Effect of Lower Limb Irradiation by Proprioceptive Neuromuscular Facilitation on Balance in Stroke Patients

BACKGROUND: Stroke is a global health problem. It is the second commonest cause of death and fourth leading cause of disability worldwide. Stroke or Cerebrovascular accident [CVA]) is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Proprioceptive neuromuscular facilitation (PNF) is a concept of treatment widely used in rehabilitation to improve the performance of the neuromusculoskeletal system through the stimulation of muscle and joint proprioceptors. OBJECTIVE: To find out the effectiveness of PNF training on contralateral lower extremity on balance in stroke patients. DESIGN: Prospective Quasi-Experimental Design. SETTING: Department of Neurology and Department of PMR, PSG Hospital, Coimbatore. PARTICIPANTS: A total of 30 stroke patients in the age group of 40 to 65 years participated in the study. The participants who satisfied the selection criteria were selected by simple random sampling and assigned into three groups. Group A - 10 patients will received contralateral PNF D1 flexion &extension pattern. Group B - 10 patients will received contralateral PNF D1 flexion pattern. Group C - 10 patients will received contralateral PNF D1 extension pattern. INTERVENTIONS: Group A received contralateral PNF D1 flexion &extension pattern, Group B received contralateral PNF D1 flexion pattern and Group c received contralateral PNF D1 extension pattern for 12 days [6 sessions per week for 2 weeks (45minutes/session)]. OUTCOME MEASURES: 1.Berg Balance Scale score, 2. Fugl- Meyer Assessment score. RESULTS: The statistical analysis shows improvement in both outcome measures. In BBS measure the mean difference of pre test and post test score for Group A was 1.600, Group B was 0.700 and Group C was 0.700. The “t” value calculated by using paired “t” test for Group A, Group B and Group C were 7.236, 4.583 and 3.280 respectively, which was less than the “t” table value 2.262 (p < 0.05). According to the calculated one way ANOVA shows statistically significant difference between three groups (F= 7.640 p < 0.05) in BBS. And post hoc analysis in homogenous subsets of BBS shows there was a significant difference among all three groups. In FMA-LE measure the mean difference of pre test and post test score for Group A was 1.600, Group B was 0.600 and Group C was 0.700. The “t” value calculated by using paired “t” test for Group A, Group B and Group C were 9.798, 2.250 and 1.964 respectively, which Group A was less than the “t” table value 2.262 (p ˂ 0.05) Group B and Group C was greater than the “t” table value. According to the calculated one way ANOVA shows statistically significant difference between Groups is F= 7.000 (p ˂ 0.05). And post hoc analysis in homogenous subsets of FMA-LE shows there was only a significant difference in Group A than Group B and C. CONCLUSION: The results of these statistical analysis showed that the PNF D1 flexion and extension was effective than PNF D1 flexion and PNF D1 extension irradiation on contralateral side improving balance and muscle activity