Constraint Induced Movement Therapy and Proprioceptive Neuromuscular Facilitation on Lower Limb Motor Function

NCT ID: NCT05191524

Last Updated: 2022-09-21

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-01-15
• Study Completion Date: 2022-06-27

Brief Summary

Stroke, described as a neurological deficit caused by the interruption of cerebral blood flow, is one of the leading causes of mortality and morbidity throughout the world. It is the second most common medical condition and the major cause of disability in adults. Recovery following stroke revolves around the severity of sensory, motor, and cognitive impairments. Lower extremity impairment is one of the major post-stroke conditions which can cause difficulty in performing activities of daily living, gait abnormalities, increased risk of fall, and restriction in social participation. Rehabilitation after stroke is the primary mechanism through which it can achieve functional recovery and independence, which is based on the principles of motor learning and neuroplasticity.

Detailed Description

There have been many rehabilitation techniques to treat post-stroke impairments. These include aerobic exercises, the Bobath approach, proprioceptive neuromuscular facilitation (PNF) constraint-induced movement therapy (CIMT), and mobilization and stimulation of neuromuscular tissue. The selection of techniques at the defined level of recovery varies among clinicians.

Constraint-induced movement therapy (CIMT) is a neurological rehabilitation technique that has been used in various neurological disorders including stroke both in acute and chronic stages, traumatic brain injury, cerebral palsy, multiple sclerosis, and spinal cord injury to improve motor function and strengthen weak muscles which are characterized by the restraint of the less affected extremity accompanied by the shaping and repetitive task-oriented training of more affected extremity.

Proprioceptive facilitation (PNF) is one of the major therapeutic techniques aimed at enhancing the essential characteristics required for the functional ambulation of patients with hemiplegia, such as muscular control, strength, and flexibility. Changes in the excitation of the cortical motor area mediate this and the corresponding.

Motor neurons. Previous researches are on the separate effect of CIMT and they have conducted PNF approaches, but there is no study available on the comparison of the effect of both techniques on lower limb function in stroke patients. Most of the studies administered PNF in combination with other approaches and the duration of intervention in these studies was in favor of CIMT groups compared to PNF. Therefore, this study is aimed at determining the comparative effect of CIMT and PNF on lower limb recovery.

Conditions

Stroke

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Constrained induced movement therapy

In this group of patients, they will use the CIMT technique for treatment. Patient will perform following tasks, while unaffected limb in constrains for 3 hours/day

• Sit-to-Stand
• Forward and Backward stepping
• Stair Climbing and Descending (only the first stair will be used)
• Side-to-Side stepping with the affected limb

Group Type: EXPERIMENTAL

Constrained induced movement

Intervention Type: OTHER

Practice in two sessions per day (supervised) for 3 days per week, for six consecutive weeks. The unaffected limb will be constraint using a knee immobilizer only during practice sessions. We will perform the interventions under the supervision of a trained physiotherapist.

Proprioceptive Neuromuscular facilitation therapy

Different PNF components (such as commands, stretching, timing, and manual resistance) will be used for optimizing patients' output. We will do ten repetitions of each pattern before

Proceeding to the next pattern. The PNF patterns in the set used in the study will be :

Lower extremity:

< Flexion-abduction-external rotation (knee flexed and knee extended) < Extension-adduction-internal rotation (knee flexed and knee extended) < Flexion-adduction-internal rotation (knee flexed and knee extended) < Extension-abduction-external rotation (knee flexed and knee extended

Group Type: ACTIVE_COMPARATOR

Proprioceptive Neuromuscular facilitation

Intervention Type: OTHER

Group B will receive PNF intervention given for 30 minutes to the lower limb 3 times a week for 6 weeks

Interventions

Constrained induced movement

Practice in two sessions per day (supervised) for 3 days per week, for six consecutive weeks. The unaffected limb will be constraint using a knee immobilizer only during practice sessions. We will perform the interventions under the supervision of a trained physiotherapist.

Intervention Type: OTHER

Proprioceptive Neuromuscular facilitation

Group B will receive PNF intervention given for 30 minutes to the lower limb 3 times a week for 6 weeks

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Both male and female
• Patients who will be diagnosed with hemiplegia due to stroke
• Patient who has an asymmetrical stance, ability to walk and stand with minimal assistance
• Patient must have 15 degrees of knee flexion in the affected limb
• Mini mental state examination Mini Mental State Examination >23

Exclusion Criteria

• Patients who cannot perform the active movement of a limb due to pre stroke musculoskeletal problems
• Cardiopulmonary diseases which could hinder their ability to take part in rehabilitation
• Patient with impaired cognition

• Minimum Eligible Age: 30 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Ayesha Afridi, PhD*

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Helping Hand institute of Rehabilitation Sciences

Mansehra, , Pakistan

Countries

Pakistan

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Other Identifiers

REC/00818 Aqdas

Identifier Type: -

Identifier Source: org_study_id