title: 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.
abstract: OBJECTIVE
  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?
  
  
  METHODS
  Pretest-posttest three-group randomized clinical experimental design.
  
  
  METHODS
  A total of 96 late-stage stroke subjects were randomly assigned to three groups.
  
  
  METHODS
  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.
  
  
  METHODS
  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-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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physiotherapy, Ergonomics, Prosthetics and Orthotics and Basics of Physiotherapy, University School of Physical Education, Katowice, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Wolny
authors.forename: Edward
authors.initials: E
authors.lastname: Saulicz
authors.forename: Rafal
authors.initials: R
authors.lastname: Gnat
authors.forename: Mirosław
authors.initials: M
authors.lastname: Kokosz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D020127:Recovery of Function; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D034941:Upper Extremity