Proprioceptive Neuromuscular Facilitation Exercise on Early Shoulder Muscle Activation in Healthy Individuals
NCT ID: NCT06667115
Last Updated: 2024-11-01
Study Results
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Basic Information
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COMPLETED
NA
30 participants
INTERVENTIONAL
2023-04-30
2023-12-30
Brief Summary
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Detailed Description
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Participants Thirty healthy volunteers (14 males and 16 females with an average age of 26.2 ± 4 years) were recruited through convenience sampling. The inclusion criteria required being 18-45 years old and capable of performing PNF D2 shoulder flexion exercise. Exclusion criteria, designed to ensure sample homogeneity and data reliability, included any shoulder injuries in the dominant arm within the last 3 months, such as pain in the scapular region, rotator cuff tear or reconstruction, shoulder dislocation, shoulder instability, frozen shoulder, fracture, and chronic neck pain. This study received ethical approval from the Institutional Review Board (IRB) as minimal risk research (IRB # 2023-0322-01). The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki (Helsinki Declaration as revised in 2013).
Researchers screened potential participants for inclusion criteria. Eligible individuals were given a detailed explanation of the study's purpose, interventions, and their role, followed by informed consent. Participants then completed a demographic information form. To protect confidentiality, participants were assigned numerical identifiers, and all identifying information was stored separately from research data in a secure location.
Outcome measures This study utilized a combination of technologies to measure shoulder muscle activation and ROM. The NORAXON 3D Motion Capture system, equipped with Ultium EMG sensors and Ultium Motion sensors, provided precise tracking of muscle activity and movement patterns (ICC ranging from 0.87-0.98). The Ultium surface EMG Sensors were utilized to detect the Maximum Voluntary Contraction (MVC) as well as muscle activation in the form of % MVC during three different interventions. Ultium Motion ROM sensors were utilized to analyze the PNF D2 shoulder flexion exercise in three different planes of motion via flexion, abduction, and external rotation. Data collection was conducted using MyoMUSCLE and MyoMOTION software.
Participants' subjective feedback was collected using the Borg Rating of Perceived Exertion (RPE) scale and a customized questionnaire including enjoyment, confidence, frustration, boredom, and level of difficulty.
Interventions The Xbox Kinect and BeCure game software were utilized for VR exercises. The U-Ball game challenged participants to hit balls coming from random targets on a screen using the PNF D2 shoulder flexion on their dominant arm. The game setting ensured 14 balls appeared within the intervention period. Visual feedback was provided through an on-screen avatar mirroring the participant's movements. While the game displayed score elements, these were excluded from the study analysis to focus on proper exercise form.
This study implemented three distinct shoulder muscle activation interventions. Intervention I (PNF alone): Foundational PNF D2 shoulder flexion exercise, incorporating shoulder flexion, abduction, and external rotation. This exercise was performed at a metronome-guided pace of 14 beats per minute to establish a consistent baseline and match the U-Ball game's tempo. Intervention II (PNF+VR): Combined the PNF D2 shoulder flexion exercise with a VR motion capture game (the U-Ball game). Intervention III (PNF+VR+CF): PNF D2 shoulder flexion exercise combined with the U-Ball game and the addition of auditory concurrent feedback ("Sword") which referenced the action of unsheathing a sword in a diagonal upward direction. Each intervention lasted 60 seconds, followed by a two-minute rest period which included the survey completion.
Procedures EMG and ROM Sensor Placement Surface EMG electrodes were placed on the identified motor points of the upper trapezius (UT), lower trapezius (LT), infraspinatus (INF), and serratus anterior (SA) muscles. ROM sensors were attached to the upper spine (C7/T1), lower spine (T12/L1), and deltoid tuberosity on the participants' dominant arm. Anatomical landmarks utilized for sensor placement were confirmed by the same two researchers for consistency. A male and female researcher assisted with sensor placement to ensure a respectful and comfortable environment.
Introduction to PNF D2 Flexion Exercise At a learning station, participants were introduced to the PNF D2 shoulder flexion exercise and auditory concurrent feedback via a pre-recorded instructional video. In the video the researcher explained how the auditory "Sword" concurrent feedback was utilized. Another researcher then provided a live demonstration, allowing participants to practice the pattern and confirm their understanding.
MVC Measurements and Calibration Researchers conducted MVC tests for baseline muscle activity. Participants exerted maximum effort against manual resistance applied by the researcher who trained to apply consistent resistance across sessions. ROM sensor calibration took place 1.5 meters from the Xbox Kinect camera, aligning participants with the U-Ball game's software requirements for optimal interaction. Subsequently, muscle activation from UT, LT, SA and INF muscles and shoulder ROM (flexion, abduction, and external rotation) were monitored and recorded for one minute using the MyoMUSCLE and MyoMOTION software (Noraxon Inc.) during the three exercises.
Intervention Administration Participants began with the PNF D2 shoulder exercise at 14 beats per minute paced by a metronome to match the tempo of the U-Ball game for 1 minute. After this initial intervention, participants were given a 2-minute break where they completed a survey (Borg and customized questionnaire). Participants were then randomized for interventions II and III. This randomization involved blindly selecting one of two papers marked II or III, designed to minimize carryover effects.
Conditions
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Study Design
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RANDOMIZED
CROSSOVER
TREATMENT
SINGLE
Study Groups
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PNF and PNF with virtual reality and PNF with concurrent feedback
Participants began with the PNF D2 shoulder exercise for 1 minute. Then participants did PNF D2 exercise with virtual reality gaming as second intervention for 1 minute and then they did PNF D2 exercise with concurrent feedback as third intervention for 1 minute. Between each intervention, participants were given a 2-minute break. Baseline was always PNF exercise, however second and third interventions for the arm 1 and arm 2 were different.
PNF exercise
Foundational PNF D2 shoulder flexion exercise incorporating shoulder flexion, abduction, and external rotation. This exercise was performed at a metronome-guided pace of 14 beats per minute to establish a consistent baseline.
PNF exercise with virtual reality gaming
Combined the PNF D2 shoulder flexion exercise with a virtual reality motion capture game (the U-Ball game).
PNF with concurrent feedback
PNF exercise with the addition of auditory concurrent feedback ("Sword") which referenced the action of unsheathing a sword in a diagonal upward direction.
PNF and PNF with concurrent feedback and PNF with virtual reality gaming
Participants began with the PNF D2 shoulder exercise for 1 minute. Then participants did PNF D2 exercise with concurrent feedback as second intervention for 1 minute and then they did PNF D2 exercise with virtual reality gaming as third intervention for 1 minute. Between each intervention, participants were given a 2-minute break. Baseline was always PNF exercise, however second and third interventions for the arm 1 and arm 2 were different.
PNF exercise
Foundational PNF D2 shoulder flexion exercise incorporating shoulder flexion, abduction, and external rotation. This exercise was performed at a metronome-guided pace of 14 beats per minute to establish a consistent baseline.
PNF exercise with virtual reality gaming
Combined the PNF D2 shoulder flexion exercise with a virtual reality motion capture game (the U-Ball game).
PNF with concurrent feedback
PNF exercise with the addition of auditory concurrent feedback ("Sword") which referenced the action of unsheathing a sword in a diagonal upward direction.
Interventions
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PNF exercise
Foundational PNF D2 shoulder flexion exercise incorporating shoulder flexion, abduction, and external rotation. This exercise was performed at a metronome-guided pace of 14 beats per minute to establish a consistent baseline.
PNF exercise with virtual reality gaming
Combined the PNF D2 shoulder flexion exercise with a virtual reality motion capture game (the U-Ball game).
PNF with concurrent feedback
PNF exercise with the addition of auditory concurrent feedback ("Sword") which referenced the action of unsheathing a sword in a diagonal upward direction.
Eligibility Criteria
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Inclusion Criteria
* capable of performing PNF D2 shoulder flexion exercise
Exclusion Criteria
* pain in the scapular region
* rotator cuff tear or reconstruction
* shoulder dislocation
* shoulder instability
* frozen shoulder
* fracture
* chronic neck pain
18 Years
45 Years
ALL
Yes
Sponsors
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Dominican University New York
OTHER
Responsible Party
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Ayse Edeer
Principal investigator
Principal Investigators
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Ayse Edeer, PT, PhD
Role: PRINCIPAL_INVESTIGATOR
Dominican University New York
Locations
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Dominican University New York, Doctor of Physical Therapy Program
Orangeburg, New York, United States
Countries
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References
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Zaidi S, Ahamad A, Fatima A, Ahmad I, Malhotra D, Al Muslem WH, Abdulaziz S, Nuhmani S. Immediate and Long-Term Effectiveness of Proprioceptive Neuromuscular Facilitation and Static Stretching on Joint Range of Motion, Flexibility, and Electromyographic Activity of Knee Muscles in Older Adults. J Clin Med. 2023 Mar 30;12(7):2610. doi: 10.3390/jcm12072610.
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Other Identifiers
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Dominican University New York
Identifier Type: -
Identifier Source: org_study_id
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