This study will be conducted to:
* Investigate the relationship between neck pain severity and bilateral gait symmetry in patients with cervical radiculopathy. * Investigate the relationship between deep neck flexors strength and gait symmetry in patients with cervical radiculopathy. * Investigate the relationship between upper limb muscles strength and bilateral gait symmetry in patients with cervical radiculopathy. * Determine factors predicting bilateral gait asymmetry in patients with cervical radiculopathy.
Patients with unilateral cervical radiculopathy at level of C5-C6 and C6-C7 confirmed by MRI.
Patient's age will be ranged from 40 to 50 years.
Patients with chronic symptoms > 3 months.
Patients with decreased strength in cervical or upper limb muscles.
Bilateral cervical radiculopathy.
History of cervical spine surgery or instability.
Diagnosed with myelopathy, canal stenosis, or severe disc protrusion.
History of vestibular dysfunction, stroke, or severe cognitive impairment.
Sixty one patients with cervical radiculopathy of both sexes will participate in this study. Patients will be diagnosed as having cervical radiculopathy by neurologist based on a careful clinical examination and will be confirmed by investigations as magnetic resonance imaging (MRI). Patients will be selected from the Outpatient Clinic of Faculty of Physical Therapy, and the British University in Egypt
Other
Cross-sectional
Pain Assessment
The level of upper limb and neck pain will be captured separately with the Numeric Pain Rating Scale (NPRS). Using an 11-point scale, ranging from 0 (no pain) to 10 (worst pain imaginable), participants will be asked to answer the following question: "On a scale of 0 to 10, where 0 = no pain and 10 = worst pain, evaluate the intensity of your neck pain at this moment ". The same question will be asked for the upper limb. The NPRS is frequently used in clinical studies in association with the neck disability index.
Assessment of function and disability
Arabic version of Neck Disability Index (NDI) will be used to assess disability and function limitation caused by neck pain. It has demonstrated excellent internal consistency (Cronbach's alpha between 0.88 and 0.94) and test-retest reliability (ICC = 0.90-0.98). It includes 10 items, each scored on a 0-5 scale, about: personal care, lifting, reading, concentration, work, driving, and sleeping. The total maximum score is 50 and categorize disability from none to complete , The Arabic version of NDI is a strong valid method for assessing self-rated disability in patients with neck pain with excellent "test-retest" reliability. Based on the total score (out of 50), disability will be categorized as: 0-4 = no disability, 5-14 = mild, 15-24 = moderate, 25-34 = severe, \>34 = complete disability
strength of deep neck flexors
Pressure Biofeedback Unit (PBU) will be used to assess deep neck flexor strength. From a supine position and both knees bent in flexion and arms relaxed at the sides. The PBU cuff will be placed under the suboccipital region of his neck and then inflated to a baseline pressure of 20 mmHg. Patients will be instructed to perform a gentle chin in motion without lifting their heads off the surface or activating superficial muscles. The patient will then be guided to increase the pressure in 2 mmHg stages to a maximum of 30 mmHg, and to hold each stage for 10 seconds taking no rest intervals between his attempts. The maximum pressure which he achieves and holds correctly without compensatory strategies will be recorded. 3 trials will be conducted.
Upper limb strength assessment
Upper limb strength will be measured using a hand-held dynamometer. Participants will be seated in upright posture, with their shoulders adducted and neutrally rotated, and their elbows will be flexed at 90 degrees, their forearms will be placed in a neutral position, and their wrists extended between 0-30 degrees, testing protocol. Each participant will be instructed to grip the dynamometer with his maximum effort for about 3-5 seconds. The participant will receive consistent verbal encouragement from the assessor to ensure maximal voluntary contraction is achieved. Each participant will perform 3 trials on their affected side, with a one-minute rest between his attempts to avoid muscle fatigue.
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