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系統識別號 U0026-1601201808261000
論文名稱(中文) 神經鬆動術對糖尿病週邊神經病變病患之神經傳導速度及神經病變症狀之影響
論文名稱(英文) Effects of Neural Mobilization on Nerve Conduction Velocity and Neuropathic Symptoms in patients with Diabetic Peripheral Neuropathy
校院名稱 成功大學
系所名稱(中) 物理治療學系
系所名稱(英) Department of Physical Therapy
學年度 106
學期 1
出版年 107
研究生(中文) 陳奕安
研究生(英文) Yi-An Chen
學號 T66044027
學位類別 碩士
語文別 英文
論文頁數 43頁
口試委員 指導教授-洪菁霞
召集委員-歐弘毅
口試委員-陳郁文
口試委員-蔡昆霖
中文關鍵字 糖尿病  糖尿病周邊神經病變  神經鬆動術  神經傳導速度 
英文關鍵字 Diabetes Mellitus  Diabetic Peripheral Neuropathy  Neural Mobilization  Nerve Conduction Velocity 
學科別分類
中文摘要 背景與目的:糖尿病周邊神經病變好發於糖尿病病患,據文獻指出,高達50%的糖尿病患者會出現此併發症。糖尿病周邊神經病變的發生與罹患糖尿病的時間以及血糖控制有關,症狀多為麻木感、針刺感、灼熱感等等,好發區域多為手腳末梢。時至今日,醫學上並沒有一個良好的方式處理糖尿病周邊神經病變所造成的問題,將血糖控制在良好的範圍是病患最核心的目標,近年來亦有許多研究著墨在藥物控制以及運動介入等方式。神經鬆動術是物理治療臨床上常用的技術之一,多被用來處理腰椎神經疾患、腕隧道症候群以及其他有關周邊神經病變的問題。先前的研究指出,糖尿病周邊神經病變之病患接受神經鬆動術一次以及維持十五天,振動閾值皆有顯著的改善。因此,本篇研究希望探討神經鬆動術對於糖尿病周邊神經病變病患的神經病變症狀以及神經生理學等改善效益。
研究方法:研究中共收錄16名第二型糖尿病及周邊神經病變之病患。受試者被分為兩組,神經鬆動術組接受物理治療師的神經鬆動術治療,兩側皆治療一組十五次,一次治療中共會做三組,每週三次維持六週;藥物治療組的受試者則服用由神經科醫師所開立的藥物美可敏(Mecomin),每天服用三次維持六週。受試者在治療前後都會接受評估,其中項目包括密西根神經病變量表(MNSI)、直膝抬腿測試(SLR test)、神經傳導測試檢查(NCV tests)以及發炎物質檢測(Cytokine Analysis)。
結果:經過六週的介入治療後,我們可以發現到在神經鬆動術組的受試者,在密西根神經病變量表的得分有顯著性的下降(p<0.05);在兩腳的直膝抬腿測試中,關節活動度(Range of Motion)也有顯著性的增加(p<0.05),然而,在藥物治療組的右腿卻在治療後有顯著性的下降(p<0.05)。神經傳導測試的部分,脛神經的傳導速度僅在神經鬆動術組的左腳有顯著性的改善(p<0.05),右腳僅有些微上升而未達統計上的顯著差異(p>0.05);然而,我們在神經鬆動術組的腓神經則發現了雙側的顯著性改善(p<0.05)。在發炎物質的檢測中,腫瘤壞死因子-α(TNF-α)以及介白素-1β(IL-1β)並未在治療前後抑或是兩組間發現顯著差異(p>0.05),另一方面,在介白素-6(IL-6)的檢測中則發現到神經鬆動術組在治療前後有顯著的增加(p<0.05)。
結論:透過密西根神經病變量表、直膝抬腿測試、神經傳導測試檢查以及發炎物質檢測等等結果,研究中發現六週的神經鬆動術後可以改善糖尿病周邊神經病變患者的神經病變症狀以及神經傳導速度,神經鬆動術將是未來具有潛力的治療選項之一,在未來的研究中期望能夠更進一步探究神經鬆動術改善糖尿病周邊神經病變之機制。
英文摘要 Background and Purpose: Diabetic peripheral neuropathy (DPN) is quite common in patients with Diabetes mellitus (DM) over long period of courses. The symptoms are numbness, tingling, burning pain and so on. To date, there is still no decisive intervention for the DPN patients. Neural mobilization is commonly applied on the patients with lumbar radiculopathy, carpal tunnel syndrome and other problems of peripheral nerve. Previous studies showed the improvements in vibration perception threshold (VPT) while DPN patients received neural mobilization immediately and for 15 times, respectively. Therefore, the purpose of this study was to investigate the effects of neural mobilization on neuropathic symptoms and neurophysiologic functions in DPN patients.
Methods: This study recruited 16 type 2 patients with DPN. Participants received a 6-week intervention program, of which contained two types of treatment. One was the Neural mobilization (NM group) of L/E, 3 sessions per week for 6 weeks. The other one was the Mecomin (500mcg/cap) (MED group) TID for 6 weeks prescribed by neurological physician.
Results: NM group had lower score in Michigan Neuropathy Screening Instrument (MNSI) after intervention (p<0.05). In Straight-Leg Raise (SLR) test, both legs of NM group had significantly increased in range of motion (ROM), while ROM of right side of MED group decreased post-intervention (p<0.05). According to Nerve Conduction Velocity (NCV) tests, the left tibial nerve conduction velocity had significantly improved in NM group, nevertheless, we didn’t find statistically significant difference in right side of NM group. For the common peroneal nerve, there was significantly improved in both sides of NM group after intervention. In cytokines analysis, we didn’t note significant change in TNF-α and IL-1β in both groups. However, IL-6 had statistically significant reduction in NM group post-intervention.
Conclusion: Depending on the results in MNSI, SLR test, NCV tests and cytokines analysis, we suggested neural mobilization would be a potential modality for managing problems of DPN. Further study is required for precise mechanism of neural mobilization affecting the pathophysiology of DPN.
論文目次 摘要.............i
Abstract.............iii
誌謝.............v
List of figures.............vii
List of tables.............viii
List of appendices.............ix
Abbreviation.............x
Introduction.............1
Methods.............8
Results.............12
Discussion.............18
Conclusions.............23
References.............24
Figures.............31
Tables.............38
Appendices.............41
參考文獻 ADA. (2017). 2. Classification and Diagnosis of Diabetes. Diabetes Care, 40(Supplement 1), S11-S24. doi:10.2337/dc17-S005
Ahmed, N., Tufel, S., Khan, M., & Khan, P. (2013). EFFECTIVENESS OF NEURAL MOBILIZATION IN THE MANAGEMENT OF SCIATICA. Journal of musculoskeletal research, 16(03), 1350012.
Akalin, E., El, O., Peker, O., Senocak, O., Tamci, S., Gulbahar, S., . . . Oncel, S. (2002). Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil, 81(2), 108-113.
Ali, M., Ur Rehman, S. S., Ahmad, S., & Farooq, M. N. (2015). Effectiveness of slump neural mobilization technique for the management of chronic radicular low back pain. Rawal Med J, 40(1), 41-43.
Ammar, T. A. (2012). Monochromatic Infrared Photo Energy in Diabetic Peripheral Neuropathy. ISRN Rehabilitation, 2012, 8. doi:10.5402/2012/484307
Andriambeloson, E., Baillet, C., Vitte, P. A., Garotta, G., Dreano, M., & Callizot, N. (2006). Interleukin-6 attenuates the development of experimental diabetes-related neuropathy. Neuropathology, 26(1), 32-42.
Barbosa, M., Saavedra, A., Severo, M., Maier, C., & Carvalho, D. (2017). Validation and Reliability of the Portuguese Version of the Michigan Neuropathy Screening Instrument. Pain Practice, 17(4), 514-521. doi:10.1111/papr.12479
Baysal, O., Altay, Z., Ozcan, C., Ertem, K., Yologlu, S., & Kayhan, A. (2006). Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract, 60(7), 820-828. doi:10.1111/j.1742-1241.2006.00867.x
Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., Vincent, K. R., & George, S. Z. (2009). A randomized sham-controlled trial of a neurodynamic technique in the treatment of carpal tunnel syndrome. J Orthop Sports Phys Ther, 39(10), 709-723. doi:10.2519/jospt.2009.3117
Billinger, S. A., Sisante, J. V., Alqahtani, A. S., Pasnoor, M., & Kluding, P. M. (2017). Aerobic exercise improves measures of vascular health in diabetic peripheral neuropathy. Int J Neurosci, 127(1), 80-85. doi:10.3109/00207454.2016.1144056
Boulton, A. J., Malik, R. A., Arezzo, J. C., & Sosenko, J. M. (2004). Diabetic somatic neuropathies. Diabetes Care, 27(6), 1458-1486.
Boulton, A. J. M., Kubrusly, D. B., Bowker, J. H., Gadia, M. T., Quintero, L., Becker, D. M., . . . Sosenko, J. M. (1986). Impaired Vibratory Perception and Diabetic Foot Ulceration. Diabetic Medicine, 3(4), 335-337. doi:10.1111/j.1464-5491.1986.tb00775.x
Boyd, B. S. (2012). Measurement properties of a hand-held inclinometer during straight leg raise neurodynamic testing. Physiotherapy, 98(2), 174-179.
Boyd, B. S., Nee, R. J., & Smoot, B. (2016). Safety of lower extremity neurodynamic exercises in adults with diabetes mellitus: a feasibility study. Journal of Manual & Manipulative Therapy, 1-9. doi:10.1080/10669817.2016.1180772
Boyd, B. S., Wanek, L., Gray, A. T., & Topp, K. S. (2009). Mechanosensitivity of the lower extremity nervous system during straight-leg raise neurodynamic testing in healthy individuals. J Orthop Sports Phys Ther, 39(11), 780-790. doi:10.2519/jospt.2009.3002
Brown, C. L., Gilbert, K. K., Brismee, J. M., Sizer, P. S., Roger James, C., & Smith, M. P. (2011). The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study. Journal of Manual & Manipulative Therapy, 19(1), 26-34.
Control, D., & Trial, C. (2005). Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. The New England journal of medicine, 353(25), 2643.
Control, D., Trial, C., Interventions, E. o. D., & Group, C. R. (2014). Effect of intensive diabetes therapy on the progression of diabetic retinopathy in patients with type 1 diabetes: 18 years of follow-up in the DCCT/EDIC. Diabetes, DB_140930.
de Souza, R. J., de Souza, A., & Nagvekar, M. D. (2015). Nerve conduction studies in diabetics presymptomatic and symptomatic for diabetic polyneuropathy. Journal of Diabetes and its Complications, 29(6), 811-817.
Dwornik, M., Kujawa, J., Biaoszewski, D., Supik, A., & Kiebzak, W. (2009). Electromyographic and Clinical Evaluation of the Efficacy of Neuromobilization in Patients with Low Back Pain. International Journal of Rehabilitation Research, 32, S89-S90.
Dy, S. M., Bennett, W. L., Sharma, R., Zhang, A., Waldfogel, J. M., Nesbit, S. A., . . . Wilson, L. M. (2017). Preventing Complications and Treating Symptoms of Diabetic Peripheral Neuropathy.
Dyck, P. J., Davies, J. L., Wilson, D. M., Service, F. J., Melton, L. J., & O'Brien, P. C. (1999). Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care, 22(9), 1479-1486. doi:10.2337/diacare.22.9.1479
Feldman, E. L., Stevens, M. J., Thomas, P. K., Brown, M. B., Canal, N., & Greene, D. A. (1994). A Practical Two-Step Quantitative Clinical and Electrophysiological Assessment for the Diagnosis and Staging of Diabetic Neuropathy. Diabetes Care, 17(11), 1281-1289. doi:10.2337/diacare.17.11.1281
Gadient, R. A., & Otten, U. H. (1997). Interleukin-6 (IL-6)—A molecule with both beneficial and destructive potentials. Progress in Neurobiology, 52(5), 379-390.
Gilbert, K. K., Roger James, C., Apte, G., Brown, C., Sizer, P. S., Brismée, J.-M., & Smith, M. P. (2015). Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: implications for the treatment of neuropathic pain and dysfunction. Journal of Manual & Manipulative Therapy, 23(4), 219-225.
Goldberg, R. B. (2009). Cytokine and Cytokine-Like Inflammation Markers, Endothelial Dysfunction, and Imbalanced Coagulation in Development of Diabetes and Its Complications. The Journal of Clinical Endocrinology & Metabolism, 94(9), 3171-3182. doi:10.1210/jc.2008-2534
Goyal, M., Mehta, S., Rana, N., Singal, R., Mittal, A., Goyal, K., . . . Sharma, M. (2016). Motor nerve conduction velocity and function in carpal tunnel syndrome following neural mobilization: A randomized clinical trial. International Journal of Health & Allied Sciences, 5(2), 104-110. doi:10.4103/2278-344x.180434
Helge, J. W., Stallknecht, B., Pedersen, B. K., Galbo, H., Kiens, B., & Richter, E. A. (2003). The effect of graded exercise on IL‐6 release and glucose uptake in human skeletal muscle. The Journal of physiology, 546(1), 299-305.
Hewston, P., & Deshpande, N. (2016). Falls and Balance Impairments in Older Adults with Type 2 Diabetes: Thinking Beyond Diabetic Peripheral Neuropathy. Canadian Journal of Diabetes, 40(1), 6-9.
Hirota, H., Kiyama, H., Kishimoto, T., & Taga, T. (1996). Accelerated Nerve Regeneration in Mice by upregulated expression of interleukin (IL) 6 and IL-6 receptor after trauma. The Journal of Experimental Medicine, 183(6), 2627-2634. doi:10.1084/jem.183.6.2627
Hussain, G., Rizvi, S. A. A., Singhal, S., Zubair, M., & Ahmad, J. (2014). Cross sectional study to evaluate the effect of duration of type 2 diabetes mellitus on the nerve conduction velocity in diabetic peripheral neuropathy. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 8(1), 48-52.
Kanchanasamut, W., & Pensri, P. (2017). Effects of weight-bearing exercise on a mini-trampoline on foot mobility, plantar pressure and sensation of diabetic neuropathic feet; a preliminary study. Diabet Foot Ankle, 8(1), 1287239. doi:10.1080/2000625X.2017.1287239
King, R. H. M. (2001). The role of glycation in the pathogenesis of diabetic polyneuropathy. Molecular Pathology, 54(6), 400-408.
Kluding, P. M., Bareiss, S. K., Hastings, M., Marcus, R. L., Sinacore, D. R., & Mueller, M. J. (2017). Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift. Phys Ther, 97(1), 31-43. doi:10.2522/ptj.20160124
Kluding, P. M., Pasnoor, M., Singh, R., Jernigan, S., Farmer, K., Rucker, J., . . . Wright, D. E. (2012). The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. Journal of Diabetes and its Complications, 26(5), 424-429.
Kumar, P., Adhikari, P., Jeganathan, P., & D’Souza, S. (2010). Immediate effects of nerve sliders and nerve massage on vibration and thermal perception thresholds in patients with painful diabetic peripheral neuropathy-a pilot randomized clinical trial (UTRN 103229513. Physiotherapy & Occupational Therapy Journal, 3(3).
Kumar, S., Adhikari, P., Jeganathan, P., D'Souza, S., & Misri, Z. (2010). Comparison of Neurodynamic Examination Findings in Normal Subjects, Type-2 Diabetes Mellitus Subjects, Painless Diabetic Peripheral Neuropathy and Painful Diabetic Peripheral Neuropathy-A Cross-sectional study. International Journal of Neurology and Neurosurgery, 2(1), 5-18.
Lavery, L. A., Murdoch, D. P., Williams, J., & Lavery, D. C. (2008). Does anodyne light therapy improve peripheral neuropathy in diabetes? A double-blind, sham-controlled, randomized trial to evaluate monochromatic infrared photoenergy. Diabetes Care, 31(2), 316-321. doi:10.2337/dc07-1794
Leggate, M., Nowell, M. A., Jones, S. A., & Nimmo, M. A. (2010). The response of interleukin-6 and soluble interleukin-6 receptor isoforms following intermittent high intensity and continuous moderate intensity cycling. Cell stress and Chaperones, 15(6), 827-833.
Leibinger, M., Müller, A., Gobrecht, P., Diekmann, H., Andreadaki, A., & Fischer, D. (2013). Interleukin-6 contributes to CNS axon regeneration upon inflammatory stimulation. Cell death & disease, 4(4), e609.
Mayfield, J. A., Reiber, G. E., Sanders, L. J., Janisse, D., & Pogach, L. M. (1998). Preventive Foot Care in People With Diabetes. Diabetes Care, 21(12), 2161-2177. doi:10.2337/diacare.21.12.2161
McLennan, S. V., Martell, S. K. Y., & Yue, D. K. (2002). Effects of Mesangium Glycation on Matrix Metalloproteinase Activities. Possible Role in Diabetic Nephropathy, 51(8), 2612-2618. doi:10.2337/diabetes.51.8.2612
Mehta, A. (2014). Effects of Maitland's Joint Mobilization Versus Shacklock's Neurodynamic Mobilization Techniques in Low Back Pain. Indian Journal of Physiotherapy and Occupational Therapy, 8(2), 248.
Meijer, J., Smit, A., Sonderen, E., Groothoff, J., Eisma, W., & Links, T. (2002). Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score. Diabetic Medicine, 19(11), 962-965.
Moghtaderi, A., Bakhshipour, A., & Rashidi, H. (2006). Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clinical Neurology and Neurosurgery, 108(5), 477-481.
Nawfar, S. A., & Yacob, N. B. (2011). Effects of monochromatic infrared energy therapy on diabetic feet with peripheral sensory neuropathy: a randomised controlled trial. Singapore Med J, 52(9), 669-672.
Nee, R. J., & Butler, D. (2006). Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence. Physical Therapy in Sport, 7(1), 36-49.
Ohkubo, Y., Kishikawa, H., Araki, E., Miyata, T., Isami, S., Motoyoshi, S., . . . Shichiri, M. (1995). Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract, 28(2), 103-117.
Oskouei, A. E., Talebi, G. A., Shakouri, S. K., & Ghabili, K. (2014). Effects of Neuromobilization Maneuver on Clinical and Electrophysiological Measures of Patients with Carpal Tunnel Syndrome. Journal of Physical Therapy Science, 26(7), 1017-1022. doi:10.1589/jpts.26.1017
Ostrowski, K., Hermann, C., Bangash, A., Schjerling, P., Nielsen, J. N., & Pedersen, B. K. (1998). A trauma‐like elevation of plasma cytokines in humans in response to treadmill running. The Journal of physiology, 513(3), 889-894.
Pal, M., Febbraio, M. A., & Whitham, M. (2014). From cytokine to myokine: the emerging role of interleukin-6 in metabolic regulation. Immunology and cell biology, 92(4), 331-339.
Pieber, K., Herceg, M., & Paternostro-Sluga, T. (2010). Electrotherapy for the treatment of painful diabetic peripheral neuropathy: a review. J Rehabil Med, 42(4), 289-295. doi:10.2340/16501977-0554
Pop-Busui, R., Ang, L., Holmes, C., Gallagher, K., & Feldman, E. L. (2016). Inflammation as a Therapeutic Target for Diabetic Neuropathies. Curr Diab Rep, 16(3), 29. doi:10.1007/s11892-016-0727-5
Pradhan, A. D., Manson, J. E., Rifai, N., Buring, J. E., & Ridker, P. M. (2001). C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA, 286(3), 327-334. doi:10.1001/jama.286.3.327
Schmid, A. B., Elliott, J. M., Strudwick, M. W., Little, M., & Coppieters, M. W. (2012). Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms. Journal of Orthopaedic Research, 30(8), 1343-1350. doi:10.1002/jor.22064
Shacklock, M. Neurodynamics. Physiotherapy, 81(1), 9-16. doi:10.1016/S0031-9406(05)67024-1
Shuto, T., Horie, H., Hikawa, N., Sango, K., Tokashiki, A., Murata, H., . . . Ishikawa, Y. (2001). IL-6 up-regulates CNTF mRNA expression and enhances neurite regeneration. Neuroreport, 12(5), 1081-1085.
Singh, P. P., Bindra, S., Singh, S., Aggarwal, R., & Singh, J. (2012). Effect of Nerve Mobilization on Vibration Perception Threshold in Diabetic Peripheral Neuropathy. Indian Journal of Physiotherapy and Occupational Therapy, 40, 195.
Stein, C., Eibel, B., Sbruzzi, G., Lago, P. D., & Plentz, R. D. (2013). Electrical stimulation and electromagnetic field use in patients with diabetic neuropathy: systematic review and meta-analysis. Braz J Phys Ther, 17(2), 93-104. doi:10.1590/s1413-35552012005000083
Williams, R., Airey, M., Nicolucci, A., & Bennett, C. (1996). Aldose reductase inhibitors for the prevention and treatment of diabetic peripheral neuropathy. Cochrane Database of Systematic Reviews(1). doi:10.1002/14651858.CD002182
Zanuso, S., Sacchetti, M., Sundberg, C. J., Orlando, G., Benvenuti, P., & Balducci, S. (2017). Exercise in type 2 diabetes: genetic, metabolic and neuromuscular adaptations. A review of the evidence. British Journal of Sports Medicine. doi:10.1136/bjsports-2016-096724
Zhu, G.-C., Tsai, K.-L., Chen, Y.-W., & Hung, C.-H. (2017). Neural Mobilization Attenuates Mechanical Allodynia and Decreases Proinflammatory Cytokine Concentrations in Rats With Painful Diabetic Neuropathy. Phys Ther.
Zhu, T., Meng, Q., Ji, J., Lou, X., & Zhang, L. (2015). Toll-like receptor 4 and tumor necrosis factor-alpha as diagnostic biomarkers for diabetic peripheral neuropathy. Neurosci Lett, 585, 28-32.
Zigmond, R. (2012). gp130 cytokines are positive signals triggering changes in gene expression and axon outgrowth in peripheral neurons following injury. Frontiers in molecular neuroscience, 4, 62.
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