NEURODYNAMIC MOBILIZATION APPLICATION IN DROP FOOT: A PEDIATRIC CASE REPORT

Year 2024, Volume: 8 Issue: 3, 383 - 396, 16.12.2024

Ömer Faruk Özçelep , Atahan Turhan

Abstract

Drop foot is characterized by the inability to lift the foot at the ankle. It is a common symptom in neurological conditions and can also result from orthopedic trauma. Neurodynamic mobilizations are techniques that involve sliding the nerves to alleviate nerve tension. There is limited literature on the use of neurodynamic mobilizations in pediatric patients. A four-year-old female patient presented with a drop foot to Kırşehir Ahi Evran University Physical Therapy and Rehabilitation Hospital. The main finding was that she dragged her foot on the ground while walking. This finding was confirmed by electromyography (EMG) testing of the deep peroneal nerve. In addition, loss of function was assessed with the Stanmore Assessment Questionnaire, loss of motor movement was assessed with the manual muscle strength test, and loss of sensation was assessed with the pinprick test and cotton wool. Electrical stimulation (EMS), passive mobilization of the peroneal nerve using neurodynamic techniques, and terminal knee extension with a resistant band and kinesiotape were applied. The pre-treatment score of 24 (poor) increased to 90 (good) after treatment. This study showed that a physiotherapy and rehabilitation program including passive neurodynamic mobilizations applied to the peroneal nerve increased functionality in a pediatric patient with foot drop.

Keywords

neurodynamic mobilization, drop foot, pediatric mobilization

DÜŞÜK AYAKTA NÖRODİNAMİK MOBİLİZASYON UYGULAMASI: PEDİATRİK OLGU SUNUMU

Abstract

Düşük ayak, ayağın ayak bileğinden kaldırılamaması ile karakterizedir. Nörolojik durumlarda yaygın bir semptomdur ve ortopedik travmadan da kaynaklanabilir. Nörodinamik mobilizasyonlar, sinir gerginliğini hafifletmek için sinirlerin kaydırılmasını içeren tekniklerdir. Nörodinamik mobilizasyonların pediatrik hastalarda kullanımına ilişkin sınırlı sayıda literatür bulunmaktadır. Dört yaşında kız hasta Kırşehir Ahi Evran Üniversitesi Fizik Tedavi ve Rehabilitasyon Hastanesi'ne ayak düşmesi ile başvurdu. Hastanın ana bulgusu yürürken ayağını yerde sürüklemesiydi. Bu bulgu derin peroneal sinirin elektromiyografi (EMG) testi ile doğrulandı. Ayrıca, Fonksiyon kaybı Stanmore Değerlendirme Anketi ile, motor hareket kaybı manuel kas gücü testi ile, duyu kaybı pinprick testi ve pamuk ile değerlendirildi. Elektrik stimülasyonu (EMS), nörodinamik teknikler kullanılarak peroneal sinirin pasif mobilizasyonu, direnç bandı ile terminal diz ekstansiyonu ve kinezyobant ile tibialis anterior kasına taktil uyarı uygulandı. Tedavi öncesi 24 (kötü) olan skor, tedavi sonrasında 90'a (iyi) yükselmiştir. Bu çalışma, peroneal sinire uygulanan pasif nörodinamik mobilizasyonları içeren bir fizyoterapi ve rehabilitasyon programının düşük ayağa sahip pediatrik hastada fonksiyonelliği arttırdığını göstermiştir.

Keywords

nörodinamik mobilizasyon, düşük ayak, pediatrik mobilizasyon

Ethical Statement

Çalışma kapsamında hastanın velisinden gönüllü onam formu alınmıştır.

Supporting Institution

Çalışmayı destekleyen kuruluş yoktur.

References

• Apok, V., Gurusinghe, N. T., Mitchell, J. D., & Emsley, H. C. A. (2011). Dermatomes and dogma. Practical Neurology, 11(2), 100–105. https://doi.org/10.1136/jnnp.2011.242222
• Boudier-Revéret, M., Gilbert, K. K., Allégue, D. R., Moussadyk, M., Brismée, J. M., Sizer, P. S., Feipel, V., Dugailly, P. M., & Sobczak, S. (2017). Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskeletal Science and Practice, 31, 45–51. https://doi.org/10.1016/j.msksp.2017.07.004
• Butler, D. S. (2005). The neurodynamic techniques. Van Gastel Publishing.
• Carolus, A. E., Becker, M., Cuny, J., Smektala, R., Schmieder, K., & Brenke, C. (2019). The interdisciplinary management of foot drop. Deutsches Arzteblatt International, 116(20), 347–354. https://doi.org/10.3238/arztebl.2019.0347
• Chen, H. Y., Yang, H., Chi, H. J., & Chen, H. M. (2014). Physiologic and behavioral effects of papoose board on anxiety in dental patients with special needs. Journal of the Formosan Medical Association, 113(2), 94–101. https://doi.org/10.1016/j.jfma.2012.04.006
• Chrzanowska, J., Zubkiewicz-Kucharska, A., Seifert, M., & Salmonowicz, B. (2023). Foot drop in children with newly diagnosed type 1 diabetes: three case reports. Endocrinology, Diabetes and Metabolism Case Reports, 2023(3), 1-5. https://doi.org/10.1530/EDM-22-0417
• Coppieters, M. W., Hough, A. D., & Dilley, A. (2009). Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: An in vivo study using dynamic ultrasound imaging. Journal of Orthopaedic and Sports Physical Therapy, 39(3), 164–171. https://doi.org/10.2519/jospt.2009.2913
• Coté, C. J., Wilson, S., Casamassimo, P., Crumrine, P., Gorman, R. L., Hegenbarth, M., & Koteras, R. J. (2006). Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: An update. Pediatrics, 118(6), 2587–2602. https://doi.org/10.1542/peds.2006-2780
• Gilbert, K. K., Smith, M. P., Sobczak, S., Roger James, C., Sizer, P. S., & Brismée, J. M. (2015). Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: An unembalmed cadaveric investigation. Journal of Manual and Manipulative Therapy, 23(5), 239–245. https://doi.org/10.1179/2042618615Y.0000000009
• Graham, J. (2010). Foot drop: Explaining the causes, characteristics and treatment. British Journal of Neuroscience Nursing, 6(4), 168–172. https://doi.org/10.12968/bjnn.2010.6.4.47792
• Ha, M., Son, Y., & Han, D. (2012). Effect of median nerve mobilization and median nerve self-mobilization on median motor nerve conduction velocity. Journal of Physical Therapy Science, 24(9), 801–804. https://doi.org/10.1589/jpts.24.801
• Jeanbart, K., & Tanner-Bräm, C. (2021). Mobilization of the neurodynamic system using proprioceptive neuromuscular facilitation decreases pain and increases mobility in lower extremities and Spine-A case report. Journal of Bodywork and Movement Therapies, 27, 682–691. https://doi.org/10.1016/j.jbmt.2021.04.010
• Lingaiah, P., Jaykumar, K., Sural, S., & Dhal, A. (2018). Functional evaluation of early tendon transfer for foot drop. Journal of Orthopaedic Surgery, 26(3), 1–7. https://doi.org/10.1177/2309499018799766
• Malik, P., Ferraz dos Santos, B., Girard, F., Hovey, R., & Bedos, C. (2022). Physical Constraint in Pediatric Dentistry: The Lived Experience of Parents. JDR Clinical and Translational Research, 7(4), 371–378. https://doi.org/10.1177/23800844211041952
• Nelson, F. R. T., & Blauvelt, C. T. (2015). Physical medicine and rehabilitation: Physical therapy and occupational therapy. In F. R. T. Nelson & C. T. Blauvelt (Eds.), A Manual of Orthopaedic Terminology (pp. 365–375). W.B. Saunders.
• Özmen, T., Acar, E., Zoroǧlu, T., & Işik, H. (2017). Effect of kinesio taping on gait performance and balance in children with hemiplegic cerebral palsy. Fizyoterapi Rehabilitasyon, 28(1), 33–37. https://doi.org/10.21653/tfrd.330648
• Saxena, A., Sehgal, S., & Jangra, M. K. (2021). Effectiveness of Neurodynamic Mobilization versus Conventional Therapy on Spasticity Reduction and Upper Limb Function in Tetraplegic Patients. Asian Spine Journal, 15(4), 498–503. https://doi.org/10.31616/asj.2020.0146
• Scrimshaw, S. V, & Maher, C. G. (2001). Randomized controlled trial of neural mobilization after spinal surgery. Spine, 26(24), 2647–2652. https://doi.org/10.1097/00007632-200112150-00002
• Shacklock, M. (1995). Neurodynamics. Physiotherapy, 81(1), 9–16. https://doi.org/10.1016/S0031-9406(05)67024-1
• Stewart, J. D. (2008). Foot drop: where, why and what to do? Practical Neurology, 8(3), 158–169. https://doi.org/10.1136/jnnp.2008.149393
• Villafañe, J. H., Pillastrini, P., & Borboni, A. (2013). Manual therapy and neurodynamic mobilization in a patient with peroneal nerve paralysis: A case report. Journal of Chiropractic Medicine, 12(3), 176–181. https://doi.org/10.1016/j.jcm.2013.10.007
• Weaver, J. M. (2010). Why is physical restraint still acceptable for dentistry? Anesthesia Progress, 57(2), 43–44. https://doi.org/10.2344/0003-3006-57.2.43
• Xu, X., Zhang, H., Yan, Y., Wang, J., & Guo, L. (2021). Effects of electrical stimulation on skin surface. Acta Mechanica Sinica/Lixue Xuebao, 37(12), 1843–1871. https://doi.org/10.1007/s10409-020-01026-2
• Yılmaz, E., Karakurt, L., Serin, E., & Güzel, H. (2004). Peroneal nerve palsy due to rare reasons: a report of three cases. Acta Orthopaedica et Traumatologica Turcica, 38(1), 75–78.