Facilitation Techniques Research Articles

Efficacy of scapular and upper limb proprioceptive neuromuscular facilitation techniques on scapular alignment, upper limb function, and gait in subacute stroke: a randomized controlled trial protocol

Background: Stroke is a neurological disability produced by vascular-related acute focal injury to the central nervous system and is one of the leading causes of disability in adults, and it is frequently accompanied by motor skill loss. Patients suffering from hemiplegia after a stroke are more prone to have fall and are more likely to experience further injury due to irregular gait, diminished muscular strength, and functional impairment. In the affected upper limb of the hemiplegic stroke, spasticity in the shoulder girdle causes scapular malalignment, which reduces the functional mobility and stability of the upper limb. This is reflected as the reduced reciprocal arm swing during walking, which is further reinforced by an abnormal synergy pattern on the affected side. Proprioceptive neuromuscular facilitation (PNF) is a treatment strategy that stimulates motor activity and enhances control and function of the neuromuscular system. This research protocol is intended to assess and evaluate the effects of applying scapular and upper limb PNF along with conventional physiotherapy treatment to subacute-stroke patients on their scapular alignment, upper limb function, and gait. Methods: A total of 40 individuals in total will be allocated equally into two groups, group-A (experimental) and group-B (control). Both groups will be receiving treatment for six weeks with five sessions per week. Each patient will be examined both before and after therapy using the Palpation Meter (PALM), the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), 10-Meter Walk Test, Handheld dynamometer (10MWT), and Dynamic gait index (DGI). After six weeks of therapy, the results will be assessed and the data will be analyzed before and after the intervention using a paired t-test to discover within-group differences in measurements. Conclusions: This physiotherapy method may be used in the management of stroke patients if our study's hypothesis is found to be valid. Registration: CTRI (CTRI/2023/05/052930, 19/05/2023).

Diagnosis and treatment of dysphagia

Background: Dysphagia refers to an abnormality in the process of transporting food from the mouth to the stomach. Patients with dysphagia have a high risk of airway aspiration, which can often lead to fatal complications such as pneumonia and asphyxia. Recently, interest in the clinical importance of dysphagia has increased in the medical community and society at large.Current Concepts: Dysphagia can be caused by neurological diseases such as stroke and brain injury, or by non-neurological diseases such as head and neck cancer or diverticulum. Diagnosis is mainly performed using videofluoroscopic swallowing study or endoscopic evaluation of swallowing based on a detailed history and physical examination, scintigraphy or esophageal manometry may also be helpful. Recently developed imaging technology using 3-dimensional computed tomography and dynamic magnetic resonance imaging has been implemented. Treatment of dysphagia can be divided into compensatory and facilitative rehabilitation techniques. The most important principle for successful treatment of dysphagia is that it should be performed with a multidisciplinary team approach.Discussion and Conclusion: Dysphagia is an important problem that can seriously impair the patients’ quality of life. Although the general public and medical professionals are interested in dysphagia, many unknown aspects exist regarding the mechanism of dysphagia, and few treatments have been sufficiently proven in terms of safety and effectiveness. Therefore, much attention and effort is still required.

Functional Electrical Stimulation in Conjunction With Proprioceptive Neuromuscular Facilitation (PNF) Technique to Improve Upper Limb Function in Traumatic Brachial Plexus Injury: A Case Report

Functional Electrical Stimulation in Conjunction With Proprioceptive Neuromuscular Facilitation (PNF) Technique to Improve Upper Limb Function in Traumatic Brachial Plexus Injury: A Case Report

Co-creation of a patient engagement strategy in cancer research funding

BackgroundAs research teams, networks, and institutes, and health, medical, and scientific communities begin to build consensus on the benefits of patient engagement in cancer research, research funders are increasingly looking to meaningfully incorporate patient partnership within funding processes and research requirements. The Canadian Cancer Society (CCS), the largest non-profit cancer research funder in Canada, set out to co-create a patient engagement in cancer research strategy with patients, survivors, caregivers and researchers. The goal of this strategy was to meaningfully and systematically engage with patients in research funding and research activities.MethodsA team of four patient partners with diverse cancer and personal experiences, and two researchers at different career stages agreed to participate as members of the strategy team. Ten staff members participated in supportive roles and to give context regarding different departments of CCS. The strategy was co-developed in 2021/2022 over a series of 7 workshops using facilitation strategies such as ground rules and consensus building, and methods such as Design Thinking. The strategy was subjected to 3 rounds of validation.ResultsThe co-creation and validation process resulted in a multi-faceted strategy with actionable sections, including vision, guiding principles, engagement methods, 13 prioritized engagement activities spanning the spectrum of research funding, and an evaluation framework. The experience of co-creating the strategy was captured using the Patient and Public Engagement Evaluation Tool and revealed a positive, supportive experience.ConclusionsLessons learned included the value of an emphasis on a co-creation process from day one, the utility of facilitation techniques such as ground rules for dialogue, consensus building and Design Thinking, and the importance (and challenge) of designing for and incorporating equity when drafting the strategy. Future work will include implementation and evaluation of the strategy, as well as an examination of further ways to meaningfully and systematically engage diverse voices in research and research funding.

Exploring the Added Value of Inclusive Dementia Research Throughout (and Beyond) the Research Process

The need for the ‘voice’ of people living with dementia to be present in research has been gaining prominence in recent years. This has been realised through the rise of ‘inclusive research’, seeking to redress unequal power dynamics that have long dominated research. However, the impact and merit of inclusive research have been questioned, with questions around what value the involvement of disabled people as co-researchers adds to the research process and impact. With reference to an inclusive photovoice project on dementia post-diagnosis experiences, we address these debates through exploring the arc of the research project in three phases. In Phase 1 project notes and reflective conversations between the research team are drawn on to examine how the lived experience of researchers living with dementia shaped the focus and the methods employed. In Phase 2 conversation analysis is used to examine the interactional delivery of the focus group, showing that the researchers living with dementia used a mix of facilitation techniques to encourage and support talk, drawing on their own expertise by experience as an interactional tool to encourage participants to talk. In Phase 3 thematic analysis of participant follow up interviews is employed to examine experiences of taking part in the research. Participants reported improved positive self-image, benefits from peer support, and increased motivation to engage in future activities because of participation. We argue that the value the researchers with dementia added was not just confined to the focus of the research, but was ‘baked into’ project design delivery, and impact upon participants living with dementia. We show that the ‘added value’ of inclusive research shaped the research methods and delivery to fit participants, supported increased participation and agency from participants during the research, and enabled participants to contest deficit framing(s) of dementia after leaving the research project.

Effect of upper extremity kinesio tape application on hand function, wrist joint position and grip strength in children with hemiparetic cerebral palsy

Abstract Although kinesio taping (KT) is frequently used in musculoskeletal disorders, there is not enough data on the effectiveness of holistic KT application on the upper extremity in spastic hemiparetic children. Our study aims to evaluate the effect of KT application on spasticity, range of motion, dexterity and hand grip strength in these patients. Twenty patients diagnosed with spastic hemiparetic cerebral palsy, aged 5-17 years, who were trained and treated in a private educational institution, were included in the study. Between November 2021 and January 2022, in addition to neurodevelopmental therapy for 12 weeks, KT was applied from the lateral epicondyle region to the end of the metacarpals, with 15-25% tension, to the dorsal face of the hand, with the taping direction facilitation technique (starting direction is the origin of the muscle). Spasticity, range of motion, dexterity and hand grip strength were evaluated as pre-test and post-test. It was determined that the mean score difference between the pre-test and post-test range of motion (ROM) shoulder abduction, ROM supination, ROM wrist flexion, ROM wrist extension and hand grip strength of the individuals was statistically significant (). It was determined that the individuals’ pre-test-post-test Jebsen hand function test (JHFT) Writing, JHFT card flipping, JHFT small objects, JHFT nutrition simulation, JHFT backgammon checkers stamps, JHFT large light objects, JHFT total score average difference was statistically significant (). These results indicate that KT application positively affects upper extremity functions in the rehabilitation of hemiparetic cerebral palsy. Longitudinal studies are recommended in patients with hemiparetic cerebral palsy.

Effectiveness of Active Releasing Technique Vs Mulligan Bent Leg Raise for Footballers with Hamstring Tightness

BACKGROUND: Hamstring tightness is common among football players, which frequently results in hamstring injuries. Although the exact cause of hamstring tightness is unknown, decreased hamstring extensibility may play a role. Stretching techniques of various types have been used to improve muscle flexibility in rehabilitation and sports. Passive stretching is one of the most commonly used methods, and the recent addition of other techniques such as ballistic stretching, Proprioceptive Neuromuscular Facilitation (PNF) techniques with variants have been effective. The current study aimed to compare the effects of Active releasing technique and Mulligan bent leg raise in footballers with hamstring tightness. AIM AND OBJECTIVE: To determine the effectiveness of Active releasing technique and Mulligan bent leg raise in reducing hamstring tightness among football players. METHOD: STUDY DESIGN: Experimental study. SAMPLING TECHNIQUE: Convenient Sampling technique. SAMPLE SIZE: 20 FOOTBALL PLAYERS. RESULT: The values were statistically analysed using paired ‘t-test and the Unpaired ‘t-test. The statistical analysis made with the quantitative data revealed a statistically significant difference between Group A and Group B and also within the group. The post-test mean value of sit and reach flexibility test of group A was 29.40 and group B was 28.50. This showed that the treatment given for group A is comparatively more effective than group B. CONCLUSION:This study shows that there was an improvement in hamstring flexibility in Active release technique as well as Mulligan bent leg raise among footballers with hamstring tightness. However, Active release technique is better as compared to Mulligan bent leg raise technique to improve hamstring flexibility and range of motion in footballers. KEYWORDS: Hamstring tightness, Active release technique, Mulligan bent leg raise, Footballers.

Philosophy outreach through teacher education

Building a university outreach programme is a complex task that requires coordination of funding, regulations, research aims, practical activities and recruitment strategies. This article describes the building of an outreach programme based on the Philosophy with Children practice and the associated changes in the programme’s research focus, practical activities and organisation over the first five years. Where did the initial inspiration come from, what form did it take eventually, and what have we learned? The article outlines our strategies and activities and I argue that two shifts in focus made the programme stronger in terms of impact and research. First, instead of sending university students into classrooms, we turned to teacher training programmes. Second, conversations with teachers indicated that the most interesting research questions were not about cognitive gains but about learning environments, teacher roles, facilitation techniques and other topics from educational studies. The article also assesses the strategies and research from the first six years of the programme and how they have demonstrated both challenges and opportunities in Philosophy with Children.

Investigation of the instant effect of Kinesio Taping on the rectus femoris muscle on pain and functional disability in knee osteoarthritis patients

Aims: The aim of this study is to determine the instant effect of kinesio taping applied to the rectus femoris muscle on pain and functional disability in patients with knee osteoarthritis Methods: Forty individuals diagnosed with osteoarthritis were included in the study and were divided into two groups as Kinesio tape (KT) and placebo groups. Kinesio taping was applied to both rectus femoris of the participants for 30 minutes with the facilitation technique in the intervention group and without tension in the placebo group. We assessed participants for pain and functional disability Western Ontario and McMaster Osteoarthritis Index (WOMAC). Results: Demographic and clinical characteristics of the groups before these interventions were similar (p > 0.05). WOMAC pain, WOMAC function and WOMAC total score improved significantly for the KT group between pre-post taping results (p<0,05). There was no significant difference between the pre-post taping in WOMAC stiffness section (p>0,05). Conclusion: It was concluded that KT applied bilaterally to the rectus femoris did not affect stiffness in patients with knee OA, but instantly improved pain and functional disability.

A Combination Effect of Sensory Motor Training and Proprioceptive Neuromuscular Facilitation in a Case of Peripheral Polyneuropathy Manifested by Foot Drop in Type II Diabetes Mellitus – A Case Study

Peripheral neuropathy is one of the common complications in patients with diabetes Mellitus (DM) which leads to disrupting the peripheral nervous system resulting in reduce sensory inputs and motor outputs. Patients with foot drop (FD) will have weakness in dorsiflexor muscles of ankle and toe and sensory loss due to disruption of small myelinated and unmyelinated nerve fibers. Sensory motor training (SMT) will facilitate sensory inputs, correcting muscle imbalance, and ensuring correct program at the level of central nervous system whereas Proprioceptive Neuromuscular facilitation techniques (PNF) not only helps facilitating the weaker group of muscles also improve strength . Hence the purpose of the study to combine the effect on use of SMT along with PNF in a case of peripheral polyneuropathy manifested by foot drop in patient with type II DM. The case report study of 72 year old male patient diagnosed with diabetic polyneuropathy manifested by foot drop in type II diabetes mellitus on medication. Intervention of patient received Sensory motor training and Proprioceptive Neuromuscular Facilitation in foot drop for 5 days a week for 4 weeks and outcome measures used were Stanmore Assessment Questionnaire (SAQ) , Diabetic Neuropathy Examination (DNE) score for diabetic neuropathy which were taken on day one and after 4 weeks of intervention and results shown improved on both the outcome measures which concluded that on combination of SMT and PNF techniques have shown efficacy on improving ankle range of motion and strength , sensory discrimination , thereby implementing these combination techniques, will reduce functional dependence and improve quality of life.

Oral Motor Facilitation Technique (OMFT) Affects the Drooling Control Ability of Children with Cerebral Palsy

Oral Motor Facilitation Technique (OMFT) Affects the Drooling Control Ability of Children with Cerebral Palsy

Effects Of Core Strengthening And Proprioceptive Neuromuscular Facilitation Technique On The Barthel Index And Balance In Patients With Hemiplegic Stroke: A Quasi-Experimental Study.

To determine the effectiveness of core strengthening exercises and proprioceptive neuromuscular facilitation techniques on functional performance and balance among patients with hemiplegic stroke. The quasi-experimental study was conducted from March to August 2021 at Imran Idrees Hospital, Sialkot, Pakistan, and comprised stroke patients of either gender who were divided into proprioceptive neuromuscular facilitation group A and core strengthening group B. In both groups, the treatment was given for 6 weeks with 5 30-minute sessions per week. Functional performance and balance were measured using Barthel Index and Berg Balance Scale. Data were collected at baseline, 3 weeks and 6 weeks. Data was analysed using SPSS 22. Of the 48 patients, 24(50%) were in each of the 2 groups. There were 39 (81.25%) male and 9(18.75%) female subjects with an overall mean age of 45±4.919 years. Mean Barthel Index score in group A was 62.50±7.22 at baseline and 74.79±7.14 after 6 weeks. Mean Berg Balance Score was 25.04±2.15 at baseline and 41.66±6.04 after 6 weeks (p<0.05). In group B, Barthel Index score was 61.45±6.33 at baseline and 80.83±7.61 after 6 weeks. Mean Berg Balance score was 25.33±3.38 at baseline and 47.08±5.99 after 6 weeks (p<0.05). There was a significant difference in group B scores compared to group A (p<0.01). Core strengthening programme was more effective than the proprioceptive neuromuscular facilitation programme in terms of activity of daily living and balance in patients with stroke.

The Early Initiation Advantages of Physical Therapy in Multiple Sclerosis-A Pilot Study.

(1) Background: Multiple sclerosis (MS), a chronic progressive neurological disorder which affects the central nervous system (CNS), can result in disorders of all the functions controlled by the CNS: motor, sensory, cognitive and emotional. Physical therapy (PT), conducted through proprioceptive neuromuscular facilitation (PNF) techniques, can be customized to the individual patient's needs and has the potential to improve the patient's evolution. This study aims to establish if PT based on PNF techniques has a beneficial role in MS treatment. (2) Methods: We performed a prospective study on 40 patients who were diagnosed with MS and previously treated only with MS drug treatment (DT). These patients have participated in a PT program throughout one year. At the beginning and at the end of our study, after one year, we have assessed the following parameters: timed walk for 25 feet (Timed 25-Foot Walk test- T25FW test), dexterity of the upper limbs (9-Hole Peg Test-9HPT), disability level (Expanded Disability Status Scale-EDSS) and cognitive function (Paced Auditory Serial Addition Test-PASAT. (3) Results: In subjects in the early stages of MS, lower limb mobility improved significantly, T25FW decreasing from 6.46 to 5.80 (p < 0.001) and upper limb ability increased significantly in the dominant hand, 9HPT decreasing from 17.73 to 16.97 (p = 0.006) and not significantly in the non-dominant hand, 9HPT decreasing from 17.73 to 17.50 (p = 0.255). Furthermore, among these subjects, cognitive performance improved; their PASAT increased from 52.14 to 54.14 (p = 0.036), while the level of disability of these subjects improved only slightly, the EDSS scale evolving from 3.08 to 2.91 (p = 0.650). (4) Conclusions: In patients with early forms of MS, combining DT with a PT program based on PNF techniques results in: regaining muscle strength in the lower limbs, improving coordination while walking, correcting dexterity in the upper limbs and increasing the ability to concentrate.

Effects of Scapular Proprioceptive Neuromuscular Facilitation Techniques in Adults with Calcific Tendinitis of the Supraspinatus

Effects of Scapular Proprioceptive Neuromuscular Facilitation Techniques in Adults with Calcific Tendinitis of the Supraspinatus

New methodological aspects in rehabilitation after proximal humerus fracture

Proximal humerus fracture ranks third in the elderly after femoral neck fractures and distal radius fractures, and seventh in adults, and the risk of occurrence is related to advancing age. In this study we aimed to analyze the efficacy of a 24-weeks physical therapy programme based on a particular methodology consisting of the reprogramming of the specific proprioceptive neuromuscular facil-itation techniques added to the classical physical therapy and by introducing modern interactive therapies and technologies: Capacitive Resistive Electric Transference, Instrument Assisted Soft Tissue Mobilization, kinesiological tapes and PRAMA system, compared with classical physical therapy. Our study included 26 patients, aged between 18 and 55 years, with proximal humerus fracture, who complete the 24-weeks rehabilitation programme. We assessed pain, shoulder range of motion, muscle strength and the ability to perform activities of daily living. The statistical analysis was performed using IBM SPSS and Excel 2021. The results showed statistically significant im-provement in all shoulder motion, increased muscle strength, decreased pain, and a better ability to perform daily activities. The physical therapy programme based on the proposed particular methodology has proven to be more effective than classical physical therapy, both regarding the improvement of the movement parameters compared to the physiological values, as well as the symmetry of both shoulders.

New methodological aspects in rehabilitation after proximal humerus fracture

Proximal humerus fracture ranks third in the elderly after femoral neck fractures and distal radius fractures, and seventh in adults, and the risk of occurrence is related to advancing age. In this study we aimed to analyze the efficacy of a 24-weeks physical therapy programme based on a particular methodology consisting of the reprogramming of the specific proprioceptive neuromuscular facil-itation techniques added to the classical physical therapy and by introducing modern interactive therapies and technologies: Capacitive Resistive Electric Transference, Instrument Assisted Soft Tissue Mobilization, kinesiological tapes and PRAMA system, compared with classical physical therapy. Our study included 26 patients, aged between 18 and 55 years, with proximal humerus fracture, who complete the 24-weeks rehabilitation programme. We assessed pain, shoulder range of motion, muscle strength and the ability to perform activities of daily living. The statistical analysis was performed using IBM SPSS and Excel 2021. The results showed statistically significant im-provement in all shoulder motion, increased muscle strength, decreased pain, and a better ability to perform daily activities. The physical therapy programme based on the proposed particular methodology has proven to be more effective than classical physical therapy, both regarding the improvement of the movement parameters compared to the physiological values, as well as the symmetry of both shoulders. Keywords: proximal humerus fracture; rehabilitation; range of motion; muscle strength; pain; activities of daily living

The Linguistic Input of Fathers of Children Who Are Deaf or Hard of Hearing

Purpose: This study presents an exploration of facilitative language techniques (FLTs) used by fathers of children who are deaf or hard of hearing (DHH) in the natural environment. Method: This investigation utilized the Language ENvironment Analysis (LENA) to collect full-day audio samples from three families with children who were DHH and between 22 and 27 months of age. A total of 6 hr of audio recordings per participant was manually coded for the presence of 10 FLTs used by fathers in the natural environment. These data were compared with FLT use by mothers from the same samples. Results: Fathers of children who are DHH used fewer overall FLTs, fewer responsive FLTs, and more directives compared with mothers. Conclusions: Results of this analysis indicate that fathers provide less linguistic input to their children who are DHH in the natural environment. Furthermore, their input tends to be directive in nature rather than responsive to the child. Implications for clinical practice are discussed. Supplemental Material: https://doi.org/10.23641/asha.23511948

Biomechanical Aspects regarding Restoration of Shoulder Stability in Athletes

Although the recovery of the body after exertion or post-trauma is particularly important, in contemporary sports, for various reasons, it is often not given the necessary time. The main objective of the research was to study the biomechanical particularities of the shoulder that ensure mobility and stability in order to recover post-luxation. The research activity was carried out on two athletes, during 8 months, and we followed the restoration of muscle imbalances and the biomechanical analysis of the unstable shoulder. The objectives of the research were to select the most effective methods and means of physical therapy, by which to restore the stability of the post-luxation shoulder, in athletes. As working methods we used exercises performed in a closed kinematic chain and neuromuscular and proprioceptive facilitation techniques, balancing the forces of the deep muscles. In conclusion, it can be said that through isometric work in a closed kinematic chain and through neuromuscular and proprioceptive facilitation techniques, we can balance the stabilizing muscle forces at the level of the shoulder joint. Through the recovery sessions performed, the muscle imbalances were diminished by the considerable increase in the muscle strength of the per articular muscles.

Effect of 4 Weeks of Scapular Proprioceptive Neuromuscular Facilitation on Scapular Alignment and Upper Extremity Motor Performance in Patients with Stroke: A Repeated Measure Design

Context: Stroke is the major cause for the impairments in adults, typically accompanying loss of motor function which leads to reduce the upper limb function and disturbance in scapular alignment. Aim: To study the effect of 4 weeks of Scapular Proprioceptive Neuromuscular Facilitation on scapular alignment and upper extremity motor performance in patients with Stroke at the intervals of 2 weeks and 4 weeks. Settings and Design: This Repeated Measure Design study conducted in physiotherapy OPD and IPD. Methods and Material: After getting the approval from the ethical committee of college, 27 participants diagnosed with stroke were screened according inclusion and exclusion criteria. Written consent were taken from the participants parents and the procedure of the study was explained to the patient. Subjects were assessed using Lateral Scapular Slide Test, Palpation Meter and Fugl Meyer Motor assessment at baseline, 2 weeks and then 4 weeks after the treatment. Scapular Proprioceptive Neuromuscular Facilitation was given in two diagonals with 20 repetitions. Statistical Analysis Used: The analysis was done using GraphPad Instat 3. For analysing the comparison between Baseline, 2 weeks and 4 weeks, the Repeated Measure ANOVA along with posthoc test was used. Results: At the end of 4 weeks, Scapular alignment and upper extremity motor performance shows significant improvement (p &lt; 0.05). Conclusions: This study concludes that 4 weeks of Scapular Proprioceptive Neuromuscular Facilitation Technique is effective intervention in improving scapular alignment and upper extremity motor performance in patients with stroke, with major improvement occurring in first 2 weeks. Hence, scapular PNF should be included in acute stage of stroke.

The impacts of Kinesio taping on muscular fatigue and proprioception following fatigue among adolescent basketball players

Aim: The present study attempted to investigate the impacts of Kinesio taping on proprioceptive responses of the knee joint before and after muscular fatigue. &#x0D; Material and Method: Thirteen healthy basketball players were recruited for this study. A fatigue protocol was designed with a load of 70% of the maximum quadriceps muscle strength and applied to the dominant lower extremity, including repetitive knee flexion and extension in a sitting position between 0°-90°. Fatigue was assessed using the Borg scale. The protocol was administered to the same participants twice at a one-week interval. Proprioception in the knee joint was assessed using the angle reconstruction test. In the evaluation of proprioception, the target angle was set as 45° of knee flexion and was measured with a digital goniometer. In the second-week measurements, the same protocol was repeated immediately following Kinesio tape application to the quadriceps femoris muscle with the facilitation technique. &#x0D; Results: The findings revealed no significant within-group differences between the proprioception measurements before and after fatigue (p &gt; 0.05). It was also the case in the evaluation with Kinesio taping (p &gt; 0.005). However, the number of movement repetitions significantly differed between the groups in the fatigue protocol (p &lt; 0.05). &#x0D; Conclusion: The proprioception values of pre- and post-fatigue did not significantly differ when Kinesio taping was applied. Overall, it was concluded that Kinesio taping was an effective factor in reducing fatigue and contributed to endurance by delaying the onset of fatigue.