Effect of Upper limb Peripheral Nerve Mobilization on Motor Abilities, Nerve conduction, and Cortical activity in subjects with middle cerebral artery (MCA) Stroke

**Introduction: -**Stroke is a debilitating neurological condition that occurs when the blood supply to the brain is disrupted, leading to a sudden loss of brain function. Stroke can give rise to various complications that further impact the individual’s functional abilities and overall well-being. These complications include muscle contractures, spasticity, joint stiffness, pain, reduced mobility, and a heightened risk of falls and injuries. These factors contribute to long-term disability and reduced quality of life for stroke survivors. Current interventions for stroke rehabilitation typically focus on motor impairments and functional recovery through various rehabilitation approaches. These interventions aim to improve muscle strength, coordination, and relearn functional tasks. While these conventional approaches have shown efficacy, there is a growing recognition that neural factors may play a crucial role in functional recovery after stroke. Peripheral nerve mobilization (PNM) techniques aim to reduce neural tension, enhance nerve gliding, and promote neural tissue mobility. These techniques have been used in various musculoskeletal and neurological conditions, demonstrating promising effects on nerve conduction, functional improvement, and cortical activity.

 **Need of the study: -**This study will contribute to the understanding of the potential benefits of peripheral nerve mobilization as a key rehabilitation approach in stroke care, addressing the neural aspects of recovery that may have been overlooked by conventional therapies. The findings will provide valuable insights for the development of more comprehensive and tailored rehabilitation strategies for stroke survivors, ultimately improving their overall functional outcomes and quality of life.

 Objectives: -

a) To assess the effect of upper limb peripheral nerve mobilization on motor abilities in middle cerebral artery stroke subjects.

b) To examine the effect of upper limb peripheral nerve mobilization on cortical activity in middle cerebral artery stroke subjects.

C) To assess the effect of upper limb peripheral nerve mobilization on median, radial, and ulnar nerve conduction in middle cerebral artery stroke subjects.

    Methodology: - 66 participants will be recruited with middle cerebral artery (MCA) Stroke based on selection criteria. Informed consent and information sheet will be explained and obtained from all participants with their voluntary consent. Included participants will be undergoing pretest such as Fugl Meyer Assessment – upper limb (FMA- UL) for functional performance, Functional Magnetic resonance Imaging (FMRI) for Cortical Activity, and Nerve conduction study for Radial, Median, and Ulnar nerve conduction velocity.

After completion of the pre-test, Participants will be allocated in to two groups by concealed envelope method as Experimental group (n=33) and Control group (n=33). Experimental group will be receiving Peripheral Neural Mobilization (PNM) techniques along with conventional exercises and control group will be receiving conventional exercises alone. Both the groups will be treated for 1 hour session per day, 4 days a week for a period of 8 weeks.

 **Statistical analysis:-**Sample size (66) is estimated assuming 4% population proportion with 5% significance level and 95% confidence interval with 10% drop-out rate. For both experimental and control group samples will be allocated through concealed envelope as 33 in each group. Statistical analysis will be performed using Mann-Whitney U tests for between-group comparisons and Wilcoxon test for within-group comparisons.

Expected outcomes: -

The primary expected outcomes of the study include significant improvements in cortical activity and connectivity patterns of Functional MRI indicating the effectiveness of upper limb peripheral nerve mobilization (PNM). Additionally, enhanced nerve conduction in the Radial, Median, and Ulnar nerves post-intervention is anticipated, reflecting improved nerve functionality. Also improved motor abilities, measured through the wolf motor function test (WMFT) is expected.