Evaluation of strength and irradiated movement pattern resulting from trunk motions of the proprioceptive neuromuscular facilitation

Electromyographic signals analysis to assess the response of a proprioceptive neuromuscular facilitation pattern execution

Proprioceptive Neuromuscular Facilitation is a rehabilitation technique that consists of the stimulation of a healthy muscle in one extremity of the body to produce an activation effect of a damaged muscle in another extremity, laterally or contralaterally. The use of the analysis of the electromyographic response during the process allows us to describe and evaluate if the damaged muscle produces an activation. This paper presents the progress of the results of a clinical protocol where PNF is explored in healthy subjects, manipulating the upper limb, and recording the electromyographic response of the lower limbs in three different muscles in both inferior limbs. Four activation patterns (movement sequence) with three different stages with different intensities of resistance are considered. Lateral plane video recording analysis is performed to extract the trajectory of the manipulated limb and correlate this information with electromyography signals. The electromyography signals are analyzed in their temporal response by integrating the rectified and smoothed signal according to the beginning and end of the trajectory of the manipulated superior limb. Additionally, the spectrogram analysis of the signals is performed. The partial results of the protocol allow us to establish that the response in the most distal muscles to the manipulated upper limb has been non-significant for the subjects, compared to the response of the proximal muscles, where a relationship with activation and trajectory of the arm is observed. particularly in the process with greater resistance. The observed changes in signal frequency across the spectrogram correspond to low-frequency changes in the 15 to 20Hz band.Clinical Relevance- This work presents a strategy to assess the rehabilitation process based on proprioceptive neuromuscular facilitation by analyzing the time and time-frequency response of the electromyographic signal.

Radial nerve palsy following humeral shaft fracture: a theoretical PNF rehabilitation approach for tendon and nerve transfers

Background:Humerus fracture-induced radial nerve injury can create severe and permanent disabilities. Purpose:Surgical management often relies on either tendon or nerve transfer. Regardless of which procedure is selected, physical therapists are challenged to restore functional outcomes without jeopardizing repair healing. Through synergistic, multi planar upper extremity movement patterns, neuromuscular irradiation, or overflow, and neuroplasticity, proprioceptive neuromuscular facilitation (PNF) may improve strength, range of motion and tone. Methods:After reviewing the literature, a five phase PNF-based treatment approach is proposed with timing differences based on the selected procedure. Findings:Phase I (2 or 4 weeks pre-surgery for tendon or nerve transfer, respectively) consists of comprehensive patient education; Phase II (4-6 or 1-2 weeks post-surgery for tendon or nerve transfer, respectively) explores variable duration peripheral and central nervous system motor learning during isometric activation to enhance central neuroplasticity; Phase III (7-12 or 3-20 weeks post-surgery for tendon or nerve transfer, respectively) incorporates low-intensity motor control including contralateral isotonic upper extremity loading to maximize overflow and neuroplastic effects; Phase IV (13-26 or 21-52 weeks post-surgery for tendon or nerve transfer, respectively) adds high-intensity strength and motor control using ipsilateral isotonic upper extremity loading to maximize overflow and neuroplastic effects. Phase V (27-52 or 53-78 weeks post-surgery for tendon or nerve transfer, respectively) progresses to more activity of daily living, vocational, or sport-specific training with higher intensity strength and motor control tasks. Conclusions:Through manually guided synergistic, multi planar movement, overflow, and neuroplasticity, a PNF treatment approach may optimize neuromuscular recovery. Validation strategies to confirm clinical treatment efficacy are discussed.

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.

THE INFLUENCE OF HIP JOINT ANGLE ON THE RATIO BETWEEN ADDUCTION AND ABDUCTION TORQUE IN EXPERIENCED, RECREATIONAL MALE ICE HOCKEY PLAYERS

BACKGROUND

Strains of the adductor muscle group of the hip are common amongst ice hockey players. The ratio of isometric strengths between the hip adductors and abductors has been offered as a risk factor for hip adductor strain; however, there is no description for how the ratio between hip adductor and abductor strength varies as a function of hip abduction angle.

HYPOTHESIS/PURPOSE

The aim of this study was to determine the influence of hip joint abduction angle on measured ratios of hip adduction to abduction torque in experienced, recreational, male hockey players. The primary null hypothesis for this study was that hip joint abduction angle would not influence hip adduction-to-abduction torque ratios in male hockey players.

STUDY DESIGN

Counterbalanced observational cohort.

METHODS

Twelve uninjured, male, recreational hockey players, with a minimum experience level of midget AAA/minor competitive or equivalent. Participants performed maximal isometric side-lying hip adduction and abduction exertions against a rigidly constrained load cell at 0, 10, and 20 degrees of hip abduction. Measured peak torques from each exertion were used to derive the hip adductor-to-abductor torque ratio. Kinematics of the trunk, pelvis, and lower limbs were monitored using an optoelectronic motion capture system.

RESULTS

Adductor-to-abductor torque ratio increased from 1.49 (SD = 0.20), to 1.92 (SD = 0.20) and to 2.30 (SD = 0.54) with successively increasing hip abduction angle (p < 0.001). Peak torque was significantly different between all angles (p ≤ 0.016) except between adduction exertions performed at 10 and 20 degrees of abduction (p = 0.895). Small changes in hip angle during the exertion were coincident with exertion direction, which confirmed the isometric nature of the task.

CONCLUSION

Hip abduction angle has a significant impact on the measured adductor-to-abductor torque ratio. The ratio increased due to a combination of increased adductor torque and decreased abductor torque as the hip abduction angle increased.

LEVEL OF EVIDENCE

2b.

Ipsilateral proprioceptive neuromuscular facilitation patterns improve overflow and reduce foot drop in patients with demyelinating polyneuropathy

The purpose of this study was to evaluate the response of the tibialis anterior muscle (TAm) using surface electromyography in patients with Charcot-Marie-Tooth disease (CMT-IA), after ipsilateral proprioceptive neuromuscular patterns (PNF). Thirteen CMT-IA patients (both sexes) were treated twice a week, for 5 weeks, with bilateral PNF pattern, four times per treatment. During the execution of the patterns, we recorded the bilateral activation of the TAm in root mean square (RMS). We used the Student paired t-test for the first and last treatments, P-value set at <0.05. Clinical significance (CS) was obtained by subtracting the values of the first treatment from the last. Chopping pattern to the right side increased RMS for the right (t=−3.52, CS=52%), but not the left TAm (t= −3.35). Flexion-abduction with external rotation pattern to the right (t= −2.46, CS=55%) and left (t=−2.07, CS=53%) significantly increased RMS for TAm on both sides. Extension-adduction with internal rotation pattern to the right (t=−0.25) and left (t=−1.84) did not produce any changes in TAm. Ipsilateral PNF patterns selectively produce TAm overflow in peripheral polyneuropathy patients and can be successfully used as supportive therapy for foot drop.

Proprioceptive neuromuscular facilitation increases alpha absolute power in the dorsolateral prefrontal cortex and superior parietal cortex

The physiotherapist's clinical practice includes proprioceptive neuromuscular facilitation (PNF), which is a treatment concept that accelerates the response of neuromuscular mechanisms through spiral and diagonal movements. The adaptations that occur in the nervous system following PNF are still poorly described in the literature. Thus, this study had a goal to investigate the electrophysiological changes in the fronto-parietal circuit during PNF and movement in sagittal and diagonal patterns. This study included 30 female participants, who were divided into three groups (control, PNF, and flexion groups). Electroencephalogram measurements were determined before and after tasks were performed by each group. For the statistical analysis, a two-way ANOVA was performed for the factors group and time. Interactions between the two factors were investigated using a one-way ANOVA. A value of p < 0.004 was considered significant. The results showed an increase in alpha absolute power in the left dorsolateral prefrontal cortex and upper left parietal cortex of the PNF group, suggesting these areas work together to execute a motor action. The PNF group showed a greater alpha absolute power compared with the other groups, indicating a specific cortical demand for planning and attention, reinforcing its use for the rehabilitation of individuals.

Comparison of abdominal muscle activity during abdominal drawing-in maneuver combined with irradiation variations

Many experts have used an indirect method for enhancing strength and performance of muscles in clinical practice. The indirect method, which called an irradiation is a basic procedure of proprioceptive neuromuscular facilitation, there is little research related the effects of irradiation. This study investigated abdominal muscle activity during abdominal drawing-in maneuver (ADIM) combined with irradiation variations. The study recruited 42 healthy, young adults who were divided randomly into three groups according to which intervention they received. The first group performed the ADIM combined with coactivation of the pelvic floor muscle. The second group performed the ADIM combined with the irradiation resulting from dorsiflexion of the ankle. The third group performed the ADIM combined with the irradiation resulting from bilateral arm extension. Electromyography data were collected from the rectus abdominis, external oblique abdominis, and transversus abdominis/internal oblique abdominis (TrA/IO) muscles during ADIM combined with irradiation variations. There were significant differences in the abdominal muscle activity and the preferential contraction ratio of the TrA/IO among the three groups (P<0.05). ADIM combined with irradiation resulting from bilateral arm extension may be effective for enhancing the deep and superficial abdominal muscles of healthy people and athletes. The ADIM without the irradiation is advantageous for recovering motor control of the TrA/IO.