Physical therapy research

course for second semester 2018-2019

course coordinator : Dr. Saad al-Nassan
PT , PhD
Rehabletation of CVA patients (PNF)

Group : D
Authors :
-mohammad mahmod
-mohannad almalki

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Abstract :
introduction. Stroke is a major medical and
social - problem. One of the methods used
in neurodevelopmental rehabilitation of
patients after ischemic stroke is the method of
Proprioceptive Neuromuscular Facilitation
(PNF). Aim: In this study we aim to
investigate the effects of PNF exercises on
strengthening of upper extremity (UE) in acute
stroke(hemiplegia). Strengths and limitations
of this study :to our knowledge this study is
the first research focused on effece of the
proprioceptive neuromuscular facilitation
(PNF) on muscle strength for stroke patients ,

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Keywords:

PNF : proprioceptive neuromuscular

facilitation
MAS : modified ashworth scale

UE : upper extremity

MMT: manual muscle test

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 Introduction / background
Is to come patients with hemiplegic stroke
carries the specifications that will remember
the methodlogi later and we apply to some of
them strengthening exercise and the other part
PNF resistance . And through this we do a
work comparing them and we conclude from
the importance of research, which indicates to
know which way to give better resuelts to the
patiant and faster time and improve the muscle
power and has knowledge of which options we
use in such cases to give satisfactory results

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Question:
1) which of the exercises is useful in
muscle power ?
2} is the muscle power response
different for age ?

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 Materials and methodolgy :
The subjects in this study included stroke
patients, in different hospitals in Jordan , all of
the stroke patients had left side hemiplegia for
at least three months. The inclusion criteria for
the subjects were a score of 24 or more higher
on the Mini Mental State exam, grade 2+or
lower on MMT scale,the dominant side is right
side and grade 1+ or lower on Modified
Ashworth Scale(MAS). We excluded those
who had dislocation in their shoulder and who
had fracture in their UE in the last 3 months.

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 We created a form and gave the form to two
therapists in order to apply the criteria to the
stroke patients. Two therapists in KHMC, Al-
basheer hospital and local community. found
34 stroke patients 17 of them met the criteria.
The two therapists classifieds the subjects into
two groups first group they applied
strengthening exercise against resistance by
their hand, second group they applied (D2-
flexion and D2-extension) PNF patterns on UE
over 2 times. For each session they measured
the muscle power of the subjects in the resting
conditions before and after the intervention
(strengthening exercises and PNF techniques)

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Statistical analysis :
0 Improved patients with muscle strength exercise as a
muscle power is more benefit than resistance PNF
techniques .
But to improved coordination in movements the PNF
techniques is an 0 optimal choice .

:Percentages
0 90% increase muscle strength by strengthening
exercise.
0 7% increase muscle strength by resistance PNF.

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Results:

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 PNF(2)
SPASTIC MMT Age

0 2 44

1 +2 47

0 2 50

1 2 52

0 2 54

1 +2 55

1 +2 59

0 2 60
1 +2 64

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 PNF(1)
SPASTIC MMT age
0 2 44
1 2 47
0 2 50
1 2 52
0 2 54
1 2 55
0 +2 59
0 2 60
1 +2 64

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Strength exercise (2)
SPASTIC MMT age
0 +2 47
0 2 52
1 +2 61
1 +2 67
1 2 68
0 2 70
0 +2 73
0 +2
+2 75

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Strength exercise (1)
SPASTIC MMT age
0 2 47
1 2 52
1 2 61
1 2 67
1 2 68
0 -2 70
0 2 73
1 +2 75

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 *patients were improved in the
strengthening exercises with a total of 5
patients . There was an improvement in PNF
with a total of 2 patients. This means :

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 1- we have found that strengthening
exercises are easier for the patient and
therapist than PNF.
2-PNF improves muscle strength but not
greater than strengthening exercises .
3-the PNF affects spasticity but not as
expected as the strengthening exercises
affect larger and better.

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Finally , the PNF improves QOL , and more
accurately improves the coordination more
than improving muscle strength . The
strengthening exercises improve muscle
strength more than the coordination . Strength
exercises not be dispensed with .

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Discution :
As you have seen the results, It's the two techniques
(PNF with resistance and strengthening exercise)
results are interrelated. we believe that the reason is
that some of therapist who used the PNF technique
with resistance told us that it's possible to use this
technique with strengthening exercise on the same
patient together in the same session, so the results
will be close to each other.
We did not find any study talking about comparison
between the two techniques,
for this reason we recommend more research studies
about this topic,

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Discution:
by applying PNF technique with resistance only for
increasing muscle power on a group of hemolgic
stroke patients after their arrival in therapy increase
muscle strength phase, and perform strengthening
exercise against resistance by hand only for
increasing muscle power on a group of hemolgic
stroke patients after their arrival in therapy increase
muscle strength phase,
provided that the same criteria of cognition, dominant
side, muscle power and spasticity (before
intervention) that applies to the both groups.
According to studies we found that the PNF used

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Implications of the study findings
on physical therapy practice :
95% of stroke patients improve and the degree of improvement
depends on many factors, including: stroke severity, age of the
patient, stroke quality, previous patient conditions

the PNF exercises are vary effective in improving muscle tone

,functional outcome and strength training reduce
musculoskeletal impairment after stroke
The role of physiotherapy in the treatment of blood clots in the
brain in the quest to regain muscle control through the
rehabilitation of PNF for one month to several months, adding
that natural therapy helps to treat up to 100% depending on the
seriousness of the situation,

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Implications of the study findings
on physical therapy practice :

- The goal of post stroke rehabilitation is to help the

patient re-learn the skills he or she lost when the
stroke affected the brain, and post-stroke
rehabilitation may help restore the patient's
independence , -
The severity of stroke complications and the ability of
each person to regain their lost abilities are very
different. Researchers have found that the central
nervous system can adapt and restore some functions
and find it important to continue training in skills

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 Conclusion:
-The strengthening exercise is better than the
PNF to increase muscle power ​The PNF it’s
Not related to a specific age

-According to last studies we found that the PNF

used more in stretch and facilitate the muscle
more than strength the muscle

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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 References :
-Research Gate
-Pubmed mesh

https://cdn.fbsbx.com/v/t59.2708-21/54454745_2240017439438961_2369756439020306432_…t=104&_nc_ht=cdn.fbsbx.com&oh=4da3ee832c63edb0895c9c8f2978a6c9&oe=5CBDF589&dl=1 4/21/19, 8I05 AM

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