Comparison of PNF Stretching and Static Stretching to Reduce Spasticity of Lower Extremity in Spastic Cerebral Palsy Children

Abstract

Background: Cerebral palsy (CP) presents a significant burden on childhood health, with the spastic type being the most prevalent manifestation. This neurological disorder, affecting 2-3 per 1000 births, stems from various prenatal, perinatal, or postnatal brain injuries. Commonly impacted outcome measures include muscle tone, pain, and range of motion, assessed by the Modified Ashworth Scale, Wong-Baker Face Pain Rating Scale, and popliteal angle measurement, respectively. While conservative static stretching is a widely used treatment option for spasticity, its efficacy remains inconclusive due to temporary effects. Conversely, proprioceptive neuromuscular facilitation (PNF) stretching, introduced by Harman Kabat and Margaret Knott in the 1940s, has shown promise in improving functional outcomes and reducing spasticity in neurological conditions like stroke and CP. However, limited evidence exists regarding its comparative efficacy with conventional static stretching in reducing spasticity among children with spastic cerebral palsy. Therefore, this study aims to compare the effectiveness of PNF stretching and static stretching in reducing lower extremity spasticity in children with spastic cerebral palsy, with pain and popliteal angle as secondary objectives. Objective: The primary objective of this study is to assess the comparative effectiveness of PNF stretching and static stretching in reducing spasticity in the lower extremities of children with spastic cerebral palsy. Additionally, pain intensity and popliteal angle will be evaluated as secondary objectives. Methods: A sample size of 60 children was determined using Epitool Google calculator and selected through non-probability purposive sampling. Participants were randomly assigned to either the experimental group, receiving PNF stretching, or the control group, receiving static stretching, with both groups undergoing identical baseline treatment. Pre- and post-intervention assessments were conducted for spasticity, pain intensity, and popliteal angle measurement using appropriate scales and instruments. Data were analyzed using SPSS 20.0, employing independent sample t-tests and paired sample t-tests for intergroup and intragroup comparisons, respectively. Results: Inter-group analysis revealed significant improvements in both groups concerning pre- and post-treatment outcomes across all variables. However, intra-group analysis demonstrated statistically significant improvements in the PNF stretching group compared to the static stretching group across all measured variables. Conclusion: The study concludes that proprioceptive neuromuscular facilitation stretching is more effective than static stretching in reducing spasticity in children with cerebral palsy. Nevertheless, both techniques exhibit efficacy in their respective capacities.