firing frequencies, peak action potentials, and average membrane potentials in both groups. Dopamine concentration was also positively correlated with the energy consumption of the pyramidal neurons, but the patterns of different interneuron types were distinct. Additionally, the ratio of mPFC's energy consumption to total energy consumption of the whole network in MDD group was lower than that in normal control group, revealing that the mPFC region in MDD group encoded less neural information, which matched the energy consumption patterns of BOLD-fMRI results. It was also in line with the behavioral characteristics that MDD patients demonstrated in the form of reward insensitivity during decision-making tasks. In conclusion, the model in this paper was the first neural network energy computational model for MDD, which showed success in explaining its dynamical mechanisms with an energy consumption perspective. To build on this, we demonstrated that energy consumption levels can be used as a potential indicator for MDD, which also showed a promising pipeline to use an energy methodology for studying other neuropsychiatric disorders.

The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: A randomized parallel-group clinical trial

INTRODUCTION

Carpal tunnel syndrome (CTS) is a common disorder that limits function and quality of life. Little evidence is available on the long-term effect of neurodynamics and exercise therapy.

PURPOSE OF THE STUDY

This study aimed to examine the long-term effect of neurodynamic techniques vs exercise therapy in managing patients with CTS.

STUDY DESIGN

Parallel group randomized clinical trial.

METHODS

Of 57 patients screened, 51 were randomly assigned to either receiving four sessions of neurodynamics and exercise or home exercise therapy alone as a control. Blinded assessment was performed before treatment allocation, at treatment completion, and 6 months posttreatment. Outcome measures included Symptom Severity Scale (SSS), Functional Status Scale (FSS), Shortened version of the Disabilities of the Arm, Shoulder, and Hand (DASH), Numerical Pain Rating Scale, grip strength and range of motion.

RESULTS

Data from 41 individuals (52 hands) were analyzed. The neurodynamics group demonstrated significant improvement in all outcome measures at 1 and 6 months (P < .05). Mean difference in SSS was 1.4 (95% CI= 0.9-1.4) at 1 month and 1.6 (95% CI = 0.9-2.2) at 6 months. Mean difference in FSS was 0.9 (95% CI = 0.4-1.4) at 1 month and 1.4 (95% CI = 0.7-2.0) at 6 months. Significant between-group differences were found in pain score at 1 month (-1.93) and in FSS (-0.5) and Shortened version of DASH (-12.6) at 6 months (P < .05). No patient needed surgery 1 year after treatment.

CONCLUSIONS

Although both treatments led to positive outcomes, neurodynamics therapy was superior in improving function and strength and in decreasing pain.

Neurodynamics: is tension contentious?

Tensioning techniqueswere the first neurodynamic techniques used therapeutically in the management of people with neuropathies. This article aims to provide a balanced evidence-informed view on the effects of optimal tensile loading on peripheral nerves and the use of tensioning techniques. Whilst the early use of neurodynamics was centered within a mechanical paradigm, research into the working mechanisms of tensioning techniques revealed neuroimmune, neurophysiological, and neurochemical effects. In-vitro and ex-vivo research confirms that tensile loading is required for mechanical adaptation of healthy and healing neurons and nerves. Moreover, elimination of tensile load can have detrimental effects on the nervous system. Beneficial effects of tensile loading and tensioning techniques, contributing to restored homeostasis at the entrapment site, dorsal root ganglia and spinal cord, include neuronal cell differentiation, neurite outgrowth and orientation, increased endogenous opioid receptors, reduced fibrosis and intraneural scar formation, improved nerve regeneration and remyelination, increased muscle power and locomotion, less mechanical and thermal hyperalgesia and allodynia, and improved conditioned pain modulation. However, animal and cellular models also show that ‘excessive’ tensile forces have negative effects on the nervous system. Although robust and designed to withstand mechanical load, the nervous system is equally a delicate system. Mechanical loads that can be easily handled by a healthy nervous system, may be sufficient to aggravate clinical symptoms in patients. This paper aims to contribute to a more balanced view regarding the use of neurodynamics and more specifically tensioning techniques.

Effects of joint and nerve mobilisation on neuroimmune responses in animals and humans with neuromusculoskeletal conditions: a systematic review and meta-analysis

Supplemental Digital Content is Available in the Text.

There is evidence that joint and nerve mobilisations compared with sham or no intervention positively influence various neuroimmune responses in animal and human neuromusculoskeletal conditions.

Several animal and human studies revealed that joint and nerve mobilisations positively influence neuroimmune responses in neuromusculoskeletal conditions. However, no systematic review and meta-analysis has been performed. Therefore, this study aimed to synthesize the effects of joint and nerve mobilisation compared with sham or no intervention on neuroimmune responses in animals and humans with neuromusculoskeletal conditions. Four electronic databases were searched for controlled trials. Two reviewers independently selected studies, extracted data, assessed the risk of bias, and graded the certainty of the evidence. Where possible, meta-analyses using random effects models were used to pool the results. Preliminary evidence from 13 animal studies report neuroimmune responses after joint and nerve mobilisations. In neuropathic pain models, meta-analysis revealed decreased spinal cord levels of glial fibrillary acidic protein, dorsal root ganglion levels of interleukin-1β, number of dorsal root ganglion nonneuronal cells, and increased spinal cord interleukin-10 levels. The 5 included human studies showed mixed effects of spinal manipulation on salivary/serum cortisol levels in people with spinal pain, and no significant effects on serum β-endorphin or interleukin-1β levels in people with spinal pain. There is evidence that joint and nerve mobilisations positively influence various neuroimmune responses. However, as most findings are based on single studies, the certainty of the evidence is low to very low. Further studies are needed.

Upper limb neurodynamic testing with radial and ulnar nerve biases: An analysis of cervical spinal nerve mechanics

BACKGROUND

Clinical research supports a combination of upper limb neurodynamic testing (ULNT) strategies to rule out upper limb and cervical neurogenic pathology; however, knowledge of the biomechanical response of spinal nerves during ULNT is lacking for radial and ulnar nerve biases.

OBJECTIVE

To assess whether radial and ulnar nerve biased strategies of ULNT elicit significant displacement and strain of cervical spinal nerves.

STUDY DESIGN

Cross-sectional.

METHODS

Radiolucent markers were implanted into spinal nerves C5-C8 proximal and distal to the intervertebral foramen in nine unembalmed cadavers (six male; three female) age 80.1 ± 13.2 years. Fluoroscopic images were captured during ULNT with radial and ulnar nerve biases. Images at rest and maximum tension were digitized and displacement and strain were measured. All data were analyzed using one sample t-tests and a generalized linear mixed models approach.

RESULTS

Upper limb neurodynamic testing with radial nerve bias resulted in displacement (2.44-3.04 mm) and strain (7.99-11.98%) and ULNT with ulnar nerve bias resulted in displacement (2.16-4.41 mm) and strain (7.12 and 12.95%). Significant extraforaminal displacement occurred during radial and ulnar nerve biases for all spinal nerves (all P < 0.05) whereas significant strain occurred during ulnar nerve biases for all spinal nerves but only in C6-C8 during radial nerve bias.

CONCLUSION

Upper limb neurodynamic testing using both radial and ulnar nerve biases resulted in cervical spinal nerve displacement and strain. Such techniques could be used to tension load or mobilize or cervical spinal nerves to evaluate for pathology.

Effect of Neurodynamics Nerve Flossing on Femoral Neuropathy in Haemophilic Patients: A randomized controlled study

OBJECTIVE

Heamophilia is considered a disorder in both children and adolescents which may affect their quality of life seriously than their normal peers; this study investigated the impact of the Neurodynamics Nerve Flossing Technique (NFT) on femoral neuropathy in patients with haemophilia.

METHOD

Thirty haemophilic children with Femoral Neuropathy were randomly allocated into two equivalent groups; the study group which received Neurodynamics NFT of the femoral nerve and conventional therapy program, and the control group which received only the conventional therapy program, three sessions/week for 12 weeks. Femoral nerve motor conduction velocity (MCV) and level of pain sensation according to the Visual Analogue Scale (VAS), were assessed pre and post interventions.

RESULTS

post-treatment comparison between both groups revealed that there was a significant increase in femoral nerve MCV and reduction of pain sensation of the study group compared to the control group (p<0.05).

CONCLUSION

Neurodynamics Nerve flossing had a clear effect in the treatment of femoral neuropathy in children with haemophilia.

A Bayesian method for inference of effective connectivity in brain networks for detecting the Mozart effect

Several studies claim that listening to Mozart music affects cognition and can be used to treat neurological conditions like epilepsy. Research into this Mozart effect has not addressed how dynamic interactions between brain networks, i.e. effective connectivity, are affected. The Granger-causality analysis is often used to infer effective connectivity. First, we investigate if a new method, Bayesian topology identification, can be used as an alternative. Both methods are evaluated on simulation data, where the Bayesian method outperforms the Granger-causality analysis in the inference of connectivity graphs of dynamic networks, especially for short data lengths. In the second part, the Bayesian method is extended to enable the inference of changes in effective connectivity between groups of subjects. Next, we apply both methods to fMRI scans of 16 healthy subjects, who were scanned before and after the exposure to Mozart's sonata K448 at least 2 hours a day for 7 days. Here, we investigate if the effective connectivity of the subjects significantly changed after listening to Mozart music. The Bayesian method detected changes in effective connectivity between networks related to cognitive processing and control in the connection from the central executive to the superior sensori-motor network, in the connection from the posterior default mode to the fronto-parietal right network, and in the connection from the anterior default mode to the dorsal attention network. This last connection was only detected in a subgroup of subjects with a longer listening duration. Only in this last connection, an effect was found by the Granger-causality analysis.

The immediate effect of neurodynamic techniques on jumping performance: A randomised double-blind study

BACKGROUND AND OBJECTIVES

Neurodynamic techniques are used to restore neural functions. However, there are few studies about the effects on performance. The aim of this study was to investigate the immediate effects on vertical jumping (VJ) and horizontal jumping (HJ) of 2 different tension loading techniques applied to young adults.

MATERIAL AND METHOD

In this randomised double-blind study, a total of 68 participants with a mean age of 21.31 ± 1.21 years were separated into 2 groups using the closed envelope system: the femoral nerve mobilization (FNM) group and the sciatic nerve mobilization (SNM) group. The FNM and SNM techniques were applied as 2 seconds stretching with 2 seconds resting for 10 repetitions. The VJ and HJ performance of the participants was evaluated before and after the interventions by a researcher blinded to the groups.

RESULTS

The mean VJ performance before and after interventions was measured as 34.56 ± 7.80 cm and 35.89 ± 8.15 cm in the FNM group (p< 0.05) and 31.74 ± 8.31 cm and 32.76 ± 8.45 cm in the SNM group (p< 0.05). The effects of the techniques on HJ performance were not statistically significant (p> 0.05). There was no superiority between the techniques (p> 0.05).

CONCLUSION

The neurodynamic techniques were found to provide an immediate increase in VJ performance. Neurodynamic techniques are generally used in patient populations to improve treatment outcomes. According to these study results, neurodynamic techniques can be safely used to provide an immediate increase in performances of individuals with no lower extremity problems.

Neurodynamic sliders promote flexibility in tight hamstring syndrome

ABSTRACT Hamstring injury prevention puts emphasis on optimizing the muscle's strength-length relationship. To assure appropriate muscle length, flexibility training is imperative. As neurodynamics play an important role herein, the goal of this study was to explore the intervention effect of home-based neurodynamic slider program on hamstring flexibility. Fifty physically active male subjects were randomly assigned to either performing a neurodynamic sliding technique (3 × 20 reps) or a static stretching protocol (3 × 30″) on a daily basis for a 6-week period. Hamstring flexibility was assessed by means of the Straight Leg Raise at baseline, immediately after the intervention and after 4 weeks follow up. There was no between group baseline difference in hamstring flexibility. The repeated measure ANOVA showed a significant interaction effect for group × time (p < 0.001). Independent sample t-test showed a significantly higher increase in flexibility gain in the neurodynamic group immediately after the intervention (p < 0.001), as well as at 4 weeks retention analysis (p = 0.001) compared to the static stretch group. In conclusion, neurodynamic sliders might be more efficient than regular static stretching in affecting hamstring flexibility in the long run.

From the hierarchical organization of the central nervous system to the hierarchical aspects of biocodes

The quite recent (at least on the evolutionary time scale) emergence of nervous systems in complex organisms enabled the living beings to build a wide-ranging model of the external world in order to predict and evaluate the outcomes of their actions. Such a process likely represents a real coding activity, since, by proper handling of information, it generates a mapping between the external environment and internal cerebral activity patterns. The patterns of neural activity that correspond to the final maps, however, emerge from the holistic assembly of a multilevel functional organization. Nerve tissue components, indeed, appear organized in compartments, also called functional modules (FM), that contain system components and circuits of different miniaturizations not only arranged to work together either in parallel or in series but also nested within each other. At least three levels can be recognized in a functional module and it is possible to point out that such a hierarchical organization of the brain circuits could be mirrored by a corresponding hierarchical organization of biocodes. This feature can also suggest the hypothesis that the same logic could operate also at system level to integrate FM into functional brain areas and to associate areas to generate the final map used by humans to image the external world and to imagine untestable worlds.

Upper Limb Neurodynamic Test 1 in patients with Acquired Brain Injury: a cross-sectional study

Introduction: Neurodynamic intervention is used in the treatment of patients with Acquired Brain Injury as a method to inhibit the spasticity or reduce the sensory impairment. Purpose of the study: Assess and compare bilateral median nerve mechanosensitivity and its relationship with physical and functional status in patients with hemiparesis or upper limb paresis after ABI. Materials and Methods: Volunteer Patients from the Brain Injury Rehabilitation Unit of the Hospital Universitario Central de Asturias were evaluated for six months. Taking into account inclusion and exclusion criteria, from the 98 original patients having treatment in the Unit included, only 32 were admitted to the final study. The assessment protocol incorporated as main outcomes: bilateral mechanosensitivity of the median nerve (sensory responses, structural differentiation and maximum range of movement in Upper Limb Neurodynamic Test 1) and as secondary outcomes: hypertonia, sensory impairment, upper limb motor function and Activities of Daily Living performance. Results: Significant differences were found when comparing the bilateral maximum range of movement in Upper Limb Neurodynamic Test 1. No relationship was found between the results of the neurodynamic test of the affected upper limb and the secondary outcomes. Conclusions: Mechanosensitivity disturbance observed in the affected upper limb may benefit from neurodynamic treatment.

Femoral nerve excursion with knee and neck movements in supine, sitting and side-lying slump: An in vivo study using ultrasound imaging

BACKGROUND

Neurodynamic assessment and management are advocated for femoral nerve pathology. Contrary to neurodynamic techniques for other nerves, there is limited research that quantifies femoral nerve biomechanics.

OBJECTIVES

To quantify longitudinal and transverse excursion of the femoral nerve during knee and neck movements.

DESIGN

Single-group, experimental study, with within-participant comparisons.

METHODS

High-resolution ultrasound recordings of the femoral nerve were made in the proximal thigh/groin region in 30 asymptomatic participants. Scans were made during knee flexion in supine and a semi-seated position, and during neck flexion in side-lying slump (Slump _FEMORAL). Healthy participants were assessed to reveal normal nerve biomechanics, not influenced by pathology. Data were analysed with one-sample and paired t-tests. Reliability was assessed with intraclass correlation coefficients (ICC).

RESULTS

Longitudinal and transverse excursion measurements were reliable (ICC≥0.87). With knee flexion, longitudinal femoral nerve excursion was significant and larger in supine than in sitting (supine (mean (SD)): 3.6 (2.0) mm; p < 0.001; sitting: 1.1 (1.6) mm; p = 0.001; comparison: p = 0.001). There was also excursion in a medial direction (supine: 1.4 (0.3) mm; p < 0.001; sitting: 0.7 (0.6) mm; p < 0.001) and anterior direction (supine: 0.2 (0.2) mm; p < 0.001; sitting: 0.1 (0.2) mm; p = 0.06). Neck flexion in Slump _FEMORAL did not result in longitudinal (0.0 (0.3) mm; p = 0.55) or anteroposterior (0.0 (0.1) mm; p = 0.10) excursion, but resulted in medial excursion (1.1 (0.5) mm; p < 0.001).

CONCLUSION

Although the femoral nerve terminates proximal to the knee, femoral nerve excursion in the proximal thigh occurred with knee flexion; Neck flexion in Slump _FEMORAL resulted in medial excursion.

The immediate effect of osteopathic cervical spine mobilization on median nerve mechanosensitivity: A triple-blind, randomized, placebo-controlled trial

BACKGROUND

Neurodynamics is a clinical medium for testing the mechanical sensitivity of peripheral nerves which innervate the tissues of both the upper and lower limb. Currently, there is paucity in the literature of neurodynamic testing in osteopathic research, and where there is research, these are often methodologically flawed, without the appropriate comparators, blinding and reliability testing.

AIMS

This study aimed to assess the physiological effects (measured through Range of Motion; ROM), of a commonly utilized cervical mobilization treatment during a neurodynamic test, with the appropriate methodology, i.e., compared against a control and sham. Specifically, this was to test whether cervical mobilization could reduce upper limb neural mechanical sensitivity.

METHODOLOGY

Thirty asymptomatic participants were assessed and randomly allocated to either a control, sham or mobilization group, where they were all given a neurodynamic test and ROM was assessed.

RESULTS

The results showed that the mobilization group had the greatest and most significant increase in ROM with Change-Left p < 0.05 and Change-Right p < 0.05 compared against the control group, and Change-Left p < 0.01 and Change-Right p < 0.05 compared against the sham group.

CONCLUSIONS

This study has highlighted that, as expected, cervical mobilization has an effect at reducing upper limb neural mechanical sensitivity. However, there may be other factors interacting with neural mechanosensitivity outside of somatic influences such as psychological expectation bias. Further research could utilize the methodology employed here, but with other treatment areas to help develop neural tissue research. In addition to this, further exploration of psychological factors should be made such as utilizing complex top-down cognitive processing theories such as the neuromatrix or categorization theories to help further understand cognitive biases such as the placebo effect, which is commonly ignored in osteopathic research, as well as other areas of science, and which would further complete a holistic perspective.

Therapeutic heat and cold around the elbow on the response of median neurodynamic test 1

OBJECTIVE

To compare the effects of the application of therapeutic heat and cold on the mechanical response of the median nerve neurodynamic testing.

DESIGN

Single-blinded randomized crossover trial.

METHODOLOGY

56 asymptomatic university students (mean age = 21.82 ± 1.64 years) of either gender with a limited elbow extension range of motion during a Median Neurodynamic Test 1 were recruited. Each subject was administered 3 testing conditions on separate days with a 24-hr washout period. The interventions included 1) therapeutic moist heat around the elbow, 2) therapeutic cold around the elbow and 3) no thermal agent as a controlled condition. Outcome measure of elbow extension range of motion at the onset of pain and submaximal pain were recorded before the intervention, immediately after the removal of the thermal agents (20^th min) and at 2 subsequent readings of 30 min and 1 hour after the removal of the thermal agent.

RESULTS

There was a significant effect of using a thermal agent with time on the elbow range of motion at the onset of pain [F(2,165) = 3.622, p = 0.029] and submaximal pain[F(2,165) = 3.841, p = 0.023] at the 20th min. A posthoc comparison indicated that at the 20th min the mean elbow range at the onset of pain and submaximal pain for the therapeutic heat condition (mean = 33.5, S.D = 13.37 and mean = 16.80, S.D = 12.99 respectively) was significantly different than the no thermal agent condition (mean = 40.17, S.D = 12.34 and mean = 23.4, S.D = 13.82 respectively). However, therapeutic cold condition did not significantly differ from both the other conditions.

CONCLUSION

Therapeutic heat causes an immediate increase in elbow extension range of motion during a Median Neurodynamic Test1 and testing post the application of thermal agents can alter the test response.

Wavelet coherence-based classifier: A resting-state functional MRI study on neurodynamics in adolescents with high-functioning autism

BACKGROUND AND OBJECTIVE

The autism spectrum disorder (ASD) diagnosis requires a long and elaborate procedure. Due to the lack of a biomarker, the procedure is subjective and is restricted to evaluating behavior. Several attempts to use functional MRI as an assisting tool (as classifier) have been reported, but they barely reach an accuracy of 80%, and have not usually been replicated or validated with independent datasets. Those attempts have used functional connectivity and structural measurements. There is, nevertheless, evidence that not the topology of networks, but their temporal dynamics is a key feature in ASD. We therefore propose a novel MRI-based ASD biomarker by analyzing temporal brain dynamics in resting-state fMRI.

METHODS

We investigate resting-state fMRI data from 2 independent datasets of adolescents: our in-house data (12 ADS, 12 controls), and the Leuven dataset (12 ASD, 18 controls, from Leuven university). Using independent component analysis we obtain relevant socio-executive resting-state networks (RSNs) and their associated time series. Upon these time series we extract wavelet coherence maps. Using these maps, we calculate our dynamics metric: time of in-phase coherence. This novel metric is then used to train classifiers for autism diagnosis. Leave-one-out cross validation is applied for performance evaluation. To assess inter-site robustness, we also train our classifiers on the in-house data, and test them on the Leuven dataset.

RESULTS

We distinguished ASD from non-ASD adolescents at 86.7% accuracy (91.7% sensitivity, 83.3% specificity). In the second experiment, using Leuven dataset, we also obtained the classification performance at 86.7% (83.3% sensitivity, and 88.9% specificity). Finally we classified the Leuven dataset, with classifiers trained with our in-house data, resulting in 80% accuracy (100% sensitivity, 66.7% specificity).

CONCLUSIONS

This study shows that change in the coherence of temporal neurodynamics is a biomarker of ASD, and wavelet coherence-based classifiers lead to robust and replicable results and could be used as an objective diagnostic tool for ASD.

Dynamic response and transfer function of social systems: A neuro-inspired model of collective human activity patterns

The interaction of social networks with the external environment gives rise to non-stationary activity patterns reflecting the temporal structure and strength of exogenous influences that drive social dynamical processes far from an equilibrium state. Following a neuro-inspired approach, based on the dynamics of a passive neuronal membrane, and the firing rate dynamics of single neurons and neuronal populations, we build a state-of-the-art model of the collective social response to exogenous interventions. In this regard, we analyze online activity patterns with a view to determining the transfer function of social systems, that is, the dynamic relationship between external influences and the resulting activity. To this end, first we estimate the impulse response (Green's function) of collective activity, and then we show that the convolution of the impulse response with a time-varying external influence field accurately reproduces empirical activity patterns. To capture the dynamics of collective activity when the generating process is in a state of statistical equilibrium, we incorporate into the model a noisy input convolved with the impulse response function, thus precisely reproducing the fluctuations of stationary collective activity around a resting value. The outstanding goodness-of-fit of the model results to empirical observations, indicates that the model explains human activity patterns generated by time-dependent external influences in various socio-economic contexts. The proposed model can be used for inferring the temporal structure and strength of external influences, as well as the inertia of collective social activity. Furthermore, it can potentially predict social activity patterns.

The influence of a depressed scapular alignment on upper limb neural tissue mechanosensitivity and local pressure pain sensitivity

BACKGROUND

A depressed scapular alignment could lead to prolonged and repetitive stress or compression of the brachial plexus, resulting in sensitization of neural tissue. However, no study has investigated the influence of alignment of the scapulae on sensitization of upper limb neural tissue in otherwise asymptomatic people. In this case-control study, we investigate the influence of a depressed scapular alignment on mechanosensitivity of the upper limb peripheral nervous system as well as pressure pain thresholds (PPT).

METHODS

Asymptomatic individuals with neutral vertical scapular alignment (n = 25) or depressed scapular alignment (n = 25) participated. We measured the upper limb neurodynamic test (ULNT1), including assessment of symptom response and elbow range of motion (ROM), and PPT measured over upper limb peripheral nerve trunks, the upper trapezius muscle and overlying cervical zygapophyseal joints.

RESULTS

Subjects with a depressed scapular reported significantly greater pain intensity (t = 5.7, p < 0.0001) and reduced elbow extension ROM (t = -2.7, p < 0.01) during the ULNT1 compared to those with a normal scapular orientation. Regardless of the location tested, the group presenting with a depressed scapular had significantly lower PPT compared to those with a normal scapular orientation (PPT averaged across all sites: normal orientation: 3.3 ± 0.6 kg/cm², depressed scapular: 2.1 ± 0.5 kg/cm², p < 0.00001).

CONCLUSIONS

Despite being asymptomatic, people with a depressed scapular have greater neck and upper limb neural tissue mechanosensitivity when compared to people with a normal scapular orientation. This study offers insight into the potential development of neck-arm pain due to a depressed scapular position.

Safety of lower extremity neurodynamic exercises in adults with diabetes mellitus: a feasibility study

OBJECTIVES

Neurodynamic exercises aim to improve neural mechanosensitivity in order to promote pain-free movement and function. People with diabetes mellitus (DM) may be candidates for neurodynamic exercises to address common DM-related impairments such as reduced lower extremity range of motion (ROM) and altered neural mechanosensitivity. However, no studies have examined the safety and immediate effects of neurodynamic exercise in people with DM. This study aims to determine the feasibility of applying neurodynamic exercises in adults with DM by evaluating the rate of adverse events and quantifying immediate changes in straight leg raise (SLR) ROM.

METHODS

This quasi-experimental study included 20 people with DM who performed a series of neurodynamic exercises on their right leg. Their left leg was used as an internal control. SLR testing was performed before and immediately after these exercises. Adverse events were monitored, including provocation of their neuropathy symptoms or discomfort or pain.

RESULTS

All participants completed the neurodynamic exercises without provocation of their neuropathy symptoms. No pain was reported and only one participant had minor discomfort with one exercise; a <30-s calf cramp. The right SLR ROM increased by an average of 5.2°-5.3° (p < 0.01) with no change on the left.

DISCUSSION

This study demonstrated that lower extremity neurodynamic exercises are safe in adults with DM and may create small immediate improvements in SLR testing. Further research is indicated to investigate the safety and efficacy of neurodynamic exercises performed over multiple sessions.

LEVEL OF EVIDENCE

3b.

Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis

BACKGROUND

Neural mobilization (NM) is widely used to assess and treat several neuromuscular disorders. However, information regarding the NM effects targeting the lower body quadrant is scarce.

OBJECTIVES

To determine the effects of NM techniques targeting the lower body quadrant in healthy and low back pain (LBP) populations.

DESIGN

Systematic review with meta-analysis.

METHOD

Randomized controlled trials were included if any form of NM was applied to the lower body quadrant. Pain, disability, and lower limb flexibility were the main outcomes. PEDro scale was used to assess methodological quality.

RESULTS

Forty-five studies were selected for full-text analysis, and ten were included in the meta-analysis, involving 502 participants. Overall, studies presented fair to good quality, with a mean PEDro score of 6.3 (from 4 to 8). Five studies used healthy participants, and five targeted people with LBP. A moderate effect size (g = 0.73, 95% CI: 0.48-0.98) was determined, favoring the use of NM to increase flexibility in healthy adults. Larger effect sizes were found for the effect of NM in pain reduction (g = 0.82, 95% CI 0.56-1.08) and disability improvement (g = 1.59, 95% CI: 1.14-2.03), in people with LBP.

CONCLUSION

Evidence suggests that there are positive effects from the application of NM to the lower body quadrant. Specifically, NM shows moderate effects on flexibility in healthy participants, and large effects on pain and disability in people with LBP. Nevertheless, more studies with high methodological quality are necessary to support these conclusions.

The effects of neurodynamic straight leg raise treatment duration on range of hip flexion and protective muscle activity at P1

STUDY DESIGN

Randomized, single blind, same subject crossover trial.

OBJECTIVES

To compare the effects of two neurodynamic treatment doses on range of hip flexion (ROM HF) and electromyographic (EMG) activity of semitendinosus, at first onset of pain (P1).

METHODS

A total of 26 healthy participants without low back or leg pain received each treatment in a random order with at least 48 hours between sessions. Baseline ROM HF and EMG magnitude of semitendinosus at P1 were collected. Subjects then received either 361 or 362 minutes of oscillating end of range (grade IVz) straight leg raise (SLR) neurodynamic treatment and were re-assessed for baseline measures.

RESULTS

There was no significant difference between groups in EMG magnitude (P50.190) and ROM HF (P50.739) at P1. There was also no significant difference within groups in EMG magnitude at P1 (P50.182); however, there was a significant improvement in ROM HF at P1 in both groups compared to baseline readings (P50.000), with increases of 6.7u and 5.1u for the 361- and 362-minute groups, respectively.

CONCLUSION

Findings indicate that 362 minutes of oscillating grade IVz SLR neurodynamic treatment has no additional benefit over 361 minute, on ROM HF or EMG magnitude of semitendinosus at P1. Using an oscillating SLR treatment may, however, help to increase pain-free ROM HF, although further studies are necessary to confirm this.

The short term effects of straight leg raise neurodynamic treatment on pressure pain and vibration thresholds in individuals with spinally referred leg pain

BACKGROUND

Limited research exists for the effects of neurodynamic treatment techniques. Understanding short term physiological outcomes could help to better understand immediate benefits or harm of treatment.

OBJECTIVES

To assess the short-term effects of a straight leg raise (SLR) tensioner 'intervention' on pressure pain thresholds (PPT) and vibration thresholds (VT), and establish if additional factors influence outcome in individuals with spinally referred leg pain.

DESIGN

Experimental, repeated measures.

METHODS

Sixty seven participants (mean age (SD) 52.9 (13.3), 33 female) with spinally referred leg pain were divided into 3 sub-groups: somatic referred pain, radicular pain and radiculopathy. Individuals were assessed for central sensitisation (CS) and completed 5 disability and psychosocial questionnaires. PPT and VT were measured pre and post a 3 × 1 min SLR tensioner intervention.

RESULTS

No significant differences (p > 0.05) were found between the 3 groups for either outcome measure, or after treatment. Slight improvements in VT were seen in the radiculopathy group after treatment, but were not significant. Only 2 participants were identified with CS. Disability and psychological factors were not significantly different at baseline between the 3 sub-groups, and did not correlate with the outcome measures.

CONCLUSIONS

No beneficial effects of treatment were found, but the trend for a decrease in VT indicated that even in individuals with radiculopathy, no detrimental changes to nerve function occurred. Psychosocial factors and levels of disability did not influence short term outcome of SLR treatment.

The effect of spinal position on sciatic nerve excursion during seated neural mobilisation exercises: an in vivo study using ultrasound imaging

Objectives

Research has established that the amount of inherent tension a peripheral nerve tract is exposed to influences nerve excursion and joint range of movement (ROM). The effect that spinal posture has on sciatic nerve excursion during neural mobilisation exercises has yet to be determined. The purpose of this research was to examine the influence of different sitting positions (slump-sitting versus upright-sitting) on the amount of longitudinal sciatic nerve movement during different neural mobilisation exercises commonly used in clinical practice.

Methods

High-resolution ultrasound imaging followed by frame-by-frame cross-correlation analysis was used to assess sciatic nerve excursion. Thirty-four healthy participants each performed three different neural mobilisation exercises in slump-sitting and upright-sitting. Means comparisons were used to examine the influence of sitting position on sciatic nerve excursion for the three mobilisation exercises. Linear regression analysis was used to determine whether any of the demographic data represented predictive variables for longitudinal sciatic nerve excursion.

Results

There was no significant difference in sciatic nerve excursion (across all neural mobilisation exercises) observed between upright-sitting and slump-sitting positions (P = 0.26). Although greater body mass index, greater knee ROM and younger age were associated with higher levels of sciatic nerve excursion, this model of variables offered weak predictability (R² = 0.22).

Discussion

Following this study, there is no evidence that, in healthy people, longitudinal sciatic nerve excursion differs significantly with regards to the spinal posture (slump-sitting and upright-sitting). Furthermore, although some demographic variables are weak predictors, the high variance suggests that there are other unknown variables that may predict sciatic nerve excursion. It can be inferred from this research that clinicians can individualise the design of seated neural mobilisation exercises, using different seated positions, based upon patient comfort and minimisation of neural mechanosensitivity with the knowledge that sciatic nerve excursion will not be significantly influenced.

Study on dynamic characteristics' change of hippocampal neuron reduced models caused by the Alzheimer's disease

In the paper, based on the electrophysiological experimental data, the Hippocampal neuron reduced model under the pathology condition of Alzheimer's disease (AD) has been built by modifying parameters' values. The reduced neuron model's dynamic characteristics under effect of AD are comparatively studied. Under direct current stimulation, compared with the normal neuron model, the AD neuron model's dynamic characteristics have obviously been changed. The neuron model under the AD condition undergoes supercritical Andronov-Hopf bifurcation from the rest state to the continuous discharge state. It is different from the neuron model under the normal condition, which undergoes saddle-node bifurcation. So, the neuron model changes into a resonator with monostable state from an integrator with bistable state under AD's action. The research reveals the neuron model's dynamic characteristics' changing under effect of AD, and provides some theoretic basis for AD research by neurodynamics theory.

Uncertainty Propagation in Nerve Impulses Through the Action Potential Mechanism

We investigate the propagation of probabilistic uncertainty through the action potential mechanism in nerve cells. Using the Hodgkin-Huxley (H-H) model and Stochastic Collocation on Sparse Grids, we obtain an accurate probabilistic interpretation of the deterministic dynamics of the transmembrane potential and gating variables. Using Sobol indices, out of the 11 uncertain parameters in the H-H model, we unravel two main uncertainty sources, which account for more than 90 % of the fluctuations in neuronal responses, and have a direct biophysical interpretation. We discuss how this interesting feature of the H-H model allows one to reduce greatly the probabilistic degrees of freedom in uncertainty quantification analyses, saving CPU time in numerical simulations and opening possibilities for probabilistic generalisation of other deterministic models of great importance in physiology and mathematical neuroscience.

Repeatability and Minimal Detectable Change in Longitudinal Median Nerve Excursion Measures During Upper Limb Neurodynamic Techniques in a Mixed Population: A Pilot Study Using Musculoskeletal Ultrasound Imaging

This study determined test-retest reliability and minimum detectable change in longitudinal median nerve excursion during upper limb neurodynamic tests (ULNTs). Seven participants with unilateral or bilateral carpal tunnel syndrome and 11 healthy participants were randomly tested with two ULNTs (i.e., tensioner and slider). Each ULNT was performed three times each at 45° and 90° of shoulder abduction on two separate visits. Video sequences of median nerve excursion, recorded by a physical therapist using ultrasound imaging, were quantified using computer software. The generalizability theory, encompassing a G-Study and a D-study, measured the dependability coefficient (Φ) along with standard error of measurement (SEM) accuracy and allowed various testing protocols to be proposed. The highest reliability (Φ = 0.84) and lowest minimal measurement error (SEM = 0.58 mm) of the longitudinal median nerve excursion were reached during the ULNT-slider performed with 45° of shoulder abduction and when measures obtained from three different image sequences recorded during a single visit were averaged. It is recommended that longitudinal median nerve excursion measures computed from three separate image sequences recorded during a single visit be averaged in clinical practice. Ideally, adding a second visit (six image sequences) is also suggested in research protocols.

The immediate and 24-hour follow-up effect of unilateral lumbar Z-joint mobilisation on posterior chain neurodynamics

Few studies have reported the effects of lumbar spine mobilization on neurodynamics. In a recent study, Szlezak et al. (2011) reported immediate improvement of posterior chain neurodynamics [range of passive straight leg raise (SLR)] following ipsilateral lumbar spine zygopophyseal (Z) joint mobilization. We re-duplicated the study with a 24 h follow-up measurement. Sixty healthy college students were assigned to two groups, mobilization and control. The mobilization group received ipsilateral grade 3 Maitland mobilizations to Z joint at a frequency of 2 MHz for 3 min and the control group received no treatment. The SLR was measured before and after the intervention for both the groups on the day of testing and 24-h later. Repeated measures ANOVA showed statistically significant pre to post improvement in SLR range after mobilization. The improvement was retained at 24-h. The results of the study are consistent with Szlezak et al. (2011).

Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial

OBJECTIVE

To investigate the added benefit of nerve-biased interventions over static stretching in hamstring flexibility and to compare the effectiveness of two types of nerve-biased interventions over a week.

DESIGN

Three-arm assessor-blinded randomized controlled trial.

SETTING

University Laboratory.

PARTICIPANTS

Sixty healthy individuals (mean age = 22 ± 2.4 years) with reduced hamstring flexibility were randomized to three groups who received static stretching and neurodynamic sliders (NS-SS); static stretching with neurodynamic tensioner (NT-SS) and static stretching (SS) alone.

OUTCOME MEASURE

Knee extension angle (KEA) in degrees.

RESULTS

Baseline characteristics including demographic, anthropomorphic and KEA between groups were comparable. A significant interaction was observed between group (intervention) and time, [F (2,114) = 3.595; p = 0.031]. Post-hoc pairwise comparisons analyses revealed significant differences at post-intervention measurement time point between NS-SS and SS (mean difference: -6.8; 95%CI = -12, -1.5; p = 0.011) and NT-SS and SS (mean difference: -11.6; 95%CI = -16.7, -6.3; p < 0.001). However there was no significant difference between NS-SS and NT-SS groups (mean difference: 4.8; 95%CI = 0.4, 9.9; p = 0.074).

CONCLUSIONS

Neural sliders and tensioners are both effective in increasing hamstring flexibility as an adjunct to static hamstring stretching when compared to static stretching alone. No neural mobilization technique proved to be superior over another.

CLINICAL TRIAL REGISTRATION

This clinical trial is registered in Clinical Trials Registry- India (CTRI) with registration number CTRI/2012/05/002619.

Changes in excursion and strain in the rat sciatic nerve under cauda equina compression induced by epidural balloon inflation

BACKGROUND CONTEXT

Healthy nerves are able to stretch and glide as responses to normal physiological movement. Injury to the nerve may alter the nerve's mechanical properties and result in neuropathy. Whether cauda equina compression alters the mechanical properties of the sciatic nerve is still unclear.

PURPOSE

The purpose of this study was to demonstrate the changes in excursions and strains of the sciatic nerve in vivo after acute cauda equina compression was induced by epidural balloon compression.

STUDY DESIGN

An animal comparative study with induced cauda equina compression was designed for in situ measurements of nerve properties.

METHODS

Twenty-six adult Sprague-Dawley rats were divided into three groups. The balloon group (n=10) underwent epidural compression induced by inflation of an embolectomy balloon catheter that was inserted through an L6 laminotomy. The control group (n=10) underwent laminotomy but without compression. The normal group (n=6) received no back surgery. This model of neuropathy was confirmed with electrophysiological examination. The excursions and strains of the sciatic nerve in response to the modified straight leg-raising (SLR) test were measured in situ and analyzed.

RESULTS

The scales of the excursions were lower in the balloon group than in the other two groups, in both 90° flexion and extension of the knee. The balloon group was more sensitive to positional changes. The strain was significantly higher under the condition of epidural balloon compression.

CONCLUSIONS

We concluded that cauda equina compression decreased the excursion and increased the strain of the sciatic nerve in response to a modified SLR test. These findings might indicate one of the mechanisms of the pain provoked by the SLR test and also possibly contribute to an understanding of the pathogenesis of the neuropathy in the lower limbs of patients with cauda equina compression.

Ear pain following temporomandibular surgery originating from the temporomandibular joint or the cranial nervous tissue? A case report

A patient presenting with local pain and limitation of movement in the temporomandibular region following surgery of the left temporomandibular joint (TMJ) is described. Manual techniques like distraction of the TMJ combined with motor control exercises to restore TMJ function were not sufficient to relieve the patient's symptoms and her orofacial functions. However, during manual assessment and treatment of cranial nervous tissue, in this case the auriculotemporal nerve and its interface, pain was relieved and orofacial functions improved.

Normal sensory and range of motion (ROM) responses during Thoracic Slump Test (ST) in asymptomatic subjects

The purpose of the study was to determine the normal sensory and range of motion (ROM) responses during the movement components of Thoracic Slump Test (Thoracic ST) in asymptomatic subjects. Sixty asymptomatic subjects were included in the study. Thoracic ST was performed in two sequences, proximal initiation, which was proximal to distal and distal initiation, which was distal to proximal. Subjects were randomized into four groups depending on the order of sequences and sides. Outcome measures of sensory responses (intensity, type, and location) and ROM responses were recorded after each sequence. Friedman's test was done to compare between sensory responses of the subjects. Between-component comparison for prevalence of sensory responses within each sequence was done using Kruskal-Wallis test and Wilcoxonsigned ranks test was used for between-component comparisons of intensity of symptoms within each sequence of testing. Independent t test was used to assess the ROM responses. Results show the prevalence of sensory responses, its nature, area and intensity. These sensory and ROM responses may be considered as normal response of Thoracic ST. The intensity of the symptoms of proximal initiation sequence (1.09±1.35 cm) was significant (P<0.05) when compared to distal initiation sequence (0.08±1.26 cm). The change in the ROM was significant (P<0.05) for distal initiation (7.55±4.51 degrees) when compared to proximal initiation (4.96±3.76 degrees). These normal responses may be used as a reference when using the Thoracic ST as an assessment technique.

Mechanosensitivity in the upper extremity following breast cancer treatment

STUDY DESIGN

Descriptive, cross-sectional.

INTRODUCTION

Breast cancer (BC) treatments place the nervous system at risk, which may contribute to upper extremity (UE) mechanosensitivity.

PURPOSE OF THE STUDY

To evaluate elbow extension range of motion (EE-ROM) during upper limb neurodynamic testing (ULNT) post-BC treatment.

METHODS

ULNT EE-ROM was measured for 145 women post-BC treatment. Women were sub-grouped by presence/absence of pain and lymphedema.

RESULTS

Mean EE-ROM during ULNT1 was -22.3° (SD 11.9°) on the unaffected limb and -25.99° (SD 13.1°) on the affected limb. The women with pain and lymphedema had the greatest limitation in EE-ROM during ULNT1 testing, particularly of their affected limb (-33.8°, SD 12.9). Symptoms were reported more frequently in the affected chest, shoulder, arm, elbow, and hand. The intensity of symptoms was greater at the affected chest (p = 0.046), shoulder (p = 0.033) and arm (p = 0.039).

CONCLUSIONS

Women with lymphedema and pain after BC treatment may present with altered neural mechanosensitivity.

LEVEL OF EVIDENCE

3a.

The influence of scapular depression on upper limb neurodynamic test responses

OBJECTIVES

Upper limb neurodynamic testing (ULNT) can be used clinically to assist in identifying neural tissue involvement in patients with upper quarter pain and dysfunction. Consideration for scapular positioning is a crucial component of ULNT standardization, as variations in positioning may dramatically impact sensory and motor responses. This study aimed to determine if there was a meaningful difference in test outcomes when the ULNT was performed in alternative scapular positions.

METHODS

This cross-sectional study included 40 asymptomatic individuals. Repeated ULNT testing was performed on the dominant limb with the scapula blocked in neutral (ULNTb) and in scapular depression (ULNTd). Sensory responses, muscle activity, and range of motion outcomes were compared between the two test variations.

RESULTS

Pre-positioning in scapular depression (ULNTd) led to reduced elbow extension range of motion, provoked greater upper trapezius muscle activity and an earlier onset and broader area of sensory responses compared to ULNTb.

DISCUSSION

During ULNTb, the limbs were taken further into range and elicited reduced muscle activation and more localized sensory response providing a less vigorous version of the test. This study demonstrates that scapular positioning has a meaningful impact on ULNT test outcomes in healthy, asymptomatic individuals. The ULNTd can be considered a more vigorous version that may be appropriate when the cervical motions commonly utilized for structural differentiation are limited or contraindicated.

Hierarchical random cellular neural networks for system-level brain-like signal processing

Sensory information processing and cognition in brains are modeled using dynamic systems theory. The brain's dynamic state is described by a trajectory evolving in a high-dimensional state space. We introduce a hierarchy of random cellular automata as the mathematical tools to describe the spatio-temporal dynamics of the cortex. The corresponding brain model is called neuropercolation which has distinct advantages compared to traditional models using differential equations, especially in describing spatio-temporal discontinuities in the form of phase transitions. Phase transitions demarcate singularities in brain operations at critical conditions, which are viewed as hallmarks of higher cognition and awareness experience. The introduced Monte-Carlo simulations obtained by parallel computing point to the importance of computer implementations using very large-scale integration (VLSI) and analog platforms.

Effect of slump stretching versus lumbar mobilization with exercise in subjects with non-radicular low back pain: a randomized clinical trial

Previous case reports, case series, and pilot studies have suggested that slump stretching may enhance the effects of spinal mobilization and stabilization exercises in patients with non-radicular low back pain (NRLBP). The purpose of this trial was to determine if slump stretching results in improvements in pain, disability, and fear and avoidance beliefs in patients with NRLBP with neural mechanosensitivity. Sixty patients, 18-60 years of age presenting with NRLBP with symptom duration >3 months, were randomized into one of two, 3-week physical therapy programs. Group one received lumbar spinal mobilization with stabilization exercises while group two received slump stretching in addition to lumbar spinal mobilization with exercise. Outcomes including the modified Oswestry disability index (ODI), numeric pain rating scale (NPRS), and the fear-avoidance belief questionnaire (FABQ) were collected at baseline, and at weeks 1, 2, 3, and 6. A doubly multivariate analysis of variance revealed a significant group-time interaction for ODI, NPRS, and FABQ. There were large within-group changes for all outcomes with P<0·01 and large between-group differences at weeks 3 and 6 for the ODI and weeks 1, 2, 3, and 6 for the NPRS and FABQ at P<0·01. A linear mixed-effect model comparing the composite slopes of the improvement lines revealed significant differences favoring the slump stretching group at P<0·01. The findings of the present study further support the use of slump stretching with spinal mobilization and stabilization exercises when treating NRLBP.

Visualization for understanding of neurodynamical systems

Complex neurodynamical systems are quite difficult to analyze and understand. New type of plots are introduced to help in visualization of high-dimensional trajectories and show global picture of the phase space, including relations between basins of attractors. Color recurrence plots (RPs) display distances from each point on the trajectory to all other points in a two-dimensional matrix. Fuzzy Symbolic Dynamics (FSD) plots enhance this information mapping the whole trajectory to two or three dimensions. Each coordinate is defined by the value of a fuzzy localized membership function, optimized to visualize interesting features of the dynamics, showing to which degree a point on the trajectory belongs to some neighborhood. The variance of the trajectory within the attraction basin plotted against the variance of the synaptic noise provides information about sizes and shapes of these basins. Plots that use color to show the distance between each trajectory point and a larger number of selected reference points (for example centers of attractor basins) are also introduced. Activity of 140 neurons in the semantic layer of dyslexia model implemented in the Emergent neural simulator is analyzed in details showing different aspects of neurodynamics that may be understood in this way. Influence of connectivity and various neural properties on network dynamics is illustrated using visualization techniques. A number of interesting conclusions about cognitive neurodynamics of lexical concept activations are drawn. Changing neural accommodation parameters has very strong influence on the dwell time of the trajectories. This may be linked to attention deficits disorders observed in autism in case of strong enslavement, and to ADHD-like behavior in case of weak enslavement.

Neuromechanical representation of fabric-evoked prickliness: a fiber-skin-neuron model

Cutaneous Aδ nociceptors encode the material and geometrical features of fiber ends evoking prickliness sensation by generating neural spikes in response to indentation of human skin, however, understanding of the underlying neuromechanism of fabric-evoked prickliness is still far from clear. This work develops and validates a fiber-skin-neuron (mechanosensitive Aδ-nociceptors) model that combines an analytical model of fiber-skin indentation, a sigmoidal function of neuronal transduction, and a leaky integrate-and-fire model of neuronal dynamics. Firstly, the model is validated to be capable of capturing the typical neurphysiological features of cutaneous Aδ nociceptors and the psychophysical phenomenon. And then, several case studies with respect to statistical features of fiber ends are carried out, and the resulting neural responses are calculated to explore the relationship between statistical features in study and evoked responses. The analysis of predicted action potentials over one second indicates that they systematically change with statistical features of fiber ends protruding above fabric surfaces, and the fitted stimulus-response relationship of Aδ nociceptors is highly similar to the stimulus-sensation relationship of prickliness rating magnitude. It follows that there might exist a linear relationship between fabric-evoked neurophysiological responses and psychophysical responses. These results provide significant new insight into the fabric-evoked prickliness sensation and raise interesting questions for further investigation, and the model described here bridges the gap between those models that transform fiber ends properties to firing rates.

Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy

Neural mobilization is a treatment modality used in relation to pathologies of the nervous system. It has been suggested that neural mobilization is an effective treatment modality, although support of this suggestion is primarily anecdotal. The purpose of this paper was to provide a systematic review of the literature pertaining to the therapeutic efficacy of neural mobilization. A search to identify randomized controlled trials investigating neural mobilization was conducted using the key words neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy. The titles and abstracts of the papers identified were reviewed to select papers specifically detailing neural mobilization as a treatment modality. The PEDro scale, a systematic tool used to critique RCTs and grade methodological quality, was used to assess these trials. Methodological assessment allowed an analysis of research investigating therapeutic efficacy of neural mobilization. Ten randomized clinical trials (discussed in 11 retrieved articles) were identified that discussed the therapeutic effect of neural mobilization. This review highlights the lack in quantity and quality of the available research. Qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilization. Future research needs to re-examine the application of neural mobilization with use of more homogeneous study designs and pathologies; in addition, it should standardize the neural mobilization interventions used in the study.

Upper Limb Neural Tension and Seated Slump Tests: The False Positive Rate among Healthy Young Adults without Cervical or Lumbar Symptoms

This study examined the false positive rate of the upper limb neural tension test (ULNTT) and seated slump test (SST) among healthy young adults with no history of cervical, lumbar, or peripheral symptoms. Eighty-four subjects (27 men and 57 women) with a mean age of 22.9 years participated in the investigation. All participants completed a screening questionnaire designed to exclude subjects with a history of cervical or lumbar spine pain or injury, or upper or lower extremity neurological symptoms. The ULNTT and the SST were performed on the left upper and lower extremity of each participant. Of the 84 participants tested, 73 (86.9%) were found to have a positive ULNTT at some point in the available range of elbow extension. Twenty-eight (33.3%) of the 84 subjects had a positive SST at some point in the available range of knee extension. The mean knee extension angle for those subjects with a positive SST was 15.1 degrees with a 95% confidence interval (CI) of 12.3 and 19.7 degrees . The mean elbow extension angle for those with a positive ULNTT was 49.4 degrees with a 95% CI of 44.8 and 54.0 degrees . The number of positive tests for both the ULNTT and the SST was found to be high in this sample of asymptomatic healthy young adults. Based on the results of this investigation, the authors suggest that the current criteria for determining a positive test for both the ULNTT and the SST should be examined using the proposed range of motion cut-off scores.

Application of a classification system and description of a combined manual therapy intervention: a case with low back related leg pain

Low back pain and leg pain commonly occur together. Multiple factors can cause low back related leg pain; therefore, identification of the source of symptoms is required in order to develop an appropriate intervention program. The patient in this case presented with low back and leg pain. A patho-mechanism based classification is described in combination with the patient's subjective and objective examination findings to guide treatment. The patient's symptoms improved marginally with intervention addressing primarily the musculoskeletal impairments and with intervention addressing primarily the neurodynamic impairments. Full functional improvements were attained with a manual therapy intervention directed at both mechanisms simultaneously. The approach described in this case address a mixed pathology utilizing passive accessory and passive physiological lumbar mobilizations in combination with lower extremity neurodynamic mobilization. The patient reported complete resolution of symptoms after a total of seven visits over a period of 6 weeks. While specific guidelines do not yet exist for treatment based on the classification approach utilized, this case report provides an example of manual therapy to address low back related leg pain of mixed pathology.