The proprioceptive neuromuscular facilitation-concept; the state of the evidence, a narrative review

Proprioceptive neuromuscular facilitation therapy versus manual therapy in patients with neck pain: a randomised controlled trial

OBJECTIVE

To compare the effects of proprioceptive neuromuscular facilitation therapy with manual therapy in improving the range of motion, decreasing pain, and improving activity of daily living in patients with neck pain.

DESIGN

Double-blinded, randomized, experimental study.

PATIENTS

Women aged 45-65 with cervical pain due to osteoarthritis of the vertebral body and intervertebral disc.

METHODS

A total of 93 randomly selected females were included in the study. They were randomly divided into 2 groups. One received proprioceptive neuromuscular facilitation treatment and the other received manual therapy. To evaluate functional capabilities, the Oswestry Disability Index and range of motion measure were used. To evaluate changes in subjective experience of pain the Visual Analogue Scale was used.

RESULTS

In terms of the activities of daily living, pain, and range of motion of flexion, extension, lateral flexion to the right and left, and rotation to the right and left improvement in group I compared with group II was statistically significant (p < 0.05) at 2 weeks and 3 months' follow-up.

CONCLUSION

Treatment according to proprioceptive neuromuscular facilitation is a better method in comparison with manual therapy regarding improvement of pain, range of motion, and daily functioning in patients with cervical pain.

Effectiveness of proprioceptive neuromuscular facilitation therapy and strength training among post-menopausal women with thumb carpometacarpal osteoarthritis. A randomized trial

BACKGROUND

Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life.

PURPOSE

Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength.

STUDY DESIGN

Superiority randomized clinical trial.

METHODS

42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks).

RESULTS

Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P<.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P<.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P<.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P = .003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P = .024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P = .003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P = .049; d = 0.62). These improvements were maintained at follow-up.

CONCLUSIONS

The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength.

Effects of proprioceptive neuromuscular facilitation and both sides up ball exercise on pain level, range of motion, muscle function after total knee arthroplasty

Knee osteoarthritis (OA) is a degenerative joint disease caused tearing and progressive wear of articular cartilage, and total knee arthroplasty (TKA) is recommended to patients with OA. The purpose of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF) and both sides up ball (BOSU) exercises on pain, range of motion (ROM), and muscle function in patients following TKA. Ten participants who have limitation of the knee joint from TKA were divided into two groups: the continuous passive motion (CPM)+PNF exercise group (n=5) and the CPM+BOUS exercise group (n=5). Exercise rehabilitation program consisted of PNF and BOSU exercises, and both exercises were performed twice a day for 2 weeks. To examine effect of exercise rehabilitation, visual analogue scale (VAS), sit and reach flexibility, knee ROM, and Timed Up and Go test (TUG) were measured before and after exercise intervention. A two-way repeated analysis of variance was used to confirm the main effect. If there was a significant interaction effect, an independent t-test between groups or a paired t-test between times was applied. VAS, sit and reach flexibility, knee ROM and TUG did not show interaction between the PNF and BOSU exercise groups, but all measured variables showed significant differences over time. Present findings provide information that PNF and BOSU exercise rehabilitation after TKA might be an important part of ensuring successful surgical outcomes as they have a positive impact on reducing pain, increasing ROM, improving muscle strength, and enhancing daily life movements.

Identifying best fall-related balance factors and robotic-assisted gait training attributes in 105 post-stroke patients using clinical machine learning models

BACKGROUND

Despite the promising effects of robot-assisted gait training (RAGT) on balance and gait in post-stroke rehabilitation, the optimal predictors of fall-related balance and effective RAGT attributes remain unclear in post-stroke patients at a high risk of fall.

OBJECTIVE

We aimed to determine the most accurate clinical machine learning (ML) algorithm for predicting fall-related balance factors and identifying RAGT attributes.

METHODS

We applied five ML algorithms- logistic regression, random forest, decision tree, support vector machine (SVM), and extreme gradient boosting (XGboost)- to a dataset of 105 post-stroke patients undergoing RAGT. The variables included the Berg Balance Scale score, walking speed, steps, hip and knee active torques, functional ambulation categories, Fugl- Meyer assessment (FMA), the Korean version of the Modified Barthel Index, and fall history.

RESULTS

The random forest algorithm excelled (receiver operating characteristic area under the curve; AUC = 0.91) in predicting balance improvement, outperforming the SVM (AUC = 0.76) and XGboost (AUC = 0.71). Key determinants identified were knee active torque, age, step count, number of RAGT sessions, FMA, and hip torque.

CONCLUSION

The random forest algorithm was the best prediction model for identifying fall-related balance and RAGT determinants, highlighting the importance of key factors for successful RAGT outcome performance in fall-related balance improvement.

Effect of PNF stretching performed in the AKE position on hip, knee, and ankle flexibility

BACKGROUND

To measure hamstring flexibility, the active knee extension (AKE) test is preferred over the straight leg raise (SLR) test as it can be used to measure hamstring flexibility more selectively. However, hamstring stretching is primarily conducted in the SLR position (maximal hip flexion in the supine position) as it allows for maximal hip flexion in the supine position.

OBJECTIVE

This study evaluates the effects of proprioceptive neuromuscular facilitation (PNF) stretching in the AKE position (maximal knee extension with 90∘ flexion of the hip in the supine position) on hip, knee, and ankle flexibility.

METHODS

SLR, AKE, and active dorsiflexion (ADF) tests were used to determine the range of motion (ROM) before (pre-ROM) and after (post-ROM) stretching. PNF stretching consisted of maximal isometric knee flexion at the end range with external resistance to prevent knee flexion. One set of PNF stretches (five trials of six seconds each) was conducted.

RESULTS

The post-ROMs of hip, knee, and ankle measured via the SLR, AKE, and ADF tests, respectively, were significantly higher than the pre-ROMs.

CONCLUSIONS

The improvement in knee flexibility was greater than the improvement in hip and ankle flexibility. The AKE position is recommended in clinical settings during PNF stretching for individuals with hamstring tightness. Furthermore, PNF stretching in the AKE position increases the ADF ROM.

Acute effects of different proprioceptive neuromuscular facilitation stabilization techniques on the balance of elderly women

AIM

To compare the acute effects of rhythmic stabilization (RS) and stabilizer reversal (SR) techniques of PNF on the balance of sedentary elderly women.

METHODS

Women aged (≥70) were allocated into three groups: RS, SR and control (CR). The experimental groups (RS and SR) performed balance exercises with the addition of rhythmic stabilization techniques (RS group) or with stabilizers reversal (SR group) for 15 min. The CR group performed the exercises without adding the PNF stabilization techniques. Participants performed the Time Up and Go (TUG) test, the Functional Reach Test (FRT) and static and dynamic stabilometry pre and post intervention. Kruskal-Wallis and Mann-Whitney tests were used for comparison between groups and post hoc analysis, respectively, with p ≤ 0.05. For the effect size measurements, the r for Wilcoxon and Mann-Whitney signal were used.

RESULTS

For functional tests intra-group analysis, a reduction in TUG time and an increase in FRT range (p ≤ 0.05) were observed in RS e SR groups. Stabilometry analysis showed a significant difference only for the RS group, with reduced average velocity of the centre of pressure (COP), and an increased in the left foot pressure.

CONCLUSIONS

A single RS or SR session reduced the TUG time and the range distance in the FRT in elderly women. A single session of the RS technique was also able to reduce the mean velocity of the COP and the maximum pressure on the left foot.

IMPACT

This study shows an easy-to-apply methods without additional materials that can help prevent falls in the elderly.

Bilateral Asymmetrical Limb Proprioceptive Neuromuscular Facilitation Effects on Pain, Multifidus Activity, Range of Motion, and Disability in Low Back Pain: A Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to determine the effects of bilateral asymmetrical limb proprioceptive neuromuscular facilitation (PNF) pattern exercises on lumbar multifidus (LM) activity, pain, disability, and lumbar range of motions (ROMs) compared to Swiss ball exercises in patients with chronic low back pain (CLBP).

METHODS

A randomized controlled trial was conducted at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan, between March 2020 and January 2021. A sample size of 150 patients with CLBP was randomized into 2 groups. Participants in the intervention group (n = 75) received bilateral asymmetrical limb PNF, while the comparison group (n = 75) received Swiss ball exercises. The scores of the visual analog scale, Oswestry Disability Index, Modified-Modified Schober's test, and percentage of the maximum voluntary contractions of LM (%MVC LM) through surface electromyography were recorded before and after 15 sessions of exercises. The Wilcoxon signed rank and Mann-Whitney U tests were employed for within-group and between-group comparisons of all outcomes, respectively. The considered level of significance was 0.05. The trial was registered with ClinicalTrials.gov (NCT04206137).

RESULTS

Pain (in sitting, standing, and walking), disability on the Oswestry Disability Index, and left side %MVC LM were significantly improved (P < .001) in the PNF group compared to the comparison group except for right side %MVC LM and ROMs on the Modified-Modified Schober's test (P > .05).

CONCLUSION

Bilateral asymmetrical limb PNF exercises showed improvement in pain, disability, and LM activity of patients with CLBP more than those who used Swiss ball exercises.

Efficacy and safety of proprioceptive neuromuscular facilitation for chronic low back pain: A meta-analysis of randomized controlled trials

Objectives: This study aimed to evaluate the effectiveness and safety of proprioceptive neuromuscular facilitation for chronic low back pain.

Materials and methods: Eleven databases were searched from their inception through January 2021. The primary outcomes were pain intensity, individual activities, quality of life, and adverse events.

Results: Four randomized controlled trials (RCTs) with 184 patients (mean age: 37.8±3.1 years; range, 35 to 50 years) met the inclusion criteria. The pooled effect size showed proprioceptive neuromuscular facilitation, relieved pain (standard means difference [SMD]: -0.835, 95% CI: -1.139 to -0.531, p<0.001, n=4), and improved individual activity (Roland Morris Disability Questionnaire, SMD: -1.765, 95% CI: -2.642 to -0.888, p<0.001, n=2; Oswestry Disability Index, SMD: -0.893, 95% CI: -1.434 to -0.352, p=0.001, n=1) for chronic low back pain (CLBP).

Conclusion: This study verified that proprioceptive neuromuscular facilitation could relieve pain and improve individual activities without serious adverse events in patients with CLBP; however, it should be cautiously recommended due to the small number of included RCTs.

Electromyographic analysis of pelvic floor muscles during the execution of pelvic patterns of proprioceptive neuromuscular facilitation-concept: An observational study

OBJECTIVE

To assess the effect of pelvic patterns of proprioceptive neuromuscular facilitation (PNF-concept) on pelvic floor muscles (PFM) recruitment, as well as the electromyographic activity of muscles synergic to the pelvic floor in healthy women.

METHODS

Observational study conducted with 31 women aged between 18 and 35 years, with mean age of 23.3 ± 3.2 (22.1-24.4). PFM activity was monitored by surface electromyography during the combination of isotonics technique of four pelvic patterns of PNF-concept (i.e., anterior elevation, posterior depression, anterior depression, and posterior elevation). The electromyographic signal was analyzed using root mean square amplitude. Two-way repeated measures analysis of variance was performed to analyze differences in PFM activity between types of contraction (i.e., concentric, isometric, and eccentric) and the four pelvic patterns.

RESULTS

PFM activity did not differ among the four pelvic pattens. However, PFM activity was significantly different between the combination of isotonics technique and baseline, F(1.6, 48.2) = 71.5; p < 0.000, with a large effect size (partial ƞ² = 0.705). Concentric (22.4 µV ± 1.1), isometric (17.3 µV ± 0.6), and eccentric (15 µV ± 0.5) contractions of combination of isotonics technique increased PFM activity compared with baseline (10.8 µV ± 0.4) in all pelvic patterns. By analyzing the electromyographic activity of the muscles synergistic to the pelvic floor, there is effect of the interaction of the type of contraction, the pelvic pattern of the PNF concept, and the synergistic muscles on the myoelectric activity of the external anal sphincter, F(3.2, 96.5) = 5.6; p < 0.000, with a large magnitude of effect (partial ƞ² = 0.15). In the anterior elevation pattern, the muscles synergistic to the pelvic floor present synergy in phase with the PFM, and in the posterior patterns there was a decrease in the activity level of all synergistic muscles, without changing the activity level of the PFM.

CONCLUSION

PFM activity did not differ among the four pelvic patterns of PNF-concept. Nonetheless, the combination of isotonics technique showed a significant effect on PFM compared with baseline, with greater PFM activity during concentric contraction. Pelvic patterns of PNF-concept may be used to increase PFM recruitment in young healthy women.

Effectiveness of proprioceptive neuromuscular facilitation and myofascial release techniques in patients with subacromial impingement syndrome

PURPOSE

To compare the effectiveness of proprioceptive neuromuscular facilitation and myofascial release technique in patients with subacromial impingement syndrome on pain, range of motion, muscle strength, quality of life, functionality and disability.

METHODS

Thirty patients were randomly divided into two groups: proprioceptive neuromuscular facilitation group (n = 15) and proprioceptive neuromuscular facilitation combined with myofascial release technique group (n = 15). Both treatment methods were performed 3 times a week for 4 weeks. Pain severity was assessed by Visuel Analog Scale, range of motion by a goniometer, muscle strength by digital hand dynamometer, quality of life by Nottingham health profile, functionality by arm, shoulder and hand problems questionnaire, disability by shoulder pain and disability index. All measurements were used before and after treatments. Pain severity, range of motion and muscle strength were also evaluated after the first session.

RESULTS

After the treatment, shoulder pain, range of motion, muscle strength, functionality and disability were improved in two groups (p < 0.05). Proprioceptive neuromuscular facilitation showed improvement in pain, whereas myofascial release technique improved pain, physical activity, emotional state, sleep and total dimensions of life quality (p < 0.05). Proprioceptive neuromuscular facilitation was more effective in reducing activity pain, whereas myofascial release technique was more effective in increasing flexion, external and internal rotation range of motion, flexion and abduction muscle strength after the first session (p < 0.05).

CONCLUSIONS

The combined application of proprioceptive neuromuscular facilitation and myofascial release technique has a more acute and cumulative positive effect on pain, range of motion, muscle strength, functionality, disability and quality of life in patients with subacromial impingement syndrome.

Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report

Dysphagia and aspiration risk are common sequelae of stroke, leading to increased risk of stroke-associated pneumonia. This is often aggravated by stroke-related impairment of cough, the most immediate mechanical defense mechanism against aspiration. In humans, reflex cough can be repeatedly and safely elicited by inhalation of nebulized capsaicin, a compound contained in chili peppers. Could this cough-eliciting property of capsaicin support the recovery of stroke survivors who present with dysphagia and aspiration risk? We present a clinical case report of a 73-year-old man, admitted to inpatient stroke rehabilitation following a right middle cerebral artery infarct with subsequent dysphagia and hospital-acquired pneumonia. A course of daily inhalation therapy with nebulized capsaicin was initiated, triggering reflex coughs to support secretion clearance and prevent recurrence of pneumonia. Clinical observations in each inhalation therapy session demonstrate good patient response, safety and tolerability of nebulized capsaicin in this mode of application. Repeated Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessments show concurrent improvement in the patient’s swallowing status. Inhalation therapy with nebulized capsaicin may offer a viable treatment to facilitate coughing and clearing of secretions, and to minimize aspiration and risk of aspiration-related pneumonia post stroke. Further investigation in a randomized controlled trial design is warranted.

Feasibility of Chest Wall and Diaphragm Proprioceptive Neuromuscular Facilitation (PNF) Techniques in Mechanically Ventilated Patients

Physical therapy is part of the treatment for patients admitted to ICU. Proprioceptive neuromuscular facilitation (PNF) is one of the physiotherapy concepts including manual techniques and verbal stimulation. The purpose of this paper is to examine the feasibility of PNF techniques in mechanically ventilated (MV) ICU patients. Another aim is to verify whether the technique using resistance during the patient’s inhalation will have a different effect than the technique used to teaching the correct breathing patterns. Methods: Patients admitted to tertiary ICU were enrolled in this study, randomly divided into two groups, and received four 90-second manual breathing stimulations each. The following vital signs were assessed: HR, SBP, DBP, and SpO₂. Results: 61 MV ICU adult patients (mean age 67.8; 25 female and 36 male) were enrolled in this study. No significant differences in HR, SBP, and DBP were observed both for two techniques measured separately and between them. Statistically significant differences were noticed analysing SpO₂ in the rhythmic initiation technique (RIT) group (p-value = 0.013). Conclusions: Short-term PNF interventions did not influence clinically relevant vital parameters among MV patients and seem to be feasible in this group of ICU patients.

Pandemic decrease of in-person physiotherapy as a factor in parent perceived decline in function in children with neuromuscular disorders

PURPOSE

Restrictions related to the COVID-19 pandemic can negatively affect patients who require physiotherapy. This study aimed to analyze the consequences of limited physiotherapy on the functional state of children with neuromuscular diseases (NMD). In addition, the caregivers' well-being and caregiver opinions on physiotherapy were analyzed.

METHODS

A questionnaire was shared with parents of children with NMD immediately after the COVID-19 lockdown. The survey included questions regarding the physical and mental condition of children and parents before the pandemic and during lockdown as well as their views on physiotherapy and telephysiotherapy. Statistical analysis was performed using the Wilcoxon Matched-Pairs Signed Ranks test, Spearman's Rank Correlation test, McNemar test, and Chi-square test.

RESULTS

Parents of 235 children participated in the study. Results indicated that children devoted more time to physiotherapy before the pandemic than during the lockdown period, which was true for those living in cities and the countryside. The functional state of 50.2% of the children deteriorated during the lockdown, in the opinion of their parents. Significant correlations were found between limited physiotherapy time and the deterioration of children's functional condition, ability to maintain a standing position, and increased anxiety. The majority of parents reported increased levels of fear and anxiety (72.8%), fatigue (67.7%), and pain (53.2%). In-person physiotherapy was rated significantly higher than telephysiotherapy by parents.

CONCLUSIONS

Limited access to physiotherapy and shorter therapy times may lead to functional deterioration in children with NMD, but this assumption needs to be objectively confirmed. According to the parents' opinions, telephysiotherapy is less beneficial than direct physiotherapy but may support therapy conducted directly by a physiotherapist. Results based on subjective parental opinions may be helpful in planning future projects.

Proprioceptive neuromuscular facilitation training reduces pain and disability in individuals with chronic low back pain: A systematic review and meta-analysis

BACKGROUND

and purpose: Although proprioceptive neuromuscular facilitation (PNF) exercises are used in rehabilitation practice, their effects in patients with low back pain (LBP) remain unclear. This study aimed to investigate the efficacy of PNF training for pain and disability in patients with LBP.

METHODS

In this systematic review, we searched five databases from the earliest date available to October 2020. Three comparisons were performed: PNF versus control, PNF versus core strengthening, and PNF versus conventional physical therapy.

RESULTS

Sixteen studies met the eligibility criteria (722 patients). PNF training improved pain (standardized mean difference [SMD]: -2.6; 95% confidence interval [CI]: -4.2 to -0.9, n = 174) and disability (SMD: -3.29; 95% CI: -5.3 to -1.3, n = 144) compared to the control. PNF training also yielded a greater benefit for pain reduction (mean difference [MD]: -1.8, 95% CI: -2.2 to -0.3, n = 177) and disability improvement (MD: -6.6, 95% CI: -9.3 to -3.8, n = 113) than did core strengthening.

CONCLUSION

PNF training seems to be a useful strategy for decreasing pain and improving disability in patients with LBP. However, the quality of evidence for the outcomes of both pain and disability was low to moderate.

PNF- based Gait Rehabilitation-training after a Total Hip Arthroplasty in congenital pelvic malformation; A case report

INTRODUCTION

Congenital dysplasia of the pelvis often occurs in isolation, however, it can also involve other pelvic components, and anomalies of the digestive system. Pelvic malformations have effects on the pelvic girdle and pelvic stability influencing the quality of gait. The condition can be treated with a total hip arthroplasty (THA). The concept of Proprioceptive Neuromuscular Facilitation (PNF) has been described as a comprehensive rehabilitation approach with a focus on motor learning. This case report seeks to illustrate the clinical reasoning and feasibility of applying the PNF-concept in a patient after a THA with multiple congenital pelvis malformations.

CASE DESCRIPTION

A male, 44 years of age, physically active laborer was treated with THA after hip dysplasia, with comorbid missing pubic symphysis. The patient presented with complaints in gait speed, gait distance, hip joint mobility and stability.

PATIENT MANAGEMENT

PNF-based motor-control training, including specified PNF-pattern exercises with specific PNF-facilitation principles and techniques was provided over a period of eighteen weeks. Results showed improvements beyond the minimal detectable change and/or the minimal clinically important difference for physical functioning in gait, strength, range of motion, and personal required activities.

DISCUSSION AND CONCLUSION

Gait rehabilitation training, restoring altered movement patterns in the patient's activities of daily living was provided with PNF. Besides targeting structural impairments, this approach elicited motor learning effects. PNF-patterns have been described as: "mimicking functional activities" from daily life and sports. A specified PNF-based therapy including motor learning components, was a feasible approach in this case of complex pelvic skeletal malformations.

Acute effects of proprioceptive neuromuscular facilitation exercises on the postural strategy in patients with chronic low back pain

INTRODUCTION

Active treatments focused on improvement in motor function are postulated in chronic low back patients (CLBP).

OBJECTIVE

to establish the acute effects of PNF exercise on the postural control strategy.

METHODS

The sway of the body was tested before intervention in fifty-three CLBP patients and after that participants were randomly assigned into the intervention PNF group (n = 25). Mean velocity (VEL) and sample entropy (SEn), over the center of pressure in the mediolateral (ML) and anterior-posterior (AP) planes served to estimate the postural strategy and automaticity levels in the neuromuscular controller. Tandem and one-leg standing tests (OLST) with eyes open and eyes closed were used.

RESULTS

Pain intensity decreased after the intervention. The VEL was no longer vision-dependent in both planes. The SEn decreased immediately after the exercise and either returned to or even exceeded the baseline values in the OLST ML plane.

CONCLUSION

A single session of PNF exercise may have a beneficial effect on pain and postural control in CLBP patients. The statistically significant pain relief combined with newly acquired better control of posture may have encouraged the PNF group participants to a subconscious exploration of the stability area. Postural movements were more automatized in OLST in the delayed test.

Mobilization of the neurodynamic system using proprioceptive neuromuscular facilitation decreases pain and increases mobility in lower extremities and Spine-A case report

INTRODUCTION

Different approaches are used in physical therapy when treating patients with peripheral nerve paralysis and pain syndrome, such as neuro-mobilization techniques, manual therapy, muscle strengthening, active mobilization and relaxation techniques. Proprioceptive neuromuscular facilitation (PNF) seems to be a promising therapy for mobilizing the neurodynamic system. This case report illustrates the clinical reasoning and feasibility of applying PNF based neuromobilization to a patient not responsive to standard physical therapy.

CASE DESCRIPTION

A 66-year-old male was diagnosed with neurofibrosarcoma grade II, paravertebral L4-L5 left (L) side. After laminectomy of the transverse process L4 and L5 L side and stent in the lumbar region, the patient presented pain and peripheral nerve paralysis. The patient's complaints 13 years later were chronic lower back, buttock and leg pain and weakness in the L leg.

PATIENT MANAGEMENT

Six treatment sessions with follow-up were provided during 3.5 months. The PNF-based-rehabilitation-approach applied the PNF philosophy, specific techniques, and facilitating principles and procedures using manual guidance in 3-dimensional PNF movement patterns in various positions, aiming to mobilize the neurodynamic system to decrease pain and achieve trunk and leg mobility.

DISCUSSION AND CONCLUSION

The PNF-based-rehabilitation-approach led to improvement in pain, nerve mobility and balance beyond or close to clinical relevance. This approach had positive effects, by supplying oxygen to the nerves, increasing nerve mobility and decreasing pain, hence restoring altered movement patterns, which all improved the patient's activities-of-daily-living. In a situation, where standard strengthening and mobilization techniques are not effective, PNF seems a feasible alternative to decrease chronic pain.

Impact of two different pulmonary rehabilitation methods in children with down syndrome

PURPOSE

To investigate and compare the effect of proprioceptive neuromuscular facilitation of respiratory muscles with that of inspiratory muscle training as a preventive measure on respiratory muscle strength, chest expansion, spirometry, and functional capacity in children with Down syndrome.

METHODS

Forty-five Down syndrome participants with an age ranged from 10 to 13 years were enrolled. There were distributed into three groups. The study group A (n = 15) underwent proprioceptive neuromuscular facilitation of respiratory muscles while study group B (n = 15) underwent inspiratory muscle training. Third group C (n = 15) was a control group. The three groups received aerobic exercises using the bicycle ergometer for 20 min, 5 times/week for 12 successive weeks. The treatment program for both study groups was conducted for 20-30 min, 5 times/week for 12 successive weeks. Measurements of respiratory muscle strength (MIP, MEP), chest expansion, spirometry test (VC, FEV1, PEFR, MVV) and 6 min walk test were measured pre and post treatment.

RESULTS

The post treatment mean values of all investigated variables were significantly increased in both study groups with higher effect to group underwent proprioceptive neuromuscular facilitation of respiratory muscles.

CONCLUSION

Both proprioceptive neuromuscular facilitation of respiratory muscles and inspiratory muscle training are effective in children with Down syndrome on improving respiratory muscle strength, chest expansion, spirometry and functional capacity with superior effect of proprioceptive neuromuscular facilitation.

The Proprioceptive Neuromuscular Facilitation Concept in Parkinson Disease: A Systematic Review and Meta-Analysis

Objective

The aim of this review was to evaluate the effects of proprioceptive neuromuscular facilitation (PNF) in individuals with Parkinson disease.

Methods

This was a systematic review. We searched for articles with the keywords "Proprioceptive neuromuscular facilitation" and "Parkinson's disease." The databases searched were Scopus, ScienceDirect, Springer, Web of Science, LILACS (Latin American and Caribbean Health Sciences Literature), CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library, PEDro (Physiotherapy Evidence Database), SciELO (Scientific Electronic Library Online), Ovid, and PubMed, in addition to reference lists of relevant articles. All scientific articles published before November 2019 that addressed rehabilitative outcomes of PNF for individuals with Parkinson disease were considered. Two investigators independently screened studies according to the eligibility criteria.

Results

Of the 674 articles found, 6 were selected. The PEDro scores of 2 articles were 3 points, and the others scored 7, 8, and 9 points. The meta-analysis investigated 3 articles with the same outcomes: walking speed, stride length, and cadence. We found a statistical difference between PNF and other therapies for gait speed (M = 0.28, 95% confidence interval = 0.21-0.34, P < .001).

Conclusion

Based on the meta-analysis, we found that PNF is similar or superior to other therapies as relates to gait speed. The efficacy of PNF for indications of Parkinson disease, however, requires further investigation, as a sufficient number of qualified, well-designed, randomized controlled studies is lacking.

Proprioceptive neuromuscular facilitation compared to conventional physiotherapy for adults with traumatic upper brachial plexus injury: A protocol for a randomized clinical trial

BACKGROUND

Traumatic upper plexus injury affects daily living activities performance and participation of individuals. Physical therapy treatment has a fundamental role on functional recovery, but it is still an unexplored and challenging field.

AIM

To develop a protocol to evaluate the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) compared to conventional physiotherapy (CPT group) on functionality and quality of life.

METHODS

A committee was formed by four physical therapists to develop the treatment protocol. A Delphi study was carried out in order to quantify the level of agreement. A protocol for a randomized controlled trial was proposed to evaluate the effectiveness of the protocol in improving functionality and quality of life, according Consolidated Standards of Reporting Trials. Participants will be randomly assigned (1:1) to PNF or CPT group and two weekly sessions will be carried out for 12 months postsurgery, with a three-month follow-up. The main outcome measurements are: upper limb functionality, quality of life, range of motion, muscle strength, tactile sensitivity, and pain, which will be assessed at baseline, on the 6th, 9th, and 12th months postsurgery.

RESULT

A PNF protocol was developed for traumatic upper brachial plexus injury, consisting of 11 illustrated exercises, three for immediate postoperative and eight for postoperative. Biomechanical objectives, observations, positions of patients and therapists and PNF principles, procedures and techniques have been described. An 80% agreement on all items in the first round of the Delphi study was achieved.

CONCLUSION

A protocol based on the PNF-concept was developed with the aim of improving the functionality and quality of life of individuals undergoing nerve transfer after traumatic injury to the upper plexus. The detailed description of a physical therapy treatment protocol through an appropriate method will allow its use in clinical practice and in future studies with this population.

Scapula motor control training with Proprioceptive Neuromuscular Facilitation in chronic subacromial impingement syndrome: A case report

INTRODUCTION

Shoulder complaints have high re-occurrence rates and scapular control seems to be a major influencing factor in sub-acromial impingement syndromes (SIS). Scapular dyskinesia disrupts the scapulohumeral rhythm, altering biomechanical loads on the rotator cuff in shoulder movements. As a result, this disturbs the natural healing process. Proprioceptive Neuromuscular Facilitation (PNF) seems to be a promising treatment approach because it has a focus on motor learning. This case report seeks to illustrate the clinical reasoning and feasibility of applying the comprehensive nature of PNF in a patient who was not responsive to standard physiotherapy.

CASE DESCRIPTION

A 47-year-old male, a former professional handball player, was diagnosed with a SIS based upon a rotator-cuff tendinopathy, scapular dyskinesia and degeneration of supraspinatus tendon. The patient presented complaints of right sided shoulder pain in overhead activities and in reaching behind the back.

PATIENT MANAGEMENT

PNF-based motor-control training was provided over a period of five weeks. This approach included specified PNF-pattern exercises with specific PNF-facilitation principles and techniques. The results were improvements beyond the minimal clinical important difference and/or minimal detectable change for physical functioning, pain, range of motion, and functional disability of the shoulder.

DISCUSSION AND CONCLUSION

PNF provided an opportunity for motor control training, restored altered movement patterns in the patient's daily life activities. The approach addressed motor learning effects and structural impairments. PNF-patterns have been described as: "mimicking functional activities" from daily life and from sports. In cases where standard strengthening and mobilization exercises are not effective, a specified PNF-based therapy has shown to be a feasible alternative.

Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial

BACKGROUND

Individuals affected by stroke present with changes in cardiovascular and respiratory functions. Cardiorespiratory training (CRT) is one of the classic intervention guidelines for cardiorespiratory fitness. CRT in association with the proprioceptive neuromuscular facilitation (PNF) technique for respiratory muscles could improve the quality of life, cardiorespiratory function and gait parameters of patients after stroke.

OBJECTIVE

To assess the effects of respiratory and trunk patterns of CRT associated with PNF on the quality of life, gait, oxygen consumption, respiratory muscle strength and thoracic volumes.

METHODS/DESIGN

A blind, randomized clinical trial with allocation confidentiality will be performed. Forty patients will be randomized into four groups: CRT-lower limb (LL) plus PNF; CRT-LL and respiration; CRT-upper limb (UL) plus PNF; or CRT-UL and respiration. Individuals will be evaluated at three different times (pretreatment, after 20 days of treatment and 1 month after the end of treatment). The treatment protocol consists of respiratory exercises, 30 min of CRT (cycle ergometer) and then repetition of the respiratory exercises, performed three times a week over a period of 20 days. Primary outcome measures are quality of life, gait, balance, peak oxygen uptake and rib cage compartment volumes. As secondary outcomes, respiratory function and maximal inspiratory and expiratory pressures will be measured.

DISCUSSION

The association of PNF with CRT may be a viable and accessible alternative to increase cardiorespiratory function in patients with stroke.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03171012. Registered on 6 June 2017.

PNF and manual therapy treatment results of patients with cervical spine osteoarthritis

PURPOSE

The aim of this study was to evaluate the effectiveness of PNF and manual therapy methods in the treatment of patients with cervical spine osteoarthritis, especially their efficacy in reducing pain and improving functionality in everyday life. Long-term results were also compared in order to determine which method of treatment is more effective.

SUBJECTS AND METHODS

Eighty randomly selected females aged 45-65 were included in the study. They were randomly divided into two groups of 40 persons. One group received PNF treatment and the other received manual therapy (MAN.T). To evaluate functional capabilities, the Functional Rating Index was used. To evaluate changes in pain, a shortened version of the McGill Questionnaire was used.

RESULT

The PNF group achieved a greater reduction in pain than the MAN.T group. The PNF group showed a greater improvement in performing daily activities such as sleeping, personal care, travelling, work, recreation, lifting, walking and standing as well as decreased intensity and frequency of pain compared to the MAN.T group.

CONCLUSION

The PNF method proved to be more effective in both short (after two weeks) and long (after three months) term.

An immediate effect of PNF specific mobilization on the angle of trunk rotation and the Trunk-Pelvis-Hip Angle range of motion in adolescent girls with double idiopathic scoliosis-a pilot study

Background

Impairment of spine rotation is a key concept in several theories explaining the pathogenesis and progression of scoliosis. In previous studies, a more limited range of motion in scoliotic girls compared to their non-scoliotic peers was noted. The Trunk-Pelvis-Hip Angle measurement is a test used to assess the range of motion in the trunk-pelvis-hip complex in the transverse plane. The aim of this study was to assess an immediate effect of Proprioceptive Neuromuscular Facilitation specific mobilization (mPNF) on the angle of trunk rotation and Trunk-Pelvis-Hip Angle range of motion in adolescent girls with double scoliosis.

Methods

The study was conducted on 83 girls aged 10 to 17 years (mean 13.7 ± 1.9) with double idiopathic scoliosis consisting of a right-sided thoracic curve (mean 25.1° ± 13.9°) and a left-sided thoracolumbar or lumbar curve (mean 20.8° ± 11.4°). The angle of trunk rotation and Trunk-Pelvis-Hip Angle were measured at baseline and after PNF mobilization. Bilateral lower limb patterns of Proprioceptive Neuromuscular Facilitation were used in combination with the “contract–relax” technique and stimulation of asymmetrical breathing. In the statistical analysis, the SAS rel. 13.2 software was used. Preliminary statistical analysis was performed using descriptive statistics. According to Shapiro-Wilk criterion of normality, the Wilcoxon test was used to compare paired samples. Next, the data was analyzed using multivariate GLM models.

Results

In adolescent girls with double scoliosis, significant differences between the left and right side of the body concerning the Trunk-Pelvis-Hip Angle ranges were noted. A single, unilateral PNF mobilization significantly decreased the angle of trunk rotation in the thoracic (p < 0.001) and lumbar spine (p < 0.001). Unilateral PNF mobilization also increased the Trunk-Pelvis-Hip Angle ranges on the left (p < 0.001) and right (p < 0.001) side significantly.

Conclusions

Unilateral PNF mobilization led to a decrease in the angle of trunk rotation, improvement in the range of motion, and the symmetry of mobility in the transverse plane in the trunk-pelvis-hip complex in adolescent girls with double idiopathic scoliosis. The effects should be treated only as immediate. Further studies are required to determine long-term effects of PNF mobilization on the spinal alignment.

Trial registration

ISRCTN11750900.