International Journal of Natural Medicine and Health Sciences (IJNMS) 2023 Mar; 2 (2)

International Journal of Natural Medicine and Health Sciences

ISSN (Online):2790-2471 ISSN (Print): 2790-2463
Volume 2 (2) Mar 2023
Journal homepage: https://journals.iub.edu.pk/index.php/ijnms

Original Research
An experimental study on comparison between proprioceptive
neuromuscular facilitation technique and conventional physical therapy
on lower extremity function of cerebral palsy
Madeeha Nabia, Syble Chiraghb, Amber Tariqc, Ayesha Rehmand, Rabab Kompale, Iqra Nadeemf*
a
Irha Physiotherapy and Rehabilitation Center, Lahore, Pakistan
b
National Hospital and Medical Centre, Lahore, Pakistan
c
Physiogic Physiotherapy Clinic, Lahore, Pakistan
d
Lahore Institute of Science and Technology, Department of Allied Health Sciences, Lahore, Pakistan
e
Royal Institute of Medical Sciences Multan, Pakistan
f*
Department of Allied Health Sciences, University of Sargodha, Pakistan

Article Info. Abstract

Background: Cerebral palsy (CP) has prevalence of 2 to 2.5 per 1000 live births. Causes of
Received: 14-04-2022
Revised: 10-06-2022
CP are still not known significantly. There are many risk factors of CP are known now a
Accepted: 16-12-2022 days. CP can cause other secondary abnormalities in musculoskeletal system like low
Online: 31-12-2022 muscle power, tightness, and many other bony and structural changes and also in gait.
There are five different levels of gross motor function in which level I is the highest level
and level V is the last level. This classification is according to the GMFCS. Objective: To
Correspondence: determine the efficacy of conventional therapy and PNF techniques in reducing spasticity
iqranadeem7979@gmail.com and improving gross motor function in subjects with cerebral palsy. Methods: Total 36
patients were divided equally into 2 groups. They were assessed at pretreatment, 4th and
8th session of treatment using GMFCS and Modified Ashworth Scale. Group A received
PNF stretching (Contract-Relax Method) and Group B received Muscle passive stretching.
Results: At post treatment assessment, PNF group had the highest score for GMFCS score
Keywords: Cerebral Palsy, Contract- (U=155.0, p=0.812), hip flexors spasm (U=121.50, p=0.178), knee flexors spasm
Relax Method, Muscle Stretching,
PNF Stretching.
(U=129.0, p=0.270), knee extensors spasm (U=152.00, p=0.731) foot dorsiflexors spasm
(U=143.50, p= 0.530), foot planter flexors spasm (U=155.00, p=0.817) and on the other
hand conventional treatment group had the high score in hip extensors spasm (U=114.50,
p=0.098). Conclusion: It is concluded that both the techniques are helpful to enhance the
GMFCS score and to reduce the spasticity. PNF stretching has the more positive effects on
improving the GMFCS score than that of conventional muscle stretching, in reducing lower
limb spasticity except the hip extensors where conventional muscle stretching was more
effective.

Citation: Nabi M, Chiragh S, Tariq A, Rehman A, Kompal R, Nadeem I. An experimental study on comparison between proprioceptive neuromuscular
facilitation technique and conventional physical therapy on lower extremity function of cerebral palsy. IJNMS. 2023; 2 (2): 35-38.

Nabi et al. 35
International Journal of Natural Medicine and Health Sciences (IJNMS) Original Research

Introduction: Cerebral paralysis (CP) is the most well- Neuromuscular Facilitation (PNF) Technique have
known reason for physical inability in youth, with an beneficial results on cerebral palsy management in
expected occurrence of 2 to 2.5 per 1000 live births. enhancing range of motion and plasticity and lowering
Cerebral Palsy rate continues rising, incompletely because level of spasticity. However, the effectiveness of these two
of more noteworthy quantities of untimely newborn procedures is yet to be decided.
children who are enduring and longer in general survival Material and Methods: Quasi experimental study was
[1]
. Intracranial blood loss and injury, birth weight under conducted in National Orthopedic Hospital (NOH),
2500g, intrauterine development hindrance and birth less Bahawalpur within 4 months with 36 participants
than 32 weeks of development are the most neonatal risk randomly recruited in two groups. Group A received PNF
factors for CP. When discussing postnatal, CP is caused in stretching (contract-relax method) and group B received
around 10-20% cases due to the different conditions like, passive muscle stretching. SAMPLING
brain detriment, from different bacterial, viral infections Participants were included with prior diagnosis with
like meningitis, encephalitis, hyperbilirubinemia, falls and Spastic CP, 6-12 years of age, both genders and 1+ grade
abusing the child on head [2]. Proper neuronal generation at modified ashworth scale. Children with any prior
and propagation of action potential is also necessary for the surgery of lower limb were excluded and those who had a
normal functioning of brain [3]. Current ways to deal with history of seizures. Data was collected by using Gross
treatment options for kids with cerebral palsy have risen up Motor Function Classification System for Cerebral Palsy
out of an assortment of sources, including Patients (GMFCS): Sitting, walking and use of mobility
neuromaturational, pharmacological, biomechanical and devices were assessed using GMFCS. A modified
careful casings of reference. In word related treatment, Ashworth Scale was used to measure resistance during
neurodevelopmental treatment (NDT), proprioceptive passive soft-tissue stretching.
neuromuscular help (PNF), development treatment, muscle Data was analyzed by using SPSS version 20. Statistical
re-instruction and the Vojta approach are clinical models significance was set at p=0.05. Descriptive statistics were
which depend on a neuromaturational establishment [4]. applied. The Mann Whitney test was applied to see changes
Development of novel drug delivery system like silver between successive visits. Friedman ANOVA was used to
nanoparticles of different compounds are also designed to measure changes of objective measurements over time.
make the accessibility of the drug to the target tissue like Results: Demographics of the CP patients are shown in
muscle, brain or neuron for treatment purpose [5]. Table 01. Pretreatment Mean rank of both groups were
According to a study hamstring's static stretching is more calculated using SPSS, GMFCS score, Hip Flex spasm,
effectual than self-stretching and PNF stretching that fuses Hip extensor spasm, knee flexor spasm, knee extensor
the hypothesis of corresponding restraint when utilizing a spasm, foot dorsiflexion and planterflexor spasm were
30-second stretching portion connected 3 days of the week recorded prior to the treatment sessions. Pre-treatment
for about a month [6]. Whereas another study showed that values are presented in table 02. Pre-treatment comparison
PNF stretching is may be “the most effective form of of both groups was done by using non-parametric T-tests.
flexibility training available to you for increasing your Table 02 showed that in pretreatment assessment, data was
range of motion (ROM)”. This is a further developed type insignificant and PNF group has the highest score for
of adaptability preparation, including both the stretch and GMFCS score (U=155.0, p=0.812), hip flexors spasm
constriction of the focused-on muscle groups. While there (U=121.50, p=0.178), knee flexors spasm (U=129.0,
are a few types of PNF stretching, they all make them think p=0.270), knee extensors spasm (U=152.00, p=0.731) and
in the same manner they encourage solid restraint. It is on the other hand convention treatment group has the high
accepted that this is the reason PNF is better than different score in hip extensors spasm (U=114.50, p=0.098).
types of adaptability training [7]. Research demonstrates Post treatment measurements were taken at session 4th and
that PNF stretching, both the CR and CRAC techniques are session 8th. Table 03 presented the comparison of both
compelling in enhancing and sustaining after ROM, groups mean at post treatment at 8th session. Table 03
expanding strong quality and control, and expanding showed that data was insignificant and at 8th sessions
athletic execution, particularly after workout. However, assessment (U = 135.00, p= 0.305) of GMFCS score, PNF
legitimate convention and congruity must be pursued to group has the highest rank. At the 8th session’s assessment
accomplish and keep up the advantages of PNF procedures of hip flexors spasm, data was insignificant and the PNF
[8]
. A systematic review by F. Kaya suggests that stretching group has the highest rank (U= 156.000, p= 0.828). At the
practices are a vital segment of the preparing process 8th sessions assessment of hip extensors spasm,
regarding protecting characteristic adaptability of joints, conventional treatment group has the highest rank U=
expanding their proficiency and expelling damage hazard. 102.000, p= 0.032. For knee flexors spasm data was
Likewise, the genuine impact of expanding adaptability on insignificant and PNF group has the highest rank at 8th
athletic execution keeps its vulnerability. Future session of treatment assessment (U= 142.000, p=0.481).
investigations ought to be for making proper conventions for Knee extensor spasm data was insignificant and
to expel the negative impacts of PNF stretching, explaining conventional treatment group has the highest rank in 8th
perfect PNF stretching sessions regarding span, recurrence session of treatment (U= 128.00, p= 0.169).
and number of redundancies and shaping conventions Discussion: A study conducted on effectiveness of passive
explicit to sports [9]. Previous studies have been reported on stretching on muscle length reported in their findings that
different settings like sports, healthy individuals etc. There all factors were fundamentally more noteworthy during
is lack of studies on comparison between PNF and pre-and post-stretch preliminaries contrasted with the
conventional therapy on CP. We hypothesize that resting angle and were self-sufficient of stretch system.
conventional therapy (passive stretch) and Proprioceptive There was an estimated 10° increment in the most extreme
Nabi et al. 36
International Journal of Natural Medicine and Health Sciences (IJNMS) Original Research

dorsiflexion post-stretch, and this was represented by Recommendations: It is recommended that in future
lengthening of both muscle (0.8 cm) and ligament (1.0 cm). studies patients with CP of below 6 years and above 12
Muscle fascicle length expanded altogether (0.6 cm) from years can be recruited to check the response of patients to
pre-to post-stretch [10]. In current study we found that both the PNF stretching in early and later ages. In future studies
treatments have positive effects on reducing the muscle comparison of improvement in male and female patients
spasms of the foot dorsiflexors (PNF group (χ2 (2) = can be studied to check the gender response to the physical
16.909, p= 0.000) and conventional treatment group (χ2 (2) therapy interventions. Inclusion and exclusion criteria for
= 14.000, p=0.001). and foot planter flexors (PNF group future studies can be modified to recruit the patients for
(χ2 (2) = 20.150, p= 0.000) and conventional treatment study.
group (χ2 (2) =14.966, p= 0.001). An evidence based References
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Nabi et al. 37
International Journal of Natural Medicine and Health Sciences Original Research
Table. 1. Demographics of PNF and Conventional group
Demographics of case and control groups
Demographics PNF Group Conventional group
Age 8.27±1.839 7.25±1.712
Gender Male 61%, Female 39% Male 44%, Female 56%
Weight 28.75±4.62 31.24±5.48
Table. 2. Pre-Treatment Comparison of Both groups
Pre-treatment comparison of both groups
GMFCS Hip Flx Spasm Hip Ext Spasm Knee Flx Spasm Knee Ext Spasm
Mann-Whitney U 155.0 121.5 114.5 129.0 152.000
Wilcoxon W 326.0 292.5 285.5 300.0 323.000
Z -.237 -1.347 -1.653 -1.103 -.344
Asymp. Sig. (2-tailed) .812 .178 .098 .270 .731
Table. 3. Post treatment comparison of both groups at 8th session
Post treatment comparison of both groups at 8th session
GMFCS Hip Flx Spasm Hip Ext Spasm Knee Flx Spasm Knee Ext Spasm
Mann-Whitney U 135.000 156.000 102.000 142.000 128.000
Wilcoxon W 306.000 327.000 273.000 313.000 299.000
Z -1.026 -.217 -2.139 -.705 -1.374
Asymp. Sig. (2-tailed) .305 .828 .032 .481 .169

Nabi et al. 38