Posts Tagged proprioceptive neuromuscular facilitation

[Abstract] The Effectiveness of the Proprioceptive Neuromuscular Facilitation Method on Gait Parameters in Patients with Stroke: A Systematic Review



The aim of this paper is to review the current evidence on the effectiveness of PNF techniques on gait parameters in patients with stroke.

Data Sources

The electronic platforms of CINAHL, MEDLINE, PubMed, and PEDro were searched using the relevant search terms.

Study Selection

Intervention studies that had gait parameters as an outcome and, in which PNF techniques were used in a post stroke population, were reviewed. The studies were reviewed by both authors and a consensus was reached. The literature search identified 84 studies. Following screening, there were 5 studies which met the inclusion criteria for this review.

Data extraction

Data was extracted from the studies by both authors and independently reviewed. Methodological quality of randomised controlled trials (RCTs) was assessed with the Physiotherapy Evidence Database (PEDro) scale and for non-RCTs with the Quality Assessment Tool for Quantitative Studies.

Data Synthesis

It was found that treatment using the PNF method led to a statistically significant improvement in gait outcome measures in patients with stroke in all the studies. Three of the studies also found that groups treated with PNF techniques had a significantly greater improvement in outcome measures than groups that received routine physiotherapy treatment.


Although some limitations were identified in the methodological quality of the studies, current research suggests that PNF is an effective treatment for the improvement of gait parameters in patients with stroke. Further research is needed to build a robust evidence base in this area.

via The Effectiveness of the Proprioceptive Neuromuscular Facilitation Method on Gait Parameters in Patients with Stroke: A Systematic Review – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: a systematic review and meta-analysis protocol – Full Text


Introduction Proprioceptive neuromuscular facilitation (PNF) is a widely used rehabilitation concept, although its efficacy has not yet been demonstrated in stroke survivors. The aim of this systematic review is to identify, assess and synthesise the potential benefits of using PNF to improve the activities of daily living (ADL) and quality of life (QoL) of individuals with stroke.

Methods and analysis A systematic electronic search will be conducted in MEDLINE, Embase, CENTRAL and PEDro. We will include randomised or quasi-randomised controlled trials of PNF interventions conducted in stroke survivors up to April 2017. Two review authors will independently select relevant studies and will extract data using the Cochrane handbook for systematic reviews of interventions approach and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The methodological quality will be assessed by using the PEDro scale. Finally, with the permitted numeric data, we will carry out a meta-analysis.

Ethics and dissemination Ethical considerations will not be required. Results will be disseminated in a peer-review journal. This systematic review aims to examine the effects of PNF (neurophysiological approach) in order to clarify its efficacy in improving ADL and QoL in the rehabilitation process of stroke survivors.


Strengths and limitations of this study

  • To our knowledge this study is the first systematic review focused on the proprioceptive neuromuscular facilitation (PNF) approach for stroke survivors.

  • This systematic review has an open eligibility criteria to clarify the efficacy of the PNF method for different clinical situations in stroke patients.

  • The electronic search will only include randomised controlled and quasi-randomised controlled trials published in English, Spanish, French and Portuguese that could limit the inclusion of studies.



Every year, stroke survivors, related deaths, and disability-adjusted life-years are increasing, although the mortality rates for stroke have decreased in the last two decades.1 Motor and sensory impairments due to stroke often affect the patients’ mobility, limiting their activities of daily living (ADL) and their social participation, and hindering their chances of resuming their professional life. Motor function among other factors (such as social or personal factors) could contribute to a low overall quality of life (QoL).2

Throughout the years, a number of conceptualisations have been used to describe QoL in stroke survivors.3–5 The lack of an agreed definition on QoL means that most QoL outcomes have been assessed using standardised questionnaires. However, these questionnaires do not reveal important domains of patients’ QoL and sometimes scores may be difficult to interpret.5

Dijkers4 separated the QoL term into three categories: (1) QoL as subjective well-being (SWB); (2) QoL as achievement; and (3) QoL as utility. QoL as SWB has been defined as the sum total of the cognitive and emotional reactions that people experience when they compare what they have and do in life with their aspirations, needs, and other expectations. QoL as achievement refers to people’s possessions, relationships and accomplishments, among others, using metrics defined by an outsider’s point of view. Within the medical rehabilitation field, QoL measurements commonly involve health status or are qualified by the term “health-related”. Health-related QoL (HRQoL) is defined by the value assigned to the duration of life when modified by impairment, functional state, perception and social factors that are influenced by disease, injury, treatment or policy.6 According to Dijkers4some researchers base themselves on the WHO’s encompassing definition of health, and may add to this different social health indicators such as interactions with others and social role functioning. Finally, in QoL as utility, achievements and statuses are judged in terms of societal norms and standards that quantify the value of a life.

An optimal rehabilitation effectively addresses components, as coded by the International Classification of Functioning (ICF), such as impairment, activity limitations and participation restrictions, and contextual and personal factors, with the goal of a satisfactory QoL as perceived by the individual. The relationship between the three domains of the ICF is clear: impairments impact activities and activities have an impact on participation. Functionality and ADL take a specific role in influencing QoL in stroke survivors positively. During the recovery process and according to the degree of disability, it is important to impact on those variables at any time throughout the rehabilitation treatment, taking into account that they are variables that change over time.7 Much of the focus of stroke rehabilitation is on the recovery of impaired movement and the associated functions. According to Jørgensen8there seems to be a correlation between motor impairments and activity limitations; for example, lower-limb strength (impairment) has been correlated with independence in walking (activity level). In order to improve the neuromuscular system’s effectiveness in coordinating movement and function, there are different physical rehabilitation approaches used for enhancing recovery in post stroke patients, but neither method was more (or less) effective in terms of improving independence in ADL or motor function.9Proprioceptive neuromuscular facilitation (PNF) is widely used in rehabilitation practice.10

The PNF approach has existed since the late 1930s and ’40s when the physician and neurologist Herman Kabat, and the physiotherapist Margaret Knott, began using proprioceptive techniques on younger individuals with cerebral palsy and other neurological conditions. The main goal of this intervention method is to help patients achieve their highest function level. PNF uses the body’s proprioceptive system to facilitate or inhibit muscle contraction. The definition of PNF encompasses the terms proprioceptive (which has to do with any of the sensory receptors that provide information concerning movement and position of the body); neuromuscular (involving the nerves and muscles); and facilitation (making it easier).11

Recently, various systematic reviews 12–17 and an evidence-based clinical practice guideline18 have evaluated the efficacy of stroke rehabilitation interventions, including PNF techniques. However, none were specifically focused on PNF, and only one narrative review assessed PNF as the principal topic.10 Furthermore, the most frequent objectives to assess the efficacy of this intervention method were motor function and mobility. It is necessary that therapists base their clinical decisions on the most reliable scientific evidence available; hence, this systematic review aims to determine the efficacy of PNF techniques in improving ADL and QoL in stroke survivors.


The primary purpose of this systematic review is to examine the efficacy of PNF in improving ADL and QoL in individuals with stroke. Secondary specific aims are to determine the efficacy of the PNF techniques in postural control, gait, upper limb function and muscle strength.[…]


Continue —> The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: a systematic review and meta-analysis protocol | BMJ Open

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[Abstract+References] Comparison of motor relearning programme with proprioceptive neuromuscular facilitation on upper limb function in stroke patients 



Introduction-Stroke is an acute, neurological event that is caused by an alteration in blood flow to the brain leading to loss of upper limb function contributing to functional disability, affecting quality of life and independence in ‘basic’ and ‘instrumental’ activities. Motor Relearning Programme (MRP) is a task-oriented approach to improving motor control, focusing on the relearning of activities and PNF approach is a neuro-motor development training to improve motor function and facilitate maximal muscular contraction.
Objective- the study was done to find the effectiveness of Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation in improving upper limb function in stroke patients.
Methods-30 stroke patients with upper extremity tone of less than 2 on Modified Ashworth Scale and Brunnstorm Voluntary Control score of 4 and 5 were selected. They were divided into two groups by simple random sampling: One group received MRP training while other with PNF training along with conventional therapy for 4 times a week for 4 weeks. Pre and post assessment was done by using Fugl Meyer Upper Extremity and Upper Extremity Stream Index. Statistical analysis done by using Wilcoxon Signed Rank Test and Mann Whitney U test.
Results-Significant improvement within the groups seen in Fugl Meyer Upper Extremity and Upper Extremity Stream Index but when compared there was no statistical significance seen in Fugl Meyer(p=0.738) and STREAM(p=0.231).
Conclusion: MRP and PNF training were equally effective in improving upper limb function in stroke patients. Keywords- Stroke, Fugl Meyer, Stream Index, MRP, PNF

Full Text: PDF


Gajanan Bhalerao, Vivek Kulkarni, Chandali Doshi, Savita Rairikar. Comparison of Motor Relearning Programme versus Bobath approach at every two week interval for improving Activities of daily living and ambulation in acute stroke rehabilitation. International Journal of Basic and Applied Medical Science. 2013 Vol. 3,pp. 70-77.

Chachu Kuriakose, Naseem Shafafiya M et al . a prospective study of clinical profile of stroke in a tertiary care hospital. Asian Journal of Pharmaceutical and Clinical Research, 2016, Vol 9, Suppl 3.

Puneet Rehani, Reena Kumari, Divya Midha. Effectiveness of motor relearning programme and mirror therapy on hand functions in patients with stroke-a randomized clinical trial, International Journal of Therapies and Rehabilitation Research 2015; 4 (3): 20-24

Garcia JH et al., In Barnett HJM et al (eds) Stroke Pathophysiology, Diagnosis, and Management New York Churchill Livingstone 1992 125

Stroke/Brain Attack reporter’s Handbook. Englewood, Colo: National Stroke Association, 1995

Carr JH, Shepard RB. A motor relearning programme for stroke. 2nd ed. Oxford: Butterworth-Heinemann, 1987.

Karen Rocha De Moraes, Evelim Leal De Freitas Dantas Gomes*, Samantha Souza Possa and Luciana Barcala. Effects of PNF Method for Hemiplegic Patients with Brachial Predominance after Stroke: Controlled and Blinded Clinical Trial. Neurological Research and Therapeutics 2014, 2378-8933-1-10

Susan S. Adler, Dominiek Beckers, Math Buck. PNF in practice. All illustrated guide. Third edition,with 215 figures in 564 separate illustrations.

Gražina Krutulytė Et Al, The Effectiveness Of Physical Therapy Method In Rehabilitation Of Stroke Patients. Medicina, 2003, 39 Tomas, Nr. 9.

Sana Batool et al, To Compare The Effectiveness Of Constraint Induced Movement Therapy Versus Motor Relearning Programme To Improve Motor Function Of Hemiplegic Upper Extremity After Stroke. Pak J Med Sci, 2015, Vol. 31 No. 5.

Franco CB, Pires LC, Pontes LS, Souza EJ (2006) Evaluation of range of motion in children with cerebral palsy after botulinum toxin injection followed by physiotherapy. RerTo Med 20: 43-49.

Dean CM, Mackey FH, Katrak P (2000) Examination of shoulder positioning after stroke: A randomized controlled pilot trial. Austr J Physiother 46: 35-40.

Tomaszâ Wolny et al, Butler’s Neuro-mobilizations Combined With Proprioceptive Neuromuscular Facilitation Are Effective In Reducing Of Upper Limb Sensory In Late-Stage Stroke Subjects: A Three-Group Randomized Trial. Clinical Rehabilitation, 2010; 24: 810–821

Source: Comparison of motor relearning programme with proprioceptive neuromuscular facilitation on upper limb function in stroke patients | Gazbare | International Journal Of Scientific Research And Education

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[ARTICLE] Robot-Assisted Rehabilitation of Ankle Plantar Flexors Spasticity: A Three-Month Study with Proprioceptive Neuromuscular Facilitation – Full Text 


In this paper, we aim to investigate the effect of Proprioceptive Neuromuscular Facilitation (PNF) based rehabilitation for ankle plantar flexors spasticity by using a Robotic Ankle-foot Rehabilitation System (RARS). A modified robot-assisted system was proposed and seven post-stroke patients with hemiplegic spastic ankles participated a three-month of robotic PNF training. Their impaired sides were used as the experimental group while their unimpaired sides as the control group. A robotic intervention for the experimental group generally started from a two minutes passive stretching to warm-up or relax the soleus and gastrocnemius muscle and also ended with the same one. Then a PNF training session included 30 trails was activated between them. The rehabilitation trainings were carried out three times a week as an addition of their regular rehabilitation exercise. Passive ankle joint range of motion, resistance torque and stiffness were measured in both ankles before and after the intervention. The changes in Achilles’ tendon length, walking speed, and lower limb function were also evaluated by the same physician or physiotherapist for each participant. Biomechanical measurements before interventions showed significant difference between the experimental group and the control group due to ankle spasticity. For the control group, there was no significant difference in the three months with no robotic intervention. But for the experimental group, passive dorsiflexion range of motion increased ($p0.05$). The robotic rehabilitation also improved the muscle strength ($p0.05$) and fast walking speed ($p<0.05$). These results indicated that PNF based robotic intervention could significantly alleviate lower limb spasticity and improve the motor function in chronic stroke participant. The robotic system could potentially be used as an effective tool in post-stroke rehabilitation training.

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Source: Frontiers | Robot-Assisted Rehabilitation of Ankle Plantar Flexors Spasticity: A Three-Month Study with Proprioceptive Neuromuscular Facilitation | Frontiers in Neurorobotics

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[ARTICLE] The effects of ramp gait exercise with PNF on stroke patients’ dynamic balance – Full Text PDF

[Purpose] This study examined the effects of ramp gait training using lower extremity patterns of proprioceptive neuromuscular facilitation (PNF) on chronic stroke patients’ dynamic balance ability.

[Subjects and Methods] In total, 30 stroke patients participated in this study, and they were assigned randomly and equally to an experimental group and a control group. The experimental group received exercise treatment for 30 min and ramp gait training with PNF for 30 min. The control group received exercise treatment for 30 min and ground gait training for 30 min. The interventions were conducted in 30 min sessions, three times per week for four week. The subjects were assessed with the Berg balance scale test, timed up and go test, and functional reach test before and after the experiment and the results were compared.

[Results] After the intervention, the BBS and FRT values had significantly increased and the TUG value had significantly decreased in the experimental group; however, the BBS, FRT, and TUG values showed no significant differences in the control group. In addition, differences between the two groups before the intervention and after the intervention were not significant.

[Conclusion] In conclusion, ramp gait training with PNF improved stroke patients’ dynamic balance ability, and a good outcome of ramp gait training with PNF is also expected for other neurological system disease patients.

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via The effects of ramp gait exercise with PNF on stroke patients’ dynamic balance.

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[Review] Hands-on physiotherapy interventions and stroke and International Classification of Functionality, Disability and Health outcomes


The effectiveness of “hands-on” physiotherapy for stroke is unclear. The objective here is to analyze the effectiveness of such interventions on movement-related International Classification of Functionality, Disability and Health (ICF) categories. A systematic review was undertaken of randomized controlled trials published since 1980, using the following criteria: stroke, humans, ≥ 18 years, outcomes related to ICF movement-related categories, physiotherapeutic handling techniques, control group as placebo or no intervention, including experiments where both groups have the same intervention and the experimental group has one extra intervention. Nine studies were included and a best evidence synthesis is presented. Recommendations with limited evidence favor slow-stroke back massage for shoulder pain, range-of-motion exercises for upper-limb and lower-limb structures and functions of muscles and joints, proprioceptive neuromuscular facilitation (PNF) for gait step, walking backwards with hip facilitation for gait parameters and performance, and conventional physiotherapy with facilitation techniques for gait parameters. Recommendations with indicative findings favor PNF with trunk rhythmic stabilizations for function and mobility of upper limbs. Recommendations with limited evidence show the non-efficacy of Bobath therapy for upper-limb function and activity and facilitation of the step on body weight support treadmill training for gait parameters and performance. In conclusion, some hands-on interventions have limited evidence in stroke rehabilitation.

via Taylor & Francis Online :: Hands-on physiotherapy interventions and stroke and International Classification of Functionality, Disability and Health outcomes: A systematic review – European Journal of Physiotherapy –.

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[VIDEO] Easy PNF and Physiotherapy Equipment – YouTube

The Freestyler PNF and Physiotherapy Equipment. The Freestyler is a great tool for rehabilitation professionals or for individual to use at home after an injury. The system gives an increased effectiveness for the rehabilitation process and for use of rehabilitation professionals.

Professional physiotherapists can use the Freestyler in everyday therapies. They can use many modified PNF (proprioceptive neuromuscular facilitation) exercises, which enable fast and effective functional rehabilitation. They can be implemented in existing programs or combined with other equipment. Our system enables the rehabilitation professionals to save time and money and increase the quality of rehabilitation process.

We offer a complete home gym rehab solution all in one place. Exercises can be undertaken during the regular rehabilitation process or after institutionalized rehabilitation treatment under supervision of a physiotherapist or a physician. Home rehabilitation users get complete step by step programs with full support and tutorials for a safe and effective home rehabilitation workout.

The Freestyler is a very efficient device with carefully planned exercise programs for muscle strengthening, improvement of coordination and balance as well as for facilitating patients efficient return to everyday activities.

via Easy PNF and Physiotherapy Equipment – YouTube.

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