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

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.