1

COMPARITIVE STUDY OF PNF TECHNIQUES VERSES NDT

TECHNIQUES IN STROKE SUBJECTS

Project work submitted to

Dr. N.T.R. University of health sciences

For Partial fulfilment of BACHELOR OF PHYSIOTHERAPY

BY

M. PRIYANKA

REGISTER NO. 13184029

NARAYANA COLLEGE OF PHYSIOTHERAPY

Affiliated to Dr. N.T.R. University of Health Sciences

CHINTHAREDDY PALEM, NELLORE – 524 003

OCTOBER – 2017
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NARAYANA COLLEGE OF PHYSIOTHERAPY

(Affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada)

CHINTHEREDDYPALEM, NELLORE – 524 004

CERTIFICATE

This is to certify that this project is bonafide work done by

M.PRIYANKA. (Register Number: 13184029) of final year B.P.T. towards partial
fulfilment for the requirement of the degree of BACHELOR OF
PHYSIOTHERAPY and submitted to Dr. N.T.R. University of Health Sciences,
Vijayawada during the year OCTOBER-2017.

External Examiner Internal Examiner

NARAYANA COLLEGE OF PHYSIOTHERAPY

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(Affiliated to the Dr. N.T.R. University of Health Sciences, Vijayawada)

CHINTHAREDDYPALEM, NELLORE – 524 003

DECLARATION

M.PRIYANKA hereby declare that this project “COMPARITIVE STUDY OF PNF

TECHNIQUES VERSES NDT TECHNIQUES IN STROKE SUBJECTS ” is a record of
first hand project work done by me under the supervision of Dr.G.HARIBABU
SIR and that it has not found the basis of duplication from any Degree,
Diploma, Associate Fellowship or other titles.

Place: NELLORE Signature of guide

Date Signature of student

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NARAYANA COLLEGE OF PHYSIOTHERAPY

(Affiliated to the Dr. N.T.R. University of Health Sciences, Vijayawada)

CHINTHAREDDYPALEM, NELLORE – 524 002

This is to certify that M.PRIYANKA of Final year B.P.T.

Student done project on “COMPARITIVE OF PNF TECHNIQUES VERSES NDT
TECHNIQUES IN STROKE SUBJECTS” towards the partial fulfilment for the
Degree of Bachelor of Physiotherapy and submitted to Dr. N.T.R. University of
Health Sciences, Vijayawada during the year OCTOBER-2017.

Signature of the Principal

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ACKNOLEDGEMENT

First and foremost I would like to thank my parents MR. M.V PRASAD
GARU AND M. JYOTHI KUMARI GARU who are my living Gods for
their valuable support and encouragement, blessing and love which has
always been a source of inspiration and strength in accomplishing this
academic task.
I wish to express our regards to Dr. A.THIRUPATHI, sir principle of
Narayana college of Physiotherapy, for support extended to me during
this study.
With due respect, I would like to express my sincere thanks to our guide
Dr. G. HARI BABU sir professor in Narayana college of physiotherapy
for his judicious information, expert suggestions, valuable guidance,
continuous support, incessant reassurance during every stage of this
work and interest shown in this project without which this work would not
have been possible.
I would also like to thank DR.K.KIRAN sir for most cooperation and
suggestion in guiding me to this work.
Last but not the least I would like to thanks all the faculty and
Individuals in our study without whom this task would not have been
possible.

My sincere thanks to all the contributors whose names we might have

missed but who truly deserve our gratitude. I would like to thank once
again to all who have helped us all the while.
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INTRODUCTION 8 - 13
AETIOLOGY 14 -16
EPIDIMIOLOGY 17-18
ANATOMY 19 – 22
PATHOPHYSIOLOGY 23 -24
BIOCHEMICAL CHANGES 25 – 26
PATHOMECHANICAL CHANGES 27 – 28
CLINICAL SYNDROMES 29 – 31
CLINICAL FEATURES 32 – 33
COMPLICATIONS 34 – 35
INVESTIGATIONS 36 – 37
MEDICAL MANAGEMENT 38 – 39
SURGICAL MANAGEMENT 40 – 41
PHYSIOTHERAPY MANAGEMENT 42 – 48
MATERIALS AND METHODOLOGY 49 – 55
CASE STUDY 56 – 68
DATA ANALYSIS 69 – 74
RESULT 75

DISCUSSION 76

CONCLUSION 77
BIBILOGRAPHY AND REFERENCES 78 – 79
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COMPARITIVE STUDY OF PNF

VERSES NDT TECHNIQUES IN
STROKE
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INTRODUCTION

Now-a-days stroke is leading cause of death and long term disabilities

All over the world. It has got great deal with physiotherapy in

Rehabilitation. Many new approaches has brought into practical view to

cure patients efficiently. Now here I am going to give a comparative
study between efficacies of PNF techniques verses NDT techniques in
stroke patients.

STROKE:

 Stroke is a clinical syndrome consisting of rapidly developing

sings of focal disturbance of cerebral function lasting more

than 24 hours or leading to death with no apparent cause

other than vascular origin.

 Stroke is classically characterised as a neurological deficit

attributed to an acute focal injury of central nervous system

by a vascular cause including cerebral infarction, intra

cerebral haemorrhage, and sub arachnoid haemorrhage and

is major cause of disability and death worldwide.

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HEMIPLEGIA:

 It is paralysis of half of body or one side of the body.

 It is paralysis of one vertical half of body.

Hemiplegia is one of the very common complications

after stroke, which may be partial hemiplegia or complete

hemiplegia. All the side effects associated with hemiplegia are

seen. A good physiotherapy helps the patient to get back to his

life.

PROPRIOCEPTIVE NEURO MUSCULAR FACILITATION

TECHNIQUE:

PNF technique is one of major therapeutic

approaches aimed at improving the important features for functional

ambulation of hemiplegic patients such as muscle tone, strength, and

flexibility. Now a day’s there is general decline in usage of PNF

techniques may be due to physically tasking nature. This work mainly

aimed at investigating the effect of PNF protocol on functional

ambulation profile and dependency in stroke patients.

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NEURO DEVOLOPMENTAL TECHNIQUES:

NDT approach has been increasing care in stroke

patients. The main aim of NDT is to reduce spasticity and promote

normal pattern of movements it sets to initiate movements, reflex

inhibiting patterns, inhibit abnormal muscle tone and the same time

facilitates more normal activity. My work finds about the efficacy of NDT

techniques in stroke patients.

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Finally my work deals in finding the protocol best in treating stroke

patients that is whether PNF or NDT techniques.

NEED FOR STUDY:

Stroke is condition in which body musculature greatly

affects the functional independence. Various studies are done to find the

effect of PNF techniques and NDT techniques, but studies evaluating

comparativeness of PNF verses NDT techniques are very less. This

study shows the best protocol in treating stroke patients.

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AIM OF THE STUDY:

To find the efficacy of PNF techniques verses NDT

techniques in stroke patients through a comparative study.

HYPOTHESIS:

NULL HYPOTHESIS: there will be no significant difference between

PNF techniques and NDT techniques in post stroke patients.

RESEARCH HYPOTHESIS: there will be significant difference between

PNF techniques and NDT techniques in post stroke patients.

`
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OBJECTIVES:

1. To reduce spasticity

2. To improve functional ambulation

3. Improve coordination and balance

4. Improve ADL’S
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AETIOLOGY

The major aetiological factors causing stroke are:

 Atherosclerosis

 Thromboplebitis

 Cardiovascular diseases

 Thromboembolism

 High lipid profile

 Obesity

 Diabetes

 Hypertension

 Vascular diseases
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MODIFIABLE RISK FACTORS:

 Smoking

 Alcoholism

 Diabetes

 Hypertension

 Sedentary life style

 High lipid profile

NON MODIFIABLE RISK FACTORS:

 Genetic

 Hereditary

 Previous stroke

 Atherosclerosis

 Arteriosclerosis

 Cardiovascular diseases

 Thromboembolism

 Thromboplebitis

 Race
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EPIDIMIOLOGY
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Epidemiology of stroke in India reveals the prevalence rate of 84-

262/100000 in rural areas and 334-426/100000 in urban areas. Recent

studies revels that greater number of population is experiencing stroke

every year. Women has lower age adjusted stroke incidence than men

where it is elevated in older age

RATIO OF PT

10

MALES
FEMALES

30
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ANATOMY
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Anterior cerebral artery:

 Primary motor area

 Primary sensory area

 Internal capsule

 Medial aspect of cortex

 Corpus callosum

 Posterior medial aspect of superior frontal gyrus

MIDDLE CEREBRAL ARTERY:

 Primary motor area

 primary sensory area

 Internal capsule

 Brocas cortical area

 Wernickes cortical area

 Parietal lobe

 parietal cortex

 Descending tracts
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POSTERIOR CEREBRAL ARTERY:

 Primary visual cortex

 Calcrine cortex

 Posterior part of corpus callosum

 Sub thalamic nuclei

 Cerebral peduncle of mid brain

 Supra nuclear fibers of 3rd cranial nerve

VERTEBRO BASILLAR ARTERY:

 Cortico spinal tract

 Descending tract

 Vestibular nuclei and connections

 Reticular activating system

 Cuneate and gracilis nuclei

 Nucleus of facial and vestibule cochlear nerve

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Right sided stroke results in left sided hemiplegia whereas left sided
stroke results in right hemiplegia this is mainly because as the fibers
cross to opposite side at medulla oblongata.
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PATHOPHYSIOLOGY
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Due to sudden cessation of blood flow, oxygen and

glucose to brain the neurons die leading to reperfusion results in

cessation of neuronal activity, as a result of which infarct expands

Followed by ischemic cascade, cerebral oedema finally necrosis due to

which there is raise in intracranial pressure leading to cerebro vascular

accident.

sudden cessation of cerebral blood flow oxygen and glucose to brain

neurons die reperfusion

remaining cells die

neruonal activity ceases

ischemic cascade
cerebro vascular accident
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BIOCHEMICAL CHANGES
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There is release of excess of neuro transmitters that is aspertate and

glutamate leading to energy metabolism disturbance and anoxic

depolarisation followed by interruption to ATP production resulting in

excess calcium influx, pump failure, leading to release of nitric acid and

cytokinins finally damage to brain cells.

release of excess of energy metabolism

no atp production
neuro transmitters disturbance and
and excess ca+
i,e aspertate and anoxic
influx
glutamate depolarisation

damage to brain
pump failure
cells
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PATHOMECHANICAL CHANGES
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The patho mechanical changes after stroke are:

 Spasticity

 Stiffness in muscle

 Negative motor signs: muscle weakness, loss of dexterity and

selective control of movement.

 Positive motor signs: co-contractions and velocity dependent

increase in excitability of phasic and tonic muscles
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CLINICAL SYNDROMES
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CLINICAL SYNDROMES IN STROKE:

ANTERIOR CEREBRAL ARTERY SYNDROME:

It is manifested as

 Contra lateral hemiplegia

 Contra lateral sensory loss
 Aphasia
 Lower limbs are more involved than upper
limbs

MIDDLE CEREBRAL ARTERY SYNDROME:

It is manifested as

 Contra lateral hemiplegia

 Wernickes aphasia
 Homonymous hemianopia
 Pusher’s syndrome
 Agnosia
 Apraxia
 Dyscalculasia

POSTERIOR CEREBRAL ARTERY SYNDROME:

It is manifested as

 Weber’s syndrome
 Postural hypertension
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 Contra lateral hemiplegia

 Cortical blindness
 Contra lateral homonymous hemianopia
 Visual field defects

WALLEN BERG’S SYNDROME:

It is manifested as

 Horner’s syndrome
 Ipsilateral sensory loss
 Ipsilateral hemiplegia
 Limp ataxia
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CLINICAL FEATURES
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Patients of stroke exhibit following features

 Facial palsy
 Dysphasia
 seizures
 Hemiplegia / hemiperisis
 Aphasia
 Dysarthria
 Visual agnosia
 Apraxia
 Bowel and bladder dysfunction
 Postural balance is lost

If there is involvement of face arm speech and time then its time of
emergency
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COMPLICATIONS
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Complications of stroke are

 Permanent hemiplegia
 Periarthritic shoulder
 Subluxation of shoulder
 Bowel and bladder dysfunction
 Reflex sympathetic dystrophy
 Deep vein thrombosis
 Pressure sores
 Depression
 Circumductory gait
 Toe clawing
 Scoliosis
 Respiratory difficulties
 Sepsis
 Deformities
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INVESTIGATIONS
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 CT SCAN:

It is very beneficial with in 24 of stroke. It is useful to identify

other causes of focal neurological dysfunction such as neoplasm
and subdural hematoma

 MRI:

It is useful in differentiating the involvement of brain

parenchyma and extension of lesion, also used for imaging of
vessels, blood flow and smaller.

 X ray
 Lipid profile
 ECG
 ECHO
 PET SCAN(POSITRON EMISSION TOPOGRAPHY)
 COMPLETE BLOOD PICTURE
 MYELOGRAM
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MEDICAL MANAGEMENT
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 Tissue plastinogen activator:

It is useful in regeneration of neuronal cells and reduces

the effect of ischemic cascade

 Anti coagulation therapy:

Low molecular weight heparin

Coumarin agents

 Supportive therapy:
Mannitol – to reduce brain perfusion

 Symptomatic treatment:
Treat nosocomial infection

 Naso gastric feeding

 Urinary catherization
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SURGICAL MANAGEMENT
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 Craniotomy: for evacuation of hematoma

 Craniectomy: surgical removal of part of cranium

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PHYSIOTHERAPY MANAGEMENT
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PNF TECHNIQUES:

PNF techniques also referred as active stretching or facilitative

stretching which integrate active muscle contractions.PNF is an
approach to therapeutic exercise that combines functionally based
diagonal patterns of movement with techniques of neuro muscular
facilitation to evoke motor responses and improve neuromuscular
control and function

DIAGONAL PATTERNS: The patterns of movements associated with

PNF are composed of multi joint, multiplanar, diagonal and rotational
movements of trunk and neck.

There are two types of diagonal patterns for both upper and lower
extremities

UPPER EXTREMITY:

 D1 FLEXION FOR UPPER EXTREMITY : flexion + adduction +

external rotation
 D1 EXTENSION PATTERNS FOR UPPER EXTREMITY:
extension +adduction + internal rotation
 D2 FLEXION FOR UPPER EXTREMITY: flexion + abduction +
external rotation
 D2 EXTENSION PATTERNS FOR UPPER EXTREMITY:
extension +abduction + internal rotation

LOWER EXTREMITY:

 D1 FLEXION FOR LOWER EXTREMITY: flexion + adduction +

external rotation
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 D1 EXTENSION PATTERNS FOR LOWER EXTREMITY:

extension +adduction + internal rotation
 D2 FLEXION FOR LOWER EXTREMITY: flexion + abduction +
external rotation
 D2 EXTENSION PATTERNS FOR LOWER EXTREMITY:
extension +abduction + internal rotation
These patterns may be both unilateral and bilateral

TECHNIQUE OF PNF:

 RHYTHAMIC INITIATION: RI of limb or body through desired

range starting with passive motion to active assisted. It is the
technique which improves ability to initiate movement. Improve
coordination, and sense of motion and finally aids in relaxation.

 INDICATIONS:
 Difficulty in initiating motion
 Movements too slow or fast
 Ataxia or rigidity

It involves voluntary relaxation followed by active assisted then

active and finally active which is further progressed to resisted
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NDT TECHNIQUES:

NDT techniques are directed toward a goal directed approach

retraining normal functional patterns of movement in adult stroke
patients by normalising tone and re-educating normal movement. The
training of normal movement patterns includes activation of postural
responses that must be available on an automatic level of function it
works by increasing level of function on hemiplegic side and prevent
development of spasticity.

INHIBITION TECHNIQUES:

 Trunk rotation
 Weight bearing
 Techniques to lengthen muscles and realign joints
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 Rotational movements of spine

 Scapular mobilization

FACILITATION TECHNIQUES:

 Handling techniques
 Stimulation techniques
 Sustained stretch

RETRAINING NORMAL MOVEMENTS:

 Retraining trunk movements incorporating hemiplegic arm

 Bed mobility
 TRANSFERS
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 Scapula mobilization
 Place and hold
 Arm movements in sitting
 Fore arm weight bearing in sitting
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MATERIALS
AND
METHODOLOGY
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METHOD OF COLLECTING DATA:

 SAMPLING TECHNIQUE:

Simple random sampling

The purpose of this study was explained to all subjects and an
informed consent was taken followed by demographic data from
each subject.

 SAMPLING SIZE:

This study include sample of 40 subjects.

 SOURCE OF DATA:

Outpatient physiotherapy department

NARAYANA MEDICAL COLLEGE AND HOSPITAL

 REASERCH DESIGN:

Comparative study design.

 POPULATION:

Adult population suffering from stroke.

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 DURATION OF STUDY:

Six months

SELECTIVE CRITERIA:

 INCLUSIVE CRITERIA:
 Chronic stroke patients with severe motor deficit
 Patient with spasticity
 Both male and female
 Age group between 20-65 years
 Hemiplegia patients.
 Patients with other associated health problems like
Diabetes, hypertension, and obesity.

 EXCLUSIVE CRITERIA:
 Patients with other neurological conditions.
 Bed ridden conditions.
 Age factor above 70 years.
 Unwilling to participate.
 Alcoholic patients

 OUTCOME MEASURE:
 spasticity
 Range of motion
 Activities of daily living
 Functional activities
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 OUTCOME MEASURENT TOOLS:

 Barthel index
 Modified ashworth scale
 Goniometry
 Functional independent measure scale

MATERIALS:

 Goniometer
 Couch
 Pen and paper
 Measurement scale
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METHODOLOGY

 STEP 1: subjects who full fill the inclusion criteria were included
in the study and a written /informed consent was taken from them.

 STEP 2: then the subjects are divided into two groups

GROUP A: Experimental group
GROUP B: Controlled group

STEP 3:
GROUP A: received PNF techniques
GROUP B: received NDT techniques.

The two groups received the treatment for 45 minutes in 5 days in

a week in the period of two months. Outcome measures were
taken from the patient.
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 EXPERIMENTAL GROUP :

 This group received PNF techniques 1 hour per day per 5

days in a week and continued for a period of 6 months.

 This intervention focused on repetitive practice of meaningful

tasks

 The protocol must be relevant, repetitive, randomly ordered,

aim towards reconstruction of whole task and positively
reinforced.

 The patterns performed must be smooth gentle rhythmical

and relevant to form engram.

 Patients were given diagonal patterns for both upper and

lower extremities along with rhythmic initiation
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 CONTROLLED GROUP :

 Patients in this group received 1 hour session per day for 5

days for a period of 6months

 Each task is performed with great accuracy and repeated

 The treatment focused on repetition of meaningful and task

oriented acts.

 Pre and post treatment assessment is taken.

 Inhibitory techniques were given to inhibit abnormal tone and
facilitatory techniques were given along with care with for
handling was taken
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CASE STUDY
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CASE STUDY – 1

SUBJECTIVE ASSESMENT:

 NAME : K. Suraj kumar

 AGE : 23
 SEX : Male
 Occupation : student
 ADDRESS : Subedarpet Nellore

CHIEF COMPLAINTS:

 Weak lower limbs

 Head ach
 Shoulder pain
 Constipation
 Irritation
 Speech difficulty

HISTORY

 MEDICAL HISTORY : Hypertension

: Diabetes
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 Family history : Hypertensive

 SOCIOECONOMIC STATUS ; poor
 PERSONAL HISTORY : NIL

OBJECTIVE ASSESMENT

VITAL SIGNS:

 Temperature : Normal
 Respiratory rate : Normal
 Pulse rate : Normal
 Blood pressure : Normal

HIGHER MENTAL FUNCTIONS:

 Consciousness : E3 V3 M5
 Alertness : Normal
 Thinking : Normal
 Memory : Normal
 Speech : Dysarthria

CRANIAL NERVE ASSESMENT:

 Olfactory nerve : Normal

 Optic : Normal
 Occulomotor : intact PTOSIS
 Trochlear : intact
 Abducent : intact
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 Trigeminal : Normal
 Facial : intact
 Vestibulocochlear : intact
 Glosopharengeal : Normal
 Vagus : Normal
 Spinal accessory : Normal
 Hypoglossal : Normal

MOTOR SYSTEM ASSESMENT:

 Muscle tone : Hypertonicity (spasticity)

 Voluntary control grading : 4 th stage of brunnstrom stages
 Reflexes : Babinski sign +ve

COORDINATION ASSESMENT:

 Non equilibrium test : Absent

 Equilibrium test : Absent

ADL’S ASSESMENT:

 Barthel index : 50

FUNCTIONAL ASSESMENT:

 Functional independent measure scale :60

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PHYSIOTHERAPY GOALS

 Short term goals :

 To promote ADL’S of patient

 To strengthen weaker upper limb muscles
 To improve balance in patient
 To get recover from facial palsy

 Long term goals :

 To make the patient completely independent
 To improve patients posture and balance
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CASE STUDY – 2

SUBJECTIVE ASSESMENT:

 NAME : k.veeraiah
 AGE : 45
 SEX : Male
 Occupation : Farmer
 ADDRESS : Atmakur, Nellore

CHIEF COMPLAINTS:

 Pricking pain in lower limbs

 Head ach
 Speech difficulty

HISTORY

 MEDICAL HISTORY: Hypertension

 Family history : Hypertensive

 SOCIOECONOMIC STATUS ; poor

 LEISURE HABITS : SMOKING DRINKING

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OBJECTIVE ASSESMENT

VITAL SIGNS:

 Temperature : Normal
 Respiratory rate : Normal
 Pulse rate : Normal
 Blood pressure : Hypertension

HIGHER MENTAL FUNCTIONS:

 Consciousness : E4 V5 M6
 Alertness : Normal
 Thinking : Normal
 Memory : Normal
 Speech : Mild Dysarthria

CRANIAL NERVE ASSESMENT:

 Olfactory nerve : Normal

 Optic : Normal
 Occulomotor : Normal
 Trochlear : Normal
 Abducent : Normal
 Trigeminal : Normal
 Facial : Normal
 Vestibulocochlear : Normal
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 Glosopharengeal : Normal
 Vagus : Normal
 Spinal accessory : Normal
 Hypoglossal : Normal

MOTOR SYSTEM ASSESMENT:

 Muscle tone : Normal

 Voluntary control grading : 7 th stage of brunnstrom stages
 Reflexes : Babinski sign +ve

COORDINATION ASSESMENT:

 Non equilibrium test : Normal

 Equilibrium test : Normal

ADL’S ASSESMENT:

Barthel index : 100

FUNCTIONAL ASSESMENT:

Functional independent measure: 120

 Posture and balance :

Posture : Normal
Balance : Normal
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PHYSIOTHERAPY GOAL

 Short term goals :

 To enhance good speech

 Prevention of secondary deformities

 Long term goals :

 To prevent reoccurrence of stroke

 To promote good life style
 To alter leisure habits
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CASE STUDY – 3

SUBJECTIVE ASSESMENT:

 NAME : H. Lakshamma
 AGE : 55
 SEX : Female
 Occupation : House wife
 ADDRESS : Ramalingapuram, Nellore

CHIEF COMPLAINTS:

 Speech difficulties
 Head ach
 Bowel and bladder dysfunction
 No functioning of right upper and lower limbs

HISTORY:

 MEDICAL HISTORY : Hypertension, diabetis

Recurrent stroke, hypernatremia
Right lower lung pneumonia,

 Family history : Hypertensive, diabetis

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 SOCIOECONOMIC STATUS ; Middle class

 PERSONAL HISTORY : Nothing

OBJECTIVE ASSESMENT

VITAL SIGNS:

 Temperature : Normal
 Respiratory rate : Normal
 Pulse rate : Normal
 Blood pressure : Normal

HIGHER MENTAL FUNCTIONS:

 Consciousness : E2 V1 M1
 Alertness : intact
 Thinking : intact
 Memory : intact
 Speech : global aphasia

CRANIAL NERVE ASSESMENT:

 Olfactory nerve : Normal

 Optic : Normal
 Occulomotor : Normal
 Trochlear : Normal
 Abducent : Normal
 Trigeminal : Normal
 Facial : Intact
 68

 Vestibulocochlear : Intact
 Glosopharengeal : Normal
 Vagus : Normal
 Spinal accessory : Normal
 Hypoglossal : Normal

MOTOR SYSTEM ASSESMENT:

 Muscle tone : Hypertonicity

 Voluntary control grading : 3 th stage of brunnstrom stages
 Reflexes : Babinski sign +ve

COORDINATION ASSESMENT:

 Non equilibrium test : Absent

 Equilibrium test : Absent

ADL’S ASSESMENT:

Barthel index :0

FUNCTIONAL ASSESMENT:

Functional independent measure: 30

 Posture and balance :

Posture : Abnormal
Balance : Abnormal
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PHYSIOTHERAPY GOALS

 Short term goals :

 To enhance good speech

 To strengthen weakened muscles
 To promote ADL’S
 To enhance gait
 To improve balance and posture
 To prevent secondary complications

 Long term goals :

 To prevent reoccurrence of stroke
 To promote good life style
 To attain good balance
 70

DATA ANALYSIS
 71

EXPERIMENTAL GROUP
ADL’S:
S.NO PRE TEST POST TEST

1 60 98

2 50 85

3 60 98

4 30 80

5 35 84

6 64 96

7 78 100

8 80 100

9 44 76

10 0 52

AVERAGE PER TEST POST TEST

MEAN 50.1 86.9
MEDIAN 55 90.5
MODE 60 98&100
 72

FIM SCALE:

S.NO PRE TEST POST TEST

1 80 110

2 78 120

3 48 100

4 42 93

5 60 88

6 75 116

7 90 126

8 95 126

9 80 120

10 20 65

AVERAGE PRE TEST POST TEST

MEAN 66.8 106.4
Median 76.5 113
Mode 80 120&126
 73

CONTROL GROUP:
ADL’S
S.NO PRE TEST POST TEST

1 66 75

2 50 65

3 68 80

4 30 50

5 90 100

6 70 80

7 55 65

8 32 46

9 46 65

10 90 100

AVERAGE PRE TEST POST TEST

MEAN 59.7 72.6
MEDIAN 60.5 70
MODE 90 65
 74

FIM SCALE:
S.NO PRE TEST POST TEST

1 80 92

2 60 75

3 56 65

4 45 60

5 85 95

6 60 67

7 50 59

8 45 56

9 80 90

10 90 110

AVERAGE PRE TEST POST TEST

MEAN 65.1 75.9
MEDIAN 60 71
MODE 60&80
 75

100

90

80

70

60
pre mean
50
post mean
40

30

20

10

0
exp con

ADLS PRE TEST AND POST TEST MEAN

120

100

80

pre mean
60
post mean
Column1
40

20

0
EXP CON

FIM SCALE PRE TEST AND POST TEST MEAN

 76

RESULT:

 The pre test mean for ADL’S and FIM scale in experimental group
are 50.1 & 66.8 where as post test mean is 86.9 & 106.4. We can
find a lot of difference in pre and post treatment values and
standard deviation for pre and post test for ADL’S is 24.13 & 15.16
for FIM scale is 15.16 &19.77. the P – VALUE for PNF techniques
is < 0.0001
 The pre test mean for ADL’S and FIM scale in control group are
59.7 & 65.1 where as post test mean is 72.6 & 75.9. the standard
deviation for pre and post test in ADL’S is 21.09 & 18.28 where as
for FIM scale is 17.10 &16.79
The P- VALUE for NDT techniques is <0.0001.
 77

DISCUSSION:

We know that stroke is one of leading cause of long term disabilities all
over the world. Many of the people affected with stroke have moderate
to severe motor impairment which is impeding them in their daily
activities and also a form of social abuse. Our goal is getting them to
normal

PNF techniques are very useful techniques in stroke patients in their

rehabilitation programme. Due to lengthy and hard for to get in deep
into it as it also a challenging task but we found greater improvement in
our patients treated for stroke.

As we know NDT techniques gained more importance in cerebral palsy it

also shows some effect on stroke patients. It reduces abnormal tone and
facilitates movements
 78

CONCLUSION:

 To identify the varying results in two different regimes in two

different groups of stroke patients 20 individuals in each group

were selected using simple random sampling technique and were

taken as experimental group and control group.

 The BARTHEL INDEX & FUNCTIONAL INDEPENDENT

MEASURE SCALE reports of two groups were compared after

their respective protocols, to expose the facts regarding their

effectiveness

 The study was experimental design. The collected data was

analyzed and interpreted, which showed a significant variation in
both scales of the two groups.
 Finally my study concluded that both PNF & NDT techniques
 Are completely effective in stroke patients with a little quicker and
most accurate improvement in PNF
 79

BIBILOGRAPHY

 SUSAN ‘O’ SULLIVAN text book of physical rehabilitation for

stroke
 LINDSEY text book of neurology for neuro anatomy
 WILLY BLACKWELL text book on concept of bobath techniques
 DARXCY UMPHRED text book of neuro rehabilitation
 SARA. J. CUCCURULLO MD. Text book of physical medicine and
rehabilitation

REFERENCES
1. Knott M. Voss B proprioceptive neuro muscular
facilitation 2nd ed London England balleire
danility and cog’s 1968
2. Lamb SE, Ferrucci L, Volapto S, et al. Women’s Health
and Aging Study: Risk factors for falling in home-
dwelling older women with stroke: the Women’s Health
and Aging Study. Stroke, 2003, 34: 494–501
3. . Klein DA, William JS, and Wayne TP: PNF training
and physical function in assisted-living older adults. J
Aging Phys Act, 2002, 41: 476–488.
4. DeJong, G., Horn, S.D., Conroy, B., Nichols, D.,
Healton, E.B. 2005. Opening the Black Box of Post
stroke Rehabilitation: Stroke Rehabilitation Patients,
 80

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Rehab., Gialanella B, Benvenuti P, Santoro R. The
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5. Effects of exercise program according to Bobath. Clin
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