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  1. Romney, Wendy PT, DPT, NCS
  2. Wormley, Michelle PT, PhD, CLT
  3. Tudini, Frank PT, DScPT, OCS, COMT, FAAOMPT


Background: As the population ages, the incidence of neurological diseases associated with aging will increase. Impairments related to neurological disease include spasticity, pain, joint contracture, weakness, and loss of mobility. Manual therapy, skilled hand movements performed by physical therapists, has been found to decrease pain and increase tissue extensibility. The purpose of this article was to review the literature on the effects of manual therapy to manage or improve the impairments and functional limitations related to neurological diseases in the older adults.


Results: Literature on the effects of manual therapy on spasticity, range of motion/joint contracture, pain, strength, gross mobility, fine motor skills, and dysphagia were included in this review. Manual therapy treatments included stretching, passive movements, joint mobilizations, massage, proprioceptive neuromuscular facilitation, neurodevelopmental technique, and gait training.


Conclusion: There was limited evidence on the effects of manual therapy to treat and prevent joint contracture. Stretching, combined with Botox (botulinum toxin A), was found more effective at improving range of motion than stretching alone. Joint mobilizations showed immediate improvements in range of motion and balance, but higher-quality studies investigating the long-term impact of joint mobilization on patient function need to be conducted. The amount of therapy (dosage) plays a role in recovery of function. Continued research is needed to determine the best practice for the use of manual therapy for individuals with neurological disease.