Can Lumbar Mulligan Mobilization Improve Gait, Balance, and Trunk Position Sense After Stroke?

Official title

Effects of Mulligan-Based Lumbar Mobilization on Trunk Position Sense, Balance, and Gait in Stroke Survivors: A Randomized Study

Overview

Stroke is a pathology caused by disturbances in the brain's arterial circulation, leading to high morbidity rates. Individuals who experience a stroke often face neurological impairments such as motor, sensory, and cognitive dysfunctions, which negatively impact muscle strength, postural control, sensation, and gait, reducing their independence in daily activities. Balance deficits in stroke patients increase the risk of falls and contribute to a fear of falling. Improving balance control is a key goal in rehabilitation. The importance of the trunk in balance control and rehabilitation is well-established, as it plays a central role in maintaining stability. In individuals with restricted lumbar mobility, weakened trunk muscles and altered muscle activation can lead to a reduction in proprioception, hip strategy, and spinal stabilization, further impairing balance. Combining conventional exercise approaches with other rehabilitation techniques has been shown to yield more effective outcomes. This study aims to investigate the effects of Mulligan-based lumbar spine mobilization on balance, trunk position sense, and gait in individuals with stroke.

Detailed description

Stroke is a high-morbidity condition caused by a disruption in the brain's arterial circulation, resulting in various neurological impairments, including motor, sensory, and cognitive deficits. These impairments lead to a decrease in the individual's ability to perform daily activities independently, as muscle strength, postural control, sensation, and gait are negatively affected. Stroke patients often face an increased risk of falls due to balance deficits, which can also contribute to a significant fear of falling. Thus, improving balance control is an essential therapeutic goal in stroke rehabilitation.

The trunk plays a pivotal role in balance control, and it should be the primary focus in rehabilitation programs. In individuals with restricted lumbar mobility, weakened trunk muscles or altered muscle activation patterns lead to decreased lumbar proprioception, impaired hip strategy, and reduced spinal stabilization, all of which contribute to balance difficulties. Recent studies suggest that combining conventional rehabilitation techniques with other interventions can provide more effective results.

In stroke rehabilitation, different mobilization techniques are increasingly being used. One such approach is the Mulligan Concept, which is commonly applied in musculoskeletal disorders, particularly in the treatment of knee, ankle, and shoulder problems in stroke patients. However, there has been limited research on the effectiveness of Mulligan-based lumbar spine mobilization in stroke patients. The Mulligan technique, particularly the Sustained Natural Apophyseal Glides (SNAG) technique, may help improve the individual's ability to move the body freely and enhance mobility and function, ultimately increasing confidence and reducing psychological barriers such as the fear of movement.

This study aims to evaluate the effectiveness of Mulligan-based lumbar mobilization in enhancing balance, trunk position sense, and gait in individuals with stroke. By assessing the impacts of this technique, the study seeks to contribute to the development of more effective rehabilitation strategies that can improve functional outcomes and quality of life for stroke patients.

Interventions

• Other Experimental Group (Mulligan Mobilization + Conventional Therapy)
  Mulligan Sustained Natural Apophyseal Glides (SNAGs) applied to the lumbar spine, combined with conventional rehabilitation exercises (neuromuscular training, stretching, strengthening, and balance exercises).
• Other (Conventional Therapy Only)
  Neuromuscular training, stretching, strengthening, balance exercises, and gait training performed without Mulligan mobilization.

Primary outcome measures

• Static Balance Assessment (Mini-BESTest) [Time frame: Baseline and After 4 Weeks]
• Static Balance Assessment (ALDA Balance Device) [Time frame: Baseline and After 4 Weeks]
• Dynamic Balance Assessment (Trunk Impairment Scale - TIS) [Time frame: Baseline and After 4 Weeks]
• Dynamic Balance Assessment (Functional Reach Test - FRT) [Time frame: Baseline and After 4 Weeks]
• Gait Performance (Dynamic Gait Index (DGI)) [Time frame: Baseline and After 4 Weeks]
• Gait Performance (10-Meter Walk Test) [Time frame: Baseline and After 4 Weeks]
• Trunk Position Sense (Proprioception) inclinometers test [Time frame: Baseline and After 4 Weeks]

Secondary outcome measures (3)

• Fall Risk (Timed Up and Go (TUG) Test) [Time frame: Baseline and After 4 Weeks]
• Cognitive Function (Standardized Mini Mental Test (SMMT)) [Time frame: Baseline and After 4 Weeks]
• Functional Independence (Barthel Index) [Time frame: Baseline and After 4 Weeks]

Eligibility criteria

Inclusion criteria

• Participants must meet all of the following conditions to be eligible for the study:

• Diagnosed with stroke by a neurologist.
• Aged 30 to 65 years.
• First-ever stroke (single episode).
• Stroke duration between 6 to 24 months.
• Score of ≤3 on the Modified Rankin Scale (mRS).
• Score of ≥24 on the Mini-Mental State Examination (MMSE).

Exclusion criteria

• Participants will be excluded if they meet any of the following conditions:

• History of musculoskeletal disorders affecting the spine (e.g., cancer, scoliosis, spondylolisthesis, rheumatoid arthritis, ankylosing spondylitis).
• Previous lumbar spine surgery.
• Presence of neurological conditions other than stroke (e.g., Parkinson's disease, multiple sclerosis).
• Severe visual impairment affecting balance or walking.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Ankara Yıldırım Beyazıt University — Ankara

Identifiers

NCT: NCT06887114 · 14.03.2024/02-592

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗