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

Effects of proprioceptive neuromuscular facilitation combined with threshold inspiratory muscle training on respiratory function in neurocritical patients with weaning failure: a randomized controlled trial

The purpose of this study was to determine the effects of combining proprioceptive neuromuscular facilitation (PNF) with threshold inspiratory muscle training (TIMT), compared with TIMT alone, on respiratory function in neurocritical patients who experienced a weaning failure. Forty-seven participants (mostly after a stroke), were randomly divided into the experimental group (n = 24) and the control group (n = 23). The control group received usual care and TIMT, whereas the experimental group, in addition, underwent four 90-s periods of manual PNF. Both groups performed training in the ICU twice a day for 5 consecutive days. The main outcome measures included maximum inspiratory pressure, diaphragmatic excursions, diaphragm thickening fraction, oxygenation index, and forced expiratory volume in 1 s/forced vital capacity. The results showed a significant group-by-time interaction effect for maximum inspiratory pressure [F (1, 45) = 17.84, η2 = 0.328, P < 0.001] and oxygenation index [F [1, 45) = 5.58, η2 = 0.11, P = 0.023]. When compared with the control group, the experimental group showed overall significantly higher maximum inspiratory pressure [mean difference = 4.37 cm H2O, 95% confidence interval (CI) 0.25-8.50, P = 0.038]. No other significant group differences were found. Combining PNF with TIMT may improve respiratory function in neurocritical patients with weaning failure. This combination approach may increase the likelihood of survival of neurocritical patients in the ICU.

Immediate Effectiveness of Chest Proprioceptive Neuromuscular Facilitation (PNF) Technique on Hemodynamic Status in COVID-19 Patients: An Original Research

Introduction

COVID-19 is an infectious illness that first appeared in Wuhan, China in December 2019, and subsequently spread over the entire world. Those who were affected suffered from fever, cough, weakness, and breathlessness, along with the probability of developing pneumonia which sometimes leads to respiratory failure. The older population with co-morbidities was at higher risk.

Methods

In this experimental study, 59 subjects with COVID-19 were included according to pre-decided inclusion and exclusion criteria. Pre-vitals before the treatment were noted such as heart rate, respiratory rate, and oxygen saturation (SPO₂), and then the chest proprioceptive neuromuscular facilitation (PNF) technique was given as a treatment regime, and its immediate effect was calculated. Post-vitals were noted immediately after the treatment session. The statistical analysis was made using the student's paired t-test.

Results

We found a mean difference of 9.45±5.27 in heart rate before and after the intervention provided which is suggestive of a statistically significant increase within normal limits. Also, the mean value of respiratory rate immediately after the intervention was shown as 22.91 and pre-intervention was 19.18 with a mean difference of 2.93±3.95, showing a statistically significant increase in respiratory rate. Additionally, the mean value of SPO2 immediately after the intervention was shown as 92.76 and pre-intervention was 94.64 and had a mean difference of 1.88±1.67 suggestive of high improvement in oxygen saturation immediately after the intervention.

Conclusion

The present study concludes from the available statistical analysis that chest PNF techniques such as intercostal stretch and anterior basal stretch lift have an immediate impact on improvement in oxygen saturation in COVID-19 patients and can be incorporated as an inpatient treatment regime in the rehabilitation protocol.