Efficacy of scapular and upper limb proprioceptive neuromuscular facilitation techniques on scapular alignment, upper limb function, and gait in subacute stroke: a randomized controlled trial protocol

Abstract

Background: Stroke is a neurological disability produced by vascular-related acute focal injury to the central nervous system and is one of the leading causes of disability in adults, and it is frequently accompanied by motor skill loss. Patients suffering from hemiplegia after a stroke are more prone to have fall and are more likely to experience further injury due to irregular gait, diminished muscular strength, and functional impairment. In the affected upper limb of the hemiplegic stroke, spasticity in the shoulder girdle causes scapular malalignment, which reduces the functional mobility and stability of the upper limb. This is reflected as the reduced reciprocal arm swing during walking, which is further reinforced by an abnormal synergy pattern on the affected side. Proprioceptive neuromuscular facilitation (PNF) is a treatment strategy that stimulates motor activity and enhances control and function of the neuromuscular system. This research protocol is intended to assess and evaluate the effects of applying scapular and upper limb PNF along with conventional physiotherapy treatment to subacute-stroke patients on their scapular alignment, upper limb function, and gait. Methods: A total of 40 individuals in total will be allocated equally into two groups, group-A (experimental) and group-B (control). Both groups will be receiving treatment for six weeks with five sessions per week. Each patient will be examined both before and after therapy using the Palpation Meter (PALM), the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), 10-Meter Walk Test, Handheld dynamometer (10MWT), and Dynamic gait index (DGI). After six weeks of therapy, the results will be assessed and the data will be analyzed before and after the intervention using a paired t-test to discover within-group differences in measurements. Conclusions: This physiotherapy method may be used in the management of stroke patients if our study's hypothesis is found to be valid. Registration: CTRI (CTRI/2023/05/052930, 19/05/2023).