Comparative Effects of PNF (Rhythmic Stabilization With Stabilizing Reversal) and NDT (Facilitatory Techniques) on Trunk Control in Sub-Acute Stroke

May 13, 2026 updated by: Lieza Iftikhar, University of Faisalabad

A stroke is a serious cerebrovascular accident defined as the sudden onset of a neurological deficit caused by vascular changes. Stroke are classified into primarily two types; ischemic and hemorrhagic stroke. In an ischemic stroke, there is an inadequate blood supply to the central nervous system, whereas a hemorrhagic stroke involves a blood vessel rupture and subsequent blood accumulation. Stroke is the fifth leading cause of death and primary cause of severe disability. In hemiplegic patient, trunk impairment is frequently present due to muscular weakness. Furthermore, it can lead to severe functional impairments and reduce a patient's quality of life. Severe complications will occur, if left untreated these complications can lead to functional dependency. Trunk muscular activity is delayed in stroke patient, muscles involved in reaching activity of upper limb activates earlier than the trunk muscles themselves. Trunk muscles play a unique role in maintaining upright posture during sitting, standing and they are important for stabilizing proximal body parts during voluntary limb movements. Patients with hemiparesis often struggle to move their trunk against gravity, regardless of the specific muscle activity required.

Different treatment approaches are used to manage trunk stability in stroke patients with Proprioceptive Neuromuscular Facilitation and Neurodevelopmental Facilitatory Techniques being two of the most common techniques in neurorehabilitation. Proprioceptive Neuromuscular Facilitation technique (PNF) is a well- established approach used to improve functional movement through facilitation, strengthening and lengthening of muscle groups. Neurodevelopmental treatment focuses on the patient's active participation to improve motor control. The aim of this study is to compare the effects of PNF (Rhythmic Stabilization with Stabilizing Reversal) and NDT (Facilitatory Techniques) on trunk control in subacute stroke patients. Thirty- two participants having age 40-65years, hemiparesis, Middle Cerebral Artery Stroke will be included. Patients with recurrent stroke, impaired cognition, severe cerebellar ataxia, severe language deficit and severe musculoskeletal disorders will be excluded.

Electrical stimulation will be given as a baseline treatment for 10-15 minutes on hemiparesis side. Group A will receive PNF facilitation along with the baseline

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treatment. Group B will receive Neurodevelopmental facilitation techniques in addition to the baseline treatment. Specific clinical tools will be used to assess trunk mobility in stroke survivors. Trunk Impairment Scale (TIS) will be used to evaluate motor rearrangement and provide clinicians with information regarding the quality of trunk movements and stability. Modified Functional Reach Test (MFRT) is reliable test for stroke survivors with impaired trunk mobility. It will be used to evaluate the participants ability to maintain dynamic sitting balance. Data will be analyzed using SPSS (2023 version). Statistical test will be selected based on data normality. If the data will be normally distributed, independent and paired t- test will be applied. If data will be not normal, then Wilcoxon Signed Rank and Mann Whitney U test will be utilized.

Study Overview

Status

Status

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Enrolling by invitation

Conditions

Conditions

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Intervention / Treatment

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Study Type

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Interventional

Enrollment (Estimated)

Enrollment

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32

Phase

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  • Not Applicable

Contacts and Locations

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Study Locations

  • Pakistan
    • Punjab Province
      • Faisalabad, Punjab Province, Pakistan, 38000
        • Madinah Teaching Hospital

Participation Criteria

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Eligibility Criteria

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Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Both males and females will be eligible for this study. Patient diagnosed with an ischemic stroke involving the Middle Cerebral Artery resulting in hemiparesis will be included. Participants with significant trunk instability, defined by a score of less than 21 on the Trunk Impairment Scale will be included.

Exclusion Criteria:

Those presenting with recurrent stroke and severe cardiovascular instability will be excluded from the study.

Patients with co-existing neurological disorders or severe cerebellar lesion will be excluded from the study.

Individuals with significant cognitive deficit or language impairments that hinder the ability to follow simple instructions will be excluded from the study.

Patients with severe pre-existing musculoskeletal pathologies will be excluded from the study.

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Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Group A PNF (Rhythmic Stabilization with Stabilizing Reversal techniques)
Procedure: PNF (Rhythmic Stabilization with Stabilizing Reversal techniques)
Baseline: Electrical Muscle Stimulation for a duration of 10-15 minutes Group A-Proprioceptive Neuromuscular Facilitation (PNF) Participants will receive baseline treatment combined with particular proprioceptive neuromuscular facilitation techniques, including Rhythmic Stabilization and Stabilizing Reversal. Both techniques are known to engage deep trunk muscles, which contributes to symmetrical movement pattern and better postural control.
Experimental: Group B NDT (Facilitatory Techniques)
Procedure: NDT (Facilitatory Techniques)
Group B will be treated with baseline EMS for a duration of 10-15 minutes. alongside various facilitatory techniques designed to restore trunk function.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Trunk control
Time Frame: 8 weeks
Trunk impairment scale (TIS) is a highly trusted clinical resource used to measure core stability in stroke survivors, especially during the vital subacute stroke recovery period. This tool breaks down core function into three key areas; how well a patient sit still, how they move while seated and how coordinated their torso is. Since, core strength is the foundation for almost every movement (from sitting upright to (walking) a low score on the TIS often highlights why a patient might struggle with mobility and balance.
8 weeks

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Modified Functional Reach Test (MFRT)
Time Frame: 8 weeks
Modified Functional Reach Test (MFRT) is reliable test for stroke survivors with impaired trunk mobility. It will be used to evaluate the participants ability to maintain dynamic sitting balance and trunk control. While based on the original Functional Reach Test, the MFRT is specifically adapted for patients who lack the ability to stand unaided.
8 weeks

Collaborators and Investigators

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Sponsor

Sponsor

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University of Faisalabad

Study record dates

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Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
May 13, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
June 11, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 11, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 13, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 13, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 20, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
May 20, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 13, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
May 1, 2026

More Information

Terms related to this study

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • TUF/EIRB/167/26

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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