Effect of Transcranial Direct Current Stimulation and Pelvic Proprioceptive Neuromuscular Facilitation in Stroke Patient
2026年9月2日 更新者：Lahore University of Biological and Applied Sciences
Effects of Transcranial Direct Current Stimulation and Pelvic Proprioceptive Neuromuscular Facilitation on Trunk Control, Balance and Functional Mobility in Stroke Patients
Stroke is a leading cause of long-term disability and commonly results in impaired trunk control, postural instability, balance deficits, and reduced functional mobility due to disrupted sensorimotor integration, impaired proprioceptive processing, and decreased cortical excitability.
Trunk control is a key determinant of balance, gait performance, and functional independence, making it a critical target in stroke rehabilitation.
Transcranial Direct Current Stimulation (tDCS) enhances cortical excitability and promotes neuroplasticity through a top-down mechanism, while Pelvic Proprioceptive Neuromuscular Facilitation (PNF) improves trunk-pelvic control, weight shifting, and sensorimotor integration through a bottom-up proprioceptive facilitation mechanism.
Emerging evidence suggests that combining tDCS with Pelvic PNF may improve trunk function and mobility in stroke survivors, supporting the concept of synergistic neuromodulation and motor facilitation.
Despite the documented benefits of tDCS and Pelvic PNF individually, the combined application of these interventions remains insufficiently explored, particularly in subacute stroke patients.
Most previous studies have focused on gait training, robotic rehabilitation, or other task-oriented interventions, with limited emphasis on trunk-focused pelvic PNF and postural control outcomes.
Furthermore, few high-quality randomized controlled trials have evaluated whether simultaneous targeting of central neuroplasticity and peripheral proprioceptive facilitation provides superior improvements in trunk control, balance, and functional mobility.
Therefore, this study aims to address this important clinical and methodological gap by investigate the combining effect of Pelvic PNF and tDCS, potentially establishing an evidence-based rehabilitation strategy that optimizes functional recovery after stroke.
調査の概要
状態
完了
詳細な説明
Stroke is a neurological disorder caused by a disruption of blood supply because of cerebral infarction or hemorrhage.
Stroke is a leading cause of long-term disability worldwide, with balance impairment recognized as one of the most disabling sequel affecting functional independence and quality of life.
In Pakistan, the annual incidence of stroke is estimated at 250 per 100,000 people, and stroke is the second leading cause of death with a mortality rate of about 9.3%.
Postural control and balance impairment are common issues among patients with stroke.
It has been estimated that approximately 83% of patients with stroke experience difficulties in maintaining balance.
Effective trunk control, often referred to as core stability, is therefore a fundamental component of motor performance and postural control.
Selective trunk exercises designed to improve trunk coordination and control can boost balance and gait parameters among stroke subjects.
Transcranial direct current stimulation (tDCS) is one of the most used noninvasive brain stimulation techniques.
Transcranial direct current stimulation (tDCS) is a means of increasing cortical excitability by promoting synaptic plasticity in the cerebral cortex.
A new "top-down" approach to enhance stroke rehabilitation outcomes.
The Pelvic Proprioceptive Neuromuscular Facilitation facilitates the control of trunk and lower extremity motion and provide mobility and stability to trunk.
The use of Pelvic PNF facilitates neuromuscular coordination through specific movement patterns, which enhance trunk stability and postural control.
The Pelvic PNF facilitates the trunk and lower extremity motion and also provides the stability to trunk.
It also promotes the exploration of postural reflexes and prioritizes eccentric muscle contraction, stimulating agonist activity.
Pelvic Proprioceptive Neuromuscular Facilitation (PNF) improves trunk-pelvic control, weight shifting, and sensorimotor integration through a bottom-up proprioceptive facilitation mechanism.
This study will contribute to knowledge by providing evidence regarding the combined effects of Pelvic PNF and tDCS on trunk control, balance, and functional mobility in subacute stroke patients.
The findings will contribute to the existing body of knowledge by providing evidence regarding synergistic effect of these interventions.
Clinically the results may help physiotherapist develop more effective, evidence-based treatment protocols for improving trunk control and functional independence.
By comparing these groups, the study will determine whether adding tDCS to Pelvic PNF provides better functional recovery by enhancing both cortical excitability and peripheral proprioceptive input.
This is important because stroke rehabilitation currently lacks clear evidence on the most effective combination of top-down (neuromodulation) and bottom-up (sensorimotor facilitation) approaches.
The findings may help establish a more effective, evidence-based intervention strategy for trunk control and mobility impairments, which are key determinants of independence after stroke.
At the community level, improved balance and mobility can reduce fall risk, decrease dependency on caregivers, enhance participation in daily and social activities, and better quality of life.
Additionally, effective rehabilitation may reduce long-term disability and healthcare burden, making stroke management more cost-effective and accessible for the community.
Experimental Group A will receive Pelvic PNF and Transcranial Direct Current Stimulation and Routine Physical Therapy while Experimental Group B will receive Pelvic PNF and Routine Physical Therapy and Experimental Group C Transcranial Direct Current Stimulation and Routine Physical Therapy. .
Therefore, this study aims to address this important clinical and methodological gap by investigate the combining effect of Pelvic PNF and tDCS, potentially establishing an evidence-based rehabilitation strategy that optimizes functional recovery after stroke.
研究の種類
介入
入学 (実際)
36
段階
- 適用できない
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
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Punjab Province
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Lahore、Punjab Province、パキスタン、54000
- Dr Salma Physiotherapy Department Psrd Hospital 042-37423455
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参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
いいえ
説明
Inclusion Criteria:
- Both genders
- Middle Cerebral Artery Ischemic Stroke
- Subacute phase of stroke
- Patients experiencing their first ever stroke
- Brunnstrom stage 3
- Patients is capable to follow commands
Exclusion Criteria:
- Frequent seizures or epileptic disorder
- Contractures in the spine and lower limb
- Patients with uncontrolled medical conditions e.g. severe musculoskeletal pain, uncontrolled heart disease, uncontrolled hypertension
- Metallic implant
- History of brain tumor, orthopedic, neurosurgical surgery
- Concurrent participation in another clinical trial.
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：独身
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的：Experimental: Pelvic PNF and Transcranial Direct Current Stimulation and Routine Physical therapy
group A will receive pelvic propriceptive neuromuscualar facilitation and transcranial direct current stimulation with routine physical therapy.
The participants will receive 20 min session of transcranial direct current stimulation with intensity of 2 mA in which anodal tDCS applied over ipsilateral side.
Then 20 min session of pelvic PNF will perform with 10 repitition per set for 3 set.
pelvic PNF pattern perform as anterior elevation and posterior elevation using rthymic initiation, slow reversal and stabilizing reversal will perform, Then perform routine therapy as ROM, Bridging, trunk flexion and swiss ball perform for 20 minutre.
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The patients will sit comfortably on a chair, with their hip and knee joints positioned at 90 degrees and their forearms resting on a table in front of the chair.
For the groups receiving tDCS, a wireless rechargeable tDCS device will use.
This device use two 5-7 cm-long sponge electrodes that will soak in 0.9% saline.
The electrodes will be carefully wrap around the patient's head.
The brain remains excited for up to 20 min following tDCS.
The tDCS will administered at a intensity of 2 mA, for 20 min, with a 30 sec ramp-up and ramp-down at the beginning and end of stimulation.
The PNF will be perform at 10 repetitions per set, with 3sets per session, conducted 3 sessions per week over a duration of 12 weeks.
Each session lasted 20 min.
Pelvic PNF pattern as anterior elevation and posterior elevation using rthymic initiation and slow reversal.
RPT include ROM, trunk flexion, bridging and swiss ball exercises.
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実験的：Experimental: Pelvic Proprioceptive Neuromuscular Facilitation and Routine Physical Therapy
Group B will receive pelvic proprioceptive neuromuscular facilitation with routine physical therapy.
In this group patient receive 20 min session of pelvic PNF with 10 repititions per set for 3 set per session apply moderate manual resistance according to patient tolerance.
Patient should be in side lying position then apply PNF pattern as anterior and posterior elevation using rthymic initiation , slow reversal and stabilizing reversal.
the routine physical therapy involve 20 repetition with moderate intensity with 3 sessions per week it involve the ROM, bridging, trunk flexion and exercise on swiss ball.
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The PNF treatment will be perform at a dosage of 10 repetitions per set, with 3sets per session, conducted 3 sessions per week over a duration of 12 weeks.
Each session lasted 20 minutes, depending on the participant's endurance and response to therapy.
The treatment will performed on the affected side, with the hips flexed to 100° and the knees flexed to 45°.
For anterior elevation, the therapist's hands will placed just on the subject's anterior iliac spine, and for posterior depression, they will placed on the patient's ischial tuberosity.
"Pull up" for anterior elevation, and "push down" and "sit into my hands" for posterior depression.
Rhythmic initiation, Slow reversal and stabilizing reversal will used.
routine physical therapy involve Sitting posture exercises as controlled forward flexion, trunk rotation to right and left.
Supine position exercises as hip roll to both sides, bridging exercise Dynamic sitting exercise on swiss ball as controlled lateral weight shifting.
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実験的：Experimental: Transcranial Direct Current Stimulation and Routine Physical Therapy
Group C will receive transcranial direct current stimulation and routine physical therapy.
The participants will receive 20 min session.
tDCS pads will soaked in saline and then apply to patients head.
Anodal tDCS apply over ipsilesional side with current of 2mA with 30 second ramp up and down in the begining and end of stimulation.
the routine physical therapy involve 20 repetition with moderate intensity with 3 sessions per week it involve the ROM, bridging, trunk flexion and exercise on swiss ball.
|
The patients will sit comfortably on a chair, with their hip and knee joints positioned at 90 degrees and their forearms resting on a table in front of the chair.
For the groups receiving tDCS, a wireless rechargeable tDCS device will use.
This device use two 5-7 cm-long sponge electrodes that will soak in 0.9% saline.
The electrodes will be carefully wrap around the patient's head.
The brain remains excited for up to 20 min following tDCS.
The tDCS will administered at a intensity of 2 mA, for 20 min, with a 30 sec ramp-up and ramp-down at the beginning and end of stimulation.
routine physical therapy involve Sitting posture exercises as controlled forward flexion, trunk rotation to right and left.
Supine position exercises as hip roll to both sides, bridging exercise Dynamic sitting exercise on swiss ball as controlled lateral weight shifting for 20 min duration
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Trunk impairement scale
時間枠：[Time Frame: baseline, week 6 and week 12]
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Trunk impairment scale evaluates static and dynamic trunk balance and trunk coordination.
These tasks are design to reflect the patient's ability to activate trunk musculature, which is often impaired after stroke.
It evaluates three components: static sitting balance (score range 0-7), dynamic sitting balance (0-10), and trunk coordination (0-6).
The total score ranges from 0 to 23, with higher scores indicating better trunk performance.
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[Time Frame: baseline, week 6 and week 12]
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Berg Balance Scale
時間枠：baseline, week 6 and week 12
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The BBS is a 14-item ordinal scale that measures balance performance during functional tasks such as sitting, standing, and weight shifting.
Each item is rate on a 5-point scale (0-4), with a maximum total score of 56.
Higher scores indicate better balance ability.
It has excellent inter-rater reliability, with ICC values of 0.989.
Concurrent validity (r = 0.970).
Interpretation of 0 to 20 (High Risk): Severe balance impairment; patients typically require a wheelchair for mobility and significant assistance.
21 to 40 (Moderate Risk): Increased fall risk; these individuals typically require walking aids and environmental modifications.
41 to 56 (Low Risk): Good balance function with minimal fall risk.
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baseline, week 6 and week 12
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Time up and go test
時間枠：baseline, week 6 and week 12
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This test measures functional mobility and fall risk by timing the patient as they rise from a chair, walk a short distance, turn around, return, and sit down.
The time taken is record in seconds and categorized into normal mobility, low, moderate, or high fall.
Reliability ICC for the TUG were 0.998 and 0.992
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baseline, week 6 and week 12
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Fugl-Meyer Assessment (FMA) for the lower extremity
時間枠：baseline, week 6 and week12
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This scale measure the motor control in stroke patients.
FMA consists of 17 items, with a maximum total score of 34 points.
Each task is rate on a 3-point ordinal scale.
0: Movement cannot be performed, 1: Movement can be performed partially, 2: Movement can be performed fully.
The higher the score, the better your motor recovery.
The scores indicate: 0-10: Severe motor impairment, 11-23: Moderate motor impairment, 24-33: Mild motor impairment, 34: Minimal to no impairment (full motor recovery).
Reliability, with Intra-class Correlation Coefficient (ICC) values 0.90 to 0.97 high inter-and intra-rater reliability (ICC > 0.90) for the total FMA-LL score.
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baseline, week 6 and week12
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協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
捜査官
- 主任研究者：psrd hospital、Pakistan Society for Rehabilitation of Disabled Hospital Lahore
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
- El-Sherbini AEIEM, Elgayar SL, Elhamrawy MY, Youssef TM. Unlocking trunk potential after stroke: a novel approach combining transcranial direct current stimulation and core stability exercise: a randomized controlled trial. J Neuroeng Rehabil. 2026 Apr 10;23(1):128. doi: 10.1186/s12984-026-01949-0.
- Boob MA, Kovela RK. Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Chronic Stroke Patients: A Randomized Clinical Trial. Cureus. 2022 Oct 24;14(10):e30630. doi: 10.7759/cureus.30630. eCollection 2022 Oct.
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始 (実際)
2026年7月23日
一次修了 (実際)
2026年9月1日
研究の完了 (実際)
2026年9月1日
試験登録日
最初に提出
2026年9月2日
QC基準を満たした最初の提出物
2026年9月2日
最初の投稿 (実際)
2026年9月9日
学習記録の更新
投稿された最後の更新 (実際)
2026年9月9日
QC基準を満たした最後の更新が送信されました
2026年9月2日
最終確認日
2026年9月1日
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追加の関連 MeSH 用語
その他の研究ID番号
- UBAS/ERB/26/07/080
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