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

Akshaya Saklecha; Moh’d Irshad Quershi; Raghumahanti Raghuveer; Pallavi Harjpal

doi:10.12688/f1000research.138133.1

Home Browse Efficacy of scapular and upper limb proprioceptive neuromuscular facilitation...

ALL Metrics

-

Views

-

Downloads

Get PDF

Get XML

Export

▬

✚

Study Protocol

Clinical trial

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

[version 1; peer review: awaiting peer review]

Akshaya Saklecha ¹, Moh’d Irshad Quershi¹, Raghumahanti Raghuveer¹, Pallavi Harjpal¹

PUBLISHED 11 Oct 2023

Author details Author details

¹ Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, 442001, India

Akshaya Saklecha
Roles: Conceptualization, Writing – Original Draft Preparation

Moh’d Irshad Quershi
Roles: Supervision, Validation

Raghumahanti Raghuveer
Roles: Supervision, Writing – Review & Editing

Pallavi Harjpal
Roles: Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS AWAITING PEER REVIEW

This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

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).

Keywords

Proprioceptive Neuromuscular Facilitation, Scapular Alignment, Upper Limb Function, Gait, hemiplegia, stroke, physiotherapy treatment

Corresponding author: Akshaya Saklecha

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Saklecha A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Saklecha A, Quershi MI, Raghuveer R and Harjpal P. 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 [version 1; peer review: awaiting peer review]. F1000Research 2023, 12:1305 (https://doi.org/10.12688/f1000research.138133.1) First published: 11 Oct 2023, 12:1305 (https://doi.org/10.12688/f1000research.138133.1) Latest published: 11 Oct 2023, 12:1305 (https://doi.org/10.12688/f1000research.138133.1)

Introduction

Stroke is clinically defined as a neurological impairment caused by a vascular-related acute focal damage to the central nervous system (CNS).¹ According to the World Health Organization (WHO), stroke has been reported as a major cause of disability and death worldwide, with an incidence between 0.2 and 2.5 per 1,000 people each year and in India the prevalence of stroke significantly increases with age, 0.80% at 45–54 years old and 1.97% at 55–69 years old.² Stroke accounts for 60 to 80% of cases of upper extremity disability due to weakness of proximal muscles, causing severe disability in hand functions and gait, considered as a significant issue.³ Stroke patients have poor voluntary control, weakness, imbalance, and malalignment, all of which impede an affected arm's ability to maintain proper scapular orientation. These elements play a role in the 76% of stroke patients who exhibit an imbalance in scapular position and the 67% of those who exhibit aberrant scapular motions, both of which indicate impaired stability of the proximal upper extremity. To increase the upper extremity's limited functions and distal movement, it is crucial to achieve stability.⁴

Following a stroke there is loss of voluntary control in the flaccid stage, followed by spasticity, which affects the shoulder joint and produces changes to the scapulothoracic joint, which in turn impacts scapular malalignment.⁵ In the spastic stage, the flexor tone dominates, causing shoulder joint retraction, depression, and adduction. The latissimus dorsi, rhomboids, elevator scapulae, pectoralis major and minor, and can become hypertonic, causing the scapula to rotate even further downward. These muscles are crucial for the shoulder complex stability, which is necessary for the shoulder joint to have a proper range of motion. Mandalidis and O'Brien hypothesized that in order to regain the normal functioning of the upper extremity's distal joints, it is crucial to strengthen the scapular stabilizers.⁶

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. According to Kelly et al., stroke patients walked more slowly than the general population, used more energy, and had shorter walking times.⁷

In current clinical practice, techniques like proprioceptive neuromuscular facilitation (PNF), motor re-learning programme (MRP), motor imagery technique, constraint-induced movement therapy (CIMT), robotic therapy, and neuromuscular stimulation techniques are used to help hemiplegic patients regain control of their upper limbs. In order to stimulate motor functions and enhance neuromuscular control and function, proprioceptive neuromuscular facilitation (PNF), a therapeutic exercise strategy, blends functionally oriented diagonal patterns with neuromuscular facilitation approaches. The main goal of exercises using the patterns of PNF is to increase functional mobility by inhibition, facilitation, strengthening, and relaxation of muscle groups. This technique of therapeutic exercise is distinguished by the utilization of diagonal patterns and the use of sensory cues—specifically proprioceptive, cutaneous, visual, and aural stimuli—to elicit or augment motor response.⁸^,⁹

Scapular PNF is used in two diagonal directions: anterior elevation—posterior depression and posterior elevation—anterior depression. Techniques of scapular PNF can be utilized to target-stretch or target-strengthen specific muscles since they involve functional or diagonal patterns for exercising. These methods also assist the muscles in relearning the appropriate timing, and amount of activation in order to keep the balance between various muscle groups. Few studies have stated that scapular PNF was efficacious in improving the upper limb mobility, but the techniques were not clear.⁸^,¹⁰^–¹²

Conventional physiotherapy includes exercises such as passive motion, active assisted exercises, active exercises, balance exercise, and gait training. Conventional exercises are ones that are practised globally. Ellenbecker et al., reported that the movement of one segment affected other proximal and distal parts. Several factors, such as muscular weakness and hypertonicity, have been known to restrict the functions of the limbs.¹³ Lai et al., reported that 55 to 80% of stroke patients with impaired upper limb functions even after six months of recovery after injury had permanent dysfunction in the performance of daily living activities.¹⁴ Wang reported that studies on the effectiveness of PNF-based treatment have been both supportive and conflicting and that very few studies on pelvic facilitation for gait improvement existed.⁹^,¹²^,¹⁵ Although there have been many studies using PNF for stroke, sports injuries, and musculoskeletal disorders.¹⁶^–¹⁹ Little research has been done on the effects of the intervention on the scapular movements and walking of stroke patients when it is applied to their scapular adductors. In this context, this study attempted to identify the effects of training using PNF along with conventional physiotherapy on the scapular alignment and upper limb function and gait velocity of stroke patients. The research question identified was whether scapular stabilization will improve upper limb function and gait velocity in subacute stroke patients?

Aims

The study’s aim is to find out the efficacy of scapular and upper limb proprioceptive neuromuscular facilitation techniques along with conventional therapy on subjects with sub-acute stroke in a randomized controlled trial (RCT) with two arms of parallel superiority/equivalence on improving scapular alignment, upper limb function and gait velocity. The end point results will be compared on a marginal basis to determine effectiveness.

Primary objectives

1. To study the subjects with subacute stroke, treated with scapular and upper limb PNF techniques in addition to conventional therapy and its effect on gaining scapular alignment (measured by palpation meter), and upper limb function (measured by Fugl Meyer Assessment for Upper limb (FMA-UE)) and gait velocity (measured using 10 Meter walk test (10MWT)).
2. To compare and evaluate the efficacy of scapular and upper limb PNF techniques along with conventional therapy over conventional physiotherapy for bringing on change in scapular alignment, upper limb function, and gait in sub-acute stroke.

Secondary objectives

1. To study the subjects with subacute stroke treated with scapular and upper limb proprioceptive neuromuscular facilitation techniques along with conventional therapy on improving hand grip strength using handheld dynamometer.
2. To study the subjects with subacute stroke treated with scapular and upper limb PNF techniques in addition to conventional therapy on improving gait and balance using dynamic gait index (DGI) over the population.

Trial design

This study is a single-centric, two arm parallel, open-label equivalence randomized controlled trial. This study has been registered with Clinical Trials Registry India (CTRI) (CTRI/2023/05/052930, 19/05/2023).

Protocol

This study protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist.²⁰ The model consent form, data collection form and schedule of enrolment, interventions, and assessments can be found as Extended data.²¹ The study will be carried out in compliance with the principles of the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Figure 1 provides a summary of the study process. After receiving approval from the Datta Meghe Institute of Higher Education and Research's institutional ethics committee (Institutional Ethical Clearance was obtained on 04/02/2023; IEC No. – DMIHER (DU)/IEC/2023/547), participants will be recruited from the Physiotherapy OPD of Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi Meghe, Wardha, Maharashtra, using inclusion and exclusion criteria for the study. Subjects will be invited and screened as part of the study's inclusion process. Following the screening, participants will be educated about the study and given a written informed consent form. After consent is obtained, the assessor will conduct the baseline assessment using the questionnaire. Then, the study's participants will be subsequently subdivided into two groups.

Figure 1. Summary of study process.

For subject allocation, a randomization procedure utilizing a computer-generated list will be used. Randomization for 1:1 allocation of Group-A (PNF) and Group-B (Conventional therapy) with the goal to treat. When engaging participants, the inclusion and exclusion criteria for selection will be based on the cut-off values at baseline parameters. Throughout the six-month recruitment phase, a secondary source of recruiting will be used if more study participants are needed. PNF and conventional therapy will be given to the active group to evaluate the improvement in scapular alignment, upper limb function, and gait velocity at endpoint results in marginal difference, whereas control group will only receive conventional therapy. As conventional physiotherapy is already proven and a novel approach to be proven should be compared with the universal one.

Participants will be enrolled and evaluated at pre-post treatment, including visits one and two for subject enrolment and screening, baseline and after the conclusion of six weeks, when primary and secondary parameters will be measured. The study schedule of enrolment, intervention and assessment of study (as recommended by the SPIRIT guidelines) is illustrated in Figure 2.

Figure 2. Schedule of enrolment, interventions, and assessments.

Inclusion criteria

1. Patients with hemiplegic subacute stroke, any gender aged between 50 and 70 years old.
2. Patients with more than 24 in Mini-mental state examination.
3. Patients with spasticity between grades (+1 and 1) on the Modified Ashworth Scale (MAS).
4. Patients with Brunnstrom Voluntary control grading more than or equal to four.
5. Patients who could walk independently, either with or without assistance.

Exclusion criteria

1. Patients who have heart failure symptoms, uncontrolled hypertension, or unstable angina.
2. Patients who have a recurrent stroke.
3. Patients who have any traumatic upper and lower limb musculoskeletal conditions.
4. Patients who had organ damage such as lung, heart, kidney, or liver failure.

Interventions

Groups

Group A: Experimental group

Group B: Control group

Experimental group

After screening and randomization, the experimental group will receive scapular PNF coupled with upper limb PNF and conventional physiotherapy treatment.

PNF will be applied to the scapula and upper limb in both D1 and D2 flexion and extension patterns of the patients in side-lying and sitting position. Table 1 shows the PNF pattern of each segment. The techniques will be initiated using rhythmic initiation then progressing to combinations of isotonics, dynamic reversal, rhythmic stabilization, contract relax and hold relax techniques of PNF. These techniques will be performed for 60 minutes/day, five days/week, for six weeks. Ample amount of rest periods will be given in-between to prevent fatigue.⁸^,¹⁰

Table 1. Showing the PNF pattern of each segment of upper limb.

Segment	Synergy Pattern	PNF Pattern
Scapula	Retracted/Depressed	D1 Flexion/D2 Flexion
Glenohumeral	Adduction/Internal Rotation	D2 Flexion
elbow	Flexion	D1 Extension
forearm	Pronation	D1 Flexion/D2 Flexion
wrist	Flexion	D1 Extension/D2 Flexion
fingers	Flexion	D1 Extension/D2 Flexion

Conventional physiotherapy treatment includes closed kinematic chain exercises of upper limb, upper and lower extremity range of motion exercises, stretching and strengthening exercises for upper limb, trunk and lower limb, balance & coordination, manual dexterity exercises (e.g., grasp release), and teaching of activities of daily living (ADLs), according to the patient’s needs.²² It will be performed for 60 minutes/day, five days/week, for six weeks.¹⁶^,²³^,²⁴

Control group

After screening and randomization, the control group will receive conventional physiotherapy treatment. It includes closed kinematic chain exercises of upper limb, upper and lower extremity range of motion exercises, stretching and strengthening exercises for upper limb, trunk and lower limb, balance & coordination, manual dexterity exercises (e.g., grasp release), and teaching of ADLs, according to patient’s needs. It will be performed for 60 minutes/day, five days/week, for six weeks.¹⁶^,²³^,²⁴

Criteria for discontinuing allocated interventions for a given trial participant

If any patients in any of the allocated groups develop complications (e.g., complex regional pain syndrome), their participation in the study will be discontinued. The patients will then receive appropriate care and offered outpatient rehabilitation as needed. Study participants will be retained in the trial (unless they withdraw their consent) to enable follow-up data collection and to prevent missing data.

Adherence and concomitant care

During the first consultation, the importance of following the study guidelines and adhering to the allocated group will be highlighted. Exercise adherence will be recorded as a percentage of completed exercises during the first follow up (after the six-week intervention) for both groups. Exercise adherence will be taken into consideration when performing the per-protocol analysis.

All enrolled patients will be encouraged to contact the principal investigator directly, if experiencing problems related to their allocated group intervention. The principal investigator will then fill out a standardized form at these calls. Patients can use medicines and nutritional products as needed, prescribed by their physician after the episode of stroke. To avoid study-contamination, patients will be asked to adhere to the allocated rehabilitation intervention and not to seek alternative health-care services during the course of the study. Patients will be advised to contact their general practitioner or the principal investigator as needed.

Outcomes

Primary outcomes

Change in palpation meter (PALM) score

A palpation meter is a dependable tool for measuring both the angles and distance of scapula. The tool is used to record the horizontal distance of scapula from spine, two measurements will be taken: the horizontal distance from the root of the spine of the scapula to the spinous process of thoracic spine(T2), and from the inferior angle of the scapula to the spinous process of thoracic spine(T7). The vertical distance of scapula will be measured from the postero-inferior angle of the acromion to spinous process of cervical spine (C7). The angles measurement will be taken from the superior angle of the two scapula and inferior angles of the two scapula. The end of one arm of the calliper will be positioned over one of the landmarks, and the end of the other arm position over another landmark. The PALM inclinometer will be level for measurement of the horizontal distance between the scapula and the thoracic spine. The inclinometer value will be used to calculate the vertical distance between the scapula and C7. A reading will be taken from both the sides, and the variances in each position will be calculated.²⁵ When there is a bilateral disparity in scapular distance that is greater than 1.0 cm to 1.5 cm, the scapular alignment is considered inappropriate or disturbed. A positive result suggests an upward scapular rotation, while a negative result shows a downward scapular rotation.²⁶^–²⁸

Change in Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score

It assesses and monitors recovery in hemiplegic patients following a stroke. The FMA-UE is one of the most commonly used tools for quantifying post-stroke upper limb impairment and rehabilitation. It is a condition-specific consequence that pertains to upper limb hemiparesis in stroke patients. Scale items are assessed based on their ability to execute the item using a 3-point ordinal scale, where 0 means cannot perform, 1 means partially performs, and 2 means fully performs. A total score is derived by adding all calculated item scores with a point range of 0-126.²⁹

Change in 10-Meter Walk Test (10MWT) score

It measures the velocity of walking in meters per second over a short period of time. To the nearest tenth of a second, the total amount of time needed to walk 6 meters (m) will be recorded. Then, 6 m will be converted to m/s by dividing it by the whole amount of time it took to ambulate (in seconds).³⁰ Normal Walking Speed m/s - Household Ambulator <0.40 m/s; Limited Community Ambulator 0.40 to <0.80 m/s; Community Ambulator ≥0.80 m/s.³¹

Secondary outcomes

Change in Hand Grip Strength (HGS) score (Handheld Dynamometer)

A handheld dynamometer will be used to measure HGS. The maximum value (in kg) will be obtained after the test is done three times with at least two minutes of rest in between.³²

Change in DGI score

The DGI evaluates a participant's ability to maintain walking balance while responding to a variety of task demands in a variety of dynamic contexts. It is a useful test for those with vestibular and balance problems, as well as those who are at risk of falling. Each item is evaluated from 0 to 3, with 3 representing normal performance and 0 representing significant impairment. A DGI score of 24 is the highest possible. A total score of less than 19/24 is indicative of geriatric falls. A score of >22 signifies a safe ambulator.³³

Sample size calculation

By using a power analysis with a 90% power and 5% Type 1 error determined for the primary variable, we determined the sample size.¹¹

Sample size calculation formula using mean difference

n 1 = n 2 = 2 \frac{{(Z_{α} + Z_{β})}^{2} σ^{2}}{{(δ)}^{2}}

Primary variable (FMA-UE)

Mean ± SD (Pre) result on FMA-UE for experimental group in stroke patients = 17.93 ± 5.22.

Mean ± SD (Post) result on FMA-UE for Experimental group in stroke patients = 25.40 ± 4.34

Difference = 7.47

Considering estimated std.dev = 7

N1 = 2^{*} [{(1.96 + 1.28)}^{2} {(7.47)}^{2}] / {(7)}^{2} = 18

Total samples required = 18 per Group.

Considering 10% drop out = 2

Total sample size required = 20 per group

Total sample size required (N) = 2*20 = 40

Notations:

Z_{α} = 1.96

α = TypeIerrorat 5 %

Z_{β} = 1.28 (1 - β) = Powerat 90 %

σ = std . dev = 7

Data collection and management

The evaluation data will be obtained from a pre-established spreadsheet with variable baseline characteristics. Research data will be placed in a secure database. Non-electronic records, such as hard copies of assessment forms, signed informed consent forms, etc., will be stored safely in the study setting. A complete backup of the data entries will be performed every month until trial completion.

Data collection and reporting will be carried out under the supervision of the principal investigators. The research reports must be carefully checked for accuracy. The Excel spreadsheet will be published at the conclusion of the study and given to the statistician for the required analysis. Checklists can be used to avoid lost data due to incorrect staff procedures.

Participant retention and completion of follow-up assessments are expected to be relatively high due to the comprehensive follow-up assessment of this trial. Patients included in this trial are invited to follow-up assessments at six weeks.

Data analysis

The overall results will be calculated using R studio software 4.3 version. Data for the total participants in the study will be collected and will be organized with variables per participants record for their demographic and analysis assessment. Demographic variables such as age having quantitative measurement will be presented with mean, standard deviation, medium, maximum and minimum. While those qualitative or categorical will be presented with frequency and percentage such as hand dominance, gender and side affected. All the results for inferential statistics will be tabulated and tested at 5% level of significance (P<0.05). The primary outcome variables (PALM for measuring scapular alignment, FMA-UE for measuring upper limb function and 10MWT for measuring gait velocity) and secondary outcome variables (handheld dynamometer for measuring HGS and DGI for measuring balance and gait) will be tested for the pre-post results using paired t-test. Data will be subjected to normality test using Kolmogorov–Smirnov test. In cases of failed normality, a non-parametric test will be applied and if the data are normally distributed, a parametric test will be applied. For the paired t-test, a Wilcoxon paired signed rank test will be used. An unpaired t-test will be used to find the significant difference over the mean for both primary and secondary variables between control and experimental groups. A Mann–Whitney test will be used for the unpaired t-test. Association analysis for finding significance of cofounding parameters will be evaluated by using Chi-squared test or Fisher’s exact test or by using multi-variant analysis.

Monitoring

We will have a data monitoring committee for maintaining and integrating the data. The whole procedure is going to be held under the supervision of clinicians and departmental committee i.e., guide, head of department, principal, and member of the research guideline cell. Every month auditing trial going to be conduct. Any deviation from the protocol will be documented and will be addressed. The final dataset will be uploaded to institutional research website and will be accessible to concerned authorities.

Ethics and dissemination

This study has received approval from the Datta Meghe Institute of Higher Education and Research's institutional ethics committee (Institutional Ethical Clearance was obtained on 04/02/2023; IEC No. – DMIHER (DU)/IEC/2023/547). Planning to publish in an indexed journal and present the study at National Conference Proceedings.

Consent

Principal Investigator will obtain the informed consent from the patient on a printed form with signature and given the proof of confidentiality. The study program will be elaborated to the participant and one of their relatives, and principal investigator will take personal information as a part of procedure. The consent form will include the confidentiality statement and signatures of the principal investigator, patient and two witnesses. If required to disclose some information for the study, consent will be obtained from the patient with complete assurance of his/her confidentiality.

Confidentiality

All study-related information about the participants will be stored securely at the study site. Paper forms will in stored in locked cabinets, while electronic data will be stored on a password protected drive at the study site. Only persons involved in the trial will have access to the study-related information. Individual study information will not be released outside of the study without permission of the individual participant.

Ancillary and post-trial care

It is not expected that the allocated interventions will cause any harm to the participants. If any harm is caused, at the end of the 6-week intervention, the patients will be offered free-of-charge in- or outpatient rehabilitation as deemed clinically needed.

Access to the trial set

The principal investigator and the principal supervisor will have full access to the data set. The full-anonymized data set will be made available for the journal reviewing the manuscript.

Study status

The recruitment of participants is yet to be started.

Discussion

In normal human movement, voluntary movement patterns rely on synergies restricted by the CNS to operate together to produce an action. This movement may be impaired in stroke patients. As a result, the patient is unable to perform even the most basic movements. There is a mechanical coupling between the serratus anterior, trapezius, and rhomboids in the scapula that is disturbed after stroke, resulting in increased rhomboidal activity.³⁴ When the movement is deliberately induced, this disturbance is obvious. During the flaccid period, the trunk tends to lean or shorten towards the hemiplegic side, causing the scapula to descend from its normal horizontal position. The trapezius and serratus anterior become flaccid as well, causing the scapula to rotate downward. The pectoralis major and minor, rhomboids, elevator scapulae, and latissimus dorsi might become hypertonic during the spastic period, further twisting the scapula downward.³⁵ Many studies have found that glenohumeral and scapulothoracic strength training improves the functionality of the paretic upper extremities.³⁶^–³⁸

Mandalidis and O'Brien demonstrated that effective movement and range of motion of muscles functioning on a distal joint are only possible when the surrounding musculatures effectively stabilize the proximal joints.⁶^,³⁹ They claimed that strengthening the scapular stabilizers is crucial for restoring the upper extremity's distal joints function.

Kazi et al., (2023) performed a narrative review on scapular malalignment in patients with stroke. He included eight studies that were conducted on individuals in the acute, subacute, and chronic stages in the review. One acute, six chronic, two subacute, and chronic strokes were among them. In patients with acute, subacute, and chronic stroke, the findings indicated that scapular malalignment had an impact on the scapular balancing angle, functional hand mobility, and range of motion.⁴⁰

Another study performed by Kim et al., (2017) examined upper limb function and gait ability in stroke patients when treated with scapular stabilization exercise during standing.³⁸ Nine patients were placed in a study group and eight individuals were placed in a control group out of 17 hemiplegic patients following stroke. On the paretic side, the study group had physical therapy and scapular stabilization exercises. Prior to treatment, participants underwent an initial examination. To compare the changes, subjects were reassessed four and eight weeks later. Both gait abilities and hand function were measured. These findings suggested that scapular stability exercise while standing on an affected side for eight weeks had an impact on hemiplegic patients' capacity to walk and use their hands. Finding the best exercise for stroke patients with gait impairment and upper limb dysfunction will require more research.³⁸

Moon et al., (2017) examined how stroke patients' scapular motions and walking abilities were affected by indirect application of PNF to the scapular adductor muscles. This study had five stroke patients who were enrolled as a single group. PNF patterns were administered to the scapulae anterior elevation and posterior depression patterns, as well as upper limb patterns, while the patients were in side laying and sitting positions. These findings imply that PNF training is useful in enhancing scapular motions and walking capability in stroke patients.⁸

When a literature search was conducted, only a small number of studies were found to focus on scapular PNF, and the available studies had been conducted on small populations and had methodological shortcomings.⁸^,¹¹^,¹² Scapular training was added to the therapy plan for stroke patients' upper limb rehabilitation and gait, although these trials were insufficient.³⁸^,⁴¹^,⁴² As a result, there is a need to investigate the effect of scapular and upper limb PNF along with conventional therapy in subacute stroke on scapular alignment, upper limb function, and gait. The benefits of the study allow for a more tailored approach to the rehabilitation protocol as well as the flexibility to react to the patients' improving capacities throughout therapy.

Data availability

Underlying data

No data are associated with this article.

Extended data

Zenodo: Extended Data.docx, https://doi.org/10.5281/zenodo.8172471.²¹

This project contains the following extended data:

‐ Model consent form
‐ Data collection Form
‐ Schedule of enrolment, interventions, and assessments.

Reporting guidelines

Zenodo: SPIRIT checklist for ‘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’, https://doi.org/10.5281/zenodo.8013812.²⁰

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

I would like to acknowledge Mr Laxmikant Umate who has helped me in sample size calculation and data analysis planning.

References

1. Sacco RL, Kasner SE, Broderick JP, et al.: An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Jul; 44(7): 2064–2089. Publisher Full Text
2. Kodali NK, Bhat LD: Prevalence and Associated Factors of Stroke among Older Adults in India: Analysis of the Longitudinal Aging Study in India-Wave 1, 2017–2018. Indian J. Public Health. 2022 Apr 1; 66(2): 128.
3. Kamalakannan S, Gudlavalleti ASV, Gudlavalleti VSM, et al.: Incidence & prevalence of stroke in India: A systematic review. Indian J. Med. Res. 2017 Aug; 146(2): 175–185. Publisher Full Text
4. Rensink M, Schuurmans M, Lindeman E, et al.: Task-oriented training in rehabilitation after stroke: systematic review. J. Adv. Nurs. 2009 Apr; 65(4): 737–754. Publisher Full Text
5. Mahmoud LSED, Aly SM: The effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity. Bull. Fac. Phys. Ther. 2020 Jul 9; 25(1): 8. Publisher Full Text
6. Mandalidis D, O’Brien M: Relationship between hand-grip isometric strength and isokinetic moment data of the shoulder stabilisers. J. Bodyw. Mov. Ther. 2010 Jan; 14(1): 19–26. Publisher Full Text
7. Eng JJ, Tang PF: Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence. Expert. Rev. Neurother. 2007 Oct; 7(10): 1417–1436. Publisher Full Text
8. Moon SH, Kim YY: Effect of PNF Approach to Scapular Adductor Muscles on Scapular Movements and Walking Ability in Patients with Stroke. J. Int. Acad. Phys. Ther. Res. 2017; 8(1): 1090–1094. Publisher Full Text
9. Salphale V, Kovela R, Qureshi M, et al.: Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Children with Spastic Diplegia: A Study Protocol for a Randomized Clinical Trial. J. Pharm. Res. Int. 2021 Dec 17; 88–95. Publisher Full Text
10. Chitra: Effect of scapular hold-relax technique on shoulder pain in hemiplegic subjects: A randomized controlled trial. Physiother-J. Indian Assoc. Physiother. 2017; [cited 2023 Jan 17]; 11: 49–52. Publisher Full Text
11. Joshi: Effect of scapular proprioceptive neuromuscular facilitation on shoulder pain, range of motion, and upper extremity function in hemiplegic patients: A randomized controlled trial. Indian J. health Sci. Biomed Res. 2017; [cited 2023 Jan 11]; 10: 276–282. Publisher Full Text
12. Kim SJ, Choi JW, Chung HA: Effects of Using Scapular-Pelvic Patterns Simultaneously to Improve the Components of Gait in Patients with Stroke. PNF Mov. 2016; 14(2): 75–81.
13. Andrew TL: Closed Kinetic Chain Exercise. A Comprehensive Guide to Multiple-Joint Exercises. J. Chiropr. Med. 2002; 1(4): 200. Publisher Full Text
14. Lai SM, Studenski S, Duncan PW, et al.: Persisting consequences of stroke measured by the Stroke Impact Scale. Stroke. 2002 Jul; 33(7): 1840–1844. PubMed Abstract | Publisher Full Text
15. Wang RY: Effect of proprioceptive neuromuscular facilitation on the gait of patients with hemiplegia of long and short duration. Phys. Ther. 1994 Dec; 74(12): 1108–1115. PubMed Abstract | Publisher Full Text
16. Desai RR, Steven VJ, Joshi RM, et al.: Proprioceptive Neuromuscular Facilitation Techniques versus Closed Kinematic Chain Exercises in Scapular Dyskinesia among Hospital Housekeeping Staff: An Experimental Study. J. Clin. Diagn. Res. 2021 [cited 2023 Jan 15]. Publisher Full Text
17. Saeed M, Hafeez S, Asad F, et al.: Comparison of Scapular Proprioceptive Neuromuscular Facilitation and Myofascial Release Techniques on Pain and Function in Scapular Dyskinesia Associated with Adhesive Capsulitis: Scapular Dyskinesia Associated with Adhesive Capsulitis. Pakistan BioMedical Journal. 5(4): 123–127. Publisher Full Text
18. Park SJ, Oh S: Changes in Gait Performance in Stroke Patients after Taping with Scapular Setting Exercise. Healthcare. 2020 Jun; 8(2): 128. PubMed Abstract | Publisher Full Text | Free Full Text
19. Tedla JS, Sangadala DR: Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. J. Musculoskelet. Neuronal Interact. 2019; 19(4): 482–491.
20. Saklecha A: SPIRIT_checklist Editied.docx. [Dataset]. Zenodo. 2023 Jun 7 [cited 2023 Jul 21]. Publisher Full Text
21. Saklecha A: Extended Data.docx. [Dataset]. Zenodo. 2023 Jul 21 [cited 2023 Jul 21]. Publisher Full Text
22. Lalwani SS, Vardhan GDV, Bele A: Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol. J. Pharm. Res. Int. 2021 Oct 2; 33(45A): 466–475. Publisher Full Text
23. Wilk KE, Arrigo CA, Andrews JR: Closed and Open Kinetic Chain Exercise for the Upper Extremity. J. Sport Rehabil. 1996 Feb 1; 5(1): 88–102. Publisher Full Text
24. Harjpal P, Qureshi MI, Kovela RK, et al.: Efficacy of Bilateral Lower-Limb Training Over Unilateral Lower-Limb Training To Reeducate Balance and Walking in Post-Stroke Survivors: A Randomized Clinical Trial. Cureus. 2022 Oct; 14(10): e30748. PubMed Abstract | Publisher Full Text
25. da Costa BR , Armijo-Olivo S, Gadotti I, et al.: Reliability of scapular positioning measurement procedure using the Palpation Meter (PALM). Physiotherapy. 2010 Mar 1; 96(1): 59–67. PubMed Abstract | Publisher Full Text
26. Anne M, Alya B, Lee H, et al.: The palpation meter (palm) is reliable for measuring scapular upward rotation in the coronal plane. Int. J. Phys. Educ. Sports Health. 2015 [cited 2023 Mar 15]; 2(2): 54–59.
27. 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. 14(10): e30630.
28. Odom CJ, Taylor AB, Hurd CE, et al.: Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys. Ther. 2001 Feb; 81(2): 799–809. PubMed Abstract | Publisher Full Text
29. Kim H, Her J, Ko J, et al.: Reliability, Concurrent Validity, and Responsiveness of the Fugl-Meyer Assessment (FMA) for Hemiplegic Patients. J. Phys. Ther. Sci. 2012 Oct 1; 24: 893–899. Publisher Full Text
30. Salphale VG, Kovela RK, Qureshi MI: Appraisal of the Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Methods to Optimize Balance and Gait in an Eight-Year-Old Child. Cureus. 2022 Sep; 14(9): e29648. PubMed Abstract | Publisher Full Text
31. Nguyen PT, Chou LW, Hsieh YL: Proprioceptive Neuromuscular Facilitation-Based Physical Therapy on the Improvement of Balance and Gait in Patients with Chronic Stroke: A Systematic Review and Meta-Analysis. Life. 2022 Jun 13; 12(6): 882. PubMed Abstract | Publisher Full Text | Free Full Text
32. Huang L, Liu Y, Lin T, et al.: Reliability and validity of two hand dynamometers when used by community-dwelling adults aged over 50 years. BMC Geriatr. 2022 Jul 15; 22(1): 580. PubMed Abstract | Publisher Full Text | Free Full Text
33. Reliability and Validity of the Dynamic Gait Index in Persons With Chronic Stroke - ScienceDirect.[cited 2023 Aug 1].
34. Raghavan P: Upper Limb Motor Impairment Post Stroke. Phys. Med. Rehabil. Clin. N. Am. 2015 Nov; 26(4): 599–610. PubMed Abstract | Publisher Full Text | Free Full Text
35. Dabholkar A, Mehta D, Yardi S, et al.: Assessment of scapular behavior in stroke patients. Int. J. Health Rehabil. Sci. IJHRS. 2015 Jan 1; 4: 95. Publisher Full Text
36. Price CI, Rodgers H, Franklin P, et al.: Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: a noninvasive evaluation. Arch. Phys. Med. Rehabil. 2001 Jul; 82(7): 955–960. PubMed Abstract | Publisher Full Text
37. Dell’Uomo D, Morone G, Centrella A, et al.: Effects of scapulohumeral rehabilitation protocol on trunk control recovery in patients with subacute stroke: A pilot randomized controlled trial. NeuroRehabilitation. 2017 Jan 1; 40(3): 337–343. PubMed Abstract | Publisher Full Text
38. Jo K, Bh L, J L.: Effect of Scapular Stabilization Exercise during Standing on Upper Limb Function and Gait Ability of Stroke Patients. J. Neurosci. Rural. Pract. 2017 Oct; 08(4): 540–544. Publisher Full Text
39. Nascimento LR, Polese JC, Faria CDCM, et al.: Isometric hand grip strength correlated with isokinetic data of the shoulder stabilizers in individuals with chronic stroke. J. Bodyw. Mov. Ther. 2012 Jul; 16(3): 275–280. PubMed Abstract | Publisher Full Text
40. (PDF) Scapular Malalignment in Patients with Stroke: A Narrative Review.[cited 2023 Jan 14].
41. Effect of shoulder girdle strengthening on trunk alignment in patients with stroke.[cited 2023 Jun 27].
42. Jaraczewska E, Long C: Kinesio® Taping in Stroke: Improving Functional Use of the Upper Extremity in Hemiplegia. Top. Stroke Rehabil. 2006 Jul 1; 13(3): 31–42. Publisher Full Text

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 11 Oct 2023

Author details Author details

¹ Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, 442001, India

Akshaya Saklecha
Roles: Conceptualization, Writing – Original Draft Preparation

Moh’d Irshad Quershi
Roles: Supervision, Validation

Raghumahanti Raghuveer
Roles: Supervision, Writing – Review & Editing

Pallavi Harjpal
Roles: Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

version 1

Published: 11 Oct 2023, 12:1305

https://doi.org/10.12688/f1000research.138133.1

Copyright

© 2023 Saklecha A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download

Export To

metrics

	Views	Downloads
F1000Research	-	-
PubMed Central Data from PMC are received and updated monthly.	-	-

Citations

0

SEE MORE DETAILS

CITE

how to cite this article

Saklecha A, Quershi MI, Raghuveer R and Harjpal P. 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 [version 1; peer review: awaiting peer review] F1000Research 2023, 12:1305 (https://doi.org/10.12688/f1000research.138133.1)

NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

track

receive updates on this article

Track an article to receive email alerts on any updates to this article.

Open Peer Review

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 11 Oct 2023

Open Peer Review

Reviewer Status

AWAITING PEER REVIEW

Comments on this article

All Comments(0)

Add a comment

Sign up for content alerts

Browse by related subjects

[1] 1. Sacco RL, Kasner SE, Broderick JP, et al.: An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Jul; 44(7): 2064–2089. Publisher Full Text

[2] 2. Kodali NK, Bhat LD: Prevalence and Associated Factors of Stroke among Older Adults in India: Analysis of the Longitudinal Aging Study in India-Wave 1, 2017–2018. Indian J. Public Health. 2022 Apr 1; 66(2): 128.

[3] 3. Kamalakannan S, Gudlavalleti ASV, Gudlavalleti VSM, et al.: Incidence & prevalence of stroke in India: A systematic review. Indian J. Med. Res. 2017 Aug; 146(2): 175–185. Publisher Full Text

[4] 4. Rensink M, Schuurmans M, Lindeman E, et al.: Task-oriented training in rehabilitation after stroke: systematic review. J. Adv. Nurs. 2009 Apr; 65(4): 737–754. Publisher Full Text

[5] 5. Mahmoud LSED, Aly SM: The effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity. Bull. Fac. Phys. Ther. 2020 Jul 9; 25(1): 8. Publisher Full Text

[6] 6. Mandalidis D, O’Brien M: Relationship between hand-grip isometric strength and isokinetic moment data of the shoulder stabilisers. J. Bodyw. Mov. Ther. 2010 Jan; 14(1): 19–26. Publisher Full Text

[7] 7. Eng JJ, Tang PF: Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence. Expert. Rev. Neurother. 2007 Oct; 7(10): 1417–1436. Publisher Full Text

[8] 8. Moon SH, Kim YY: Effect of PNF Approach to Scapular Adductor Muscles on Scapular Movements and Walking Ability in Patients with Stroke. J. Int. Acad. Phys. Ther. Res. 2017; 8(1): 1090–1094. Publisher Full Text

[9] 9. Salphale V, Kovela R, Qureshi M, et al.: Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Children with Spastic Diplegia: A Study Protocol for a Randomized Clinical Trial. J. Pharm. Res. Int. 2021 Dec 17; 88–95. Publisher Full Text

[10] 10. Chitra: Effect of scapular hold-relax technique on shoulder pain in hemiplegic subjects: A randomized controlled trial. Physiother-J. Indian Assoc. Physiother. 2017; [cited 2023 Jan 17]; 11: 49–52. Publisher Full Text

[11] 11. Joshi: Effect of scapular proprioceptive neuromuscular facilitation on shoulder pain, range of motion, and upper extremity function in hemiplegic patients: A randomized controlled trial. Indian J. health Sci. Biomed Res. 2017; [cited 2023 Jan 11]; 10: 276–282. Publisher Full Text

[12] 12. Kim SJ, Choi JW, Chung HA: Effects of Using Scapular-Pelvic Patterns Simultaneously to Improve the Components of Gait in Patients with Stroke. PNF Mov. 2016; 14(2): 75–81.

[13] 13. Andrew TL: Closed Kinetic Chain Exercise. A Comprehensive Guide to Multiple-Joint Exercises. J. Chiropr. Med. 2002; 1(4): 200. Publisher Full Text

[14] 14. Lai SM, Studenski S, Duncan PW, et al.: Persisting consequences of stroke measured by the Stroke Impact Scale. Stroke. 2002 Jul; 33(7): 1840–1844. PubMed Abstract | Publisher Full Text

[15] 15. Wang RY: Effect of proprioceptive neuromuscular facilitation on the gait of patients with hemiplegia of long and short duration. Phys. Ther. 1994 Dec; 74(12): 1108–1115. PubMed Abstract | Publisher Full Text

[16] 16. Desai RR, Steven VJ, Joshi RM, et al.: Proprioceptive Neuromuscular Facilitation Techniques versus Closed Kinematic Chain Exercises in Scapular Dyskinesia among Hospital Housekeeping Staff: An Experimental Study. J. Clin. Diagn. Res. 2021 [cited 2023 Jan 15]. Publisher Full Text

[17] 17. Saeed M, Hafeez S, Asad F, et al.: Comparison of Scapular Proprioceptive Neuromuscular Facilitation and Myofascial Release Techniques on Pain and Function in Scapular Dyskinesia Associated with Adhesive Capsulitis: Scapular Dyskinesia Associated with Adhesive Capsulitis. Pakistan BioMedical Journal. 5(4): 123–127. Publisher Full Text

[18] 18. Park SJ, Oh S: Changes in Gait Performance in Stroke Patients after Taping with Scapular Setting Exercise. Healthcare. 2020 Jun; 8(2): 128. PubMed Abstract | Publisher Full Text | Free Full Text

[19] 19. Tedla JS, Sangadala DR: Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. J. Musculoskelet. Neuronal Interact. 2019; 19(4): 482–491.

[20] 20. Saklecha A: SPIRIT_checklist Editied.docx. [Dataset]. Zenodo. 2023 Jun 7 [cited 2023 Jul 21]. Publisher Full Text

[21] 21. Saklecha A: Extended Data.docx. [Dataset]. Zenodo. 2023 Jul 21 [cited 2023 Jul 21]. Publisher Full Text

[22] 22. Lalwani SS, Vardhan GDV, Bele A: Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol. J. Pharm. Res. Int. 2021 Oct 2; 33(45A): 466–475. Publisher Full Text

[23] 23. Wilk KE, Arrigo CA, Andrews JR: Closed and Open Kinetic Chain Exercise for the Upper Extremity. J. Sport Rehabil. 1996 Feb 1; 5(1): 88–102. Publisher Full Text

[24] 24. Harjpal P, Qureshi MI, Kovela RK, et al.: Efficacy of Bilateral Lower-Limb Training Over Unilateral Lower-Limb Training To Reeducate Balance and Walking in Post-Stroke Survivors: A Randomized Clinical Trial. Cureus. 2022 Oct; 14(10): e30748. PubMed Abstract | Publisher Full Text

[25] 25. da Costa BR , Armijo-Olivo S, Gadotti I, et al.: Reliability of scapular positioning measurement procedure using the Palpation Meter (PALM). Physiotherapy. 2010 Mar 1; 96(1): 59–67. PubMed Abstract | Publisher Full Text

[26] 26. Anne M, Alya B, Lee H, et al.: The palpation meter (palm) is reliable for measuring scapular upward rotation in the coronal plane. Int. J. Phys. Educ. Sports Health. 2015 [cited 2023 Mar 15]; 2(2): 54–59.

[27] 27. 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. 14(10): e30630.

[28] 28. Odom CJ, Taylor AB, Hurd CE, et al.: Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys. Ther. 2001 Feb; 81(2): 799–809. PubMed Abstract | Publisher Full Text

[29] 29. Kim H, Her J, Ko J, et al.: Reliability, Concurrent Validity, and Responsiveness of the Fugl-Meyer Assessment (FMA) for Hemiplegic Patients. J. Phys. Ther. Sci. 2012 Oct 1; 24: 893–899. Publisher Full Text

[30] 30. Salphale VG, Kovela RK, Qureshi MI: Appraisal of the Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Methods to Optimize Balance and Gait in an Eight-Year-Old Child. Cureus. 2022 Sep; 14(9): e29648. PubMed Abstract | Publisher Full Text

[31] 31. Nguyen PT, Chou LW, Hsieh YL: Proprioceptive Neuromuscular Facilitation-Based Physical Therapy on the Improvement of Balance and Gait in Patients with Chronic Stroke: A Systematic Review and Meta-Analysis. Life. 2022 Jun 13; 12(6): 882. PubMed Abstract | Publisher Full Text | Free Full Text

[32] 32. Huang L, Liu Y, Lin T, et al.: Reliability and validity of two hand dynamometers when used by community-dwelling adults aged over 50 years. BMC Geriatr. 2022 Jul 15; 22(1): 580. PubMed Abstract | Publisher Full Text | Free Full Text

[33] 33. Reliability and Validity of the Dynamic Gait Index in Persons With Chronic Stroke - ScienceDirect.[cited 2023 Aug 1].

[34] 34. Raghavan P: Upper Limb Motor Impairment Post Stroke. Phys. Med. Rehabil. Clin. N. Am. 2015 Nov; 26(4): 599–610. PubMed Abstract | Publisher Full Text | Free Full Text

[35] 35. Dabholkar A, Mehta D, Yardi S, et al.: Assessment of scapular behavior in stroke patients. Int. J. Health Rehabil. Sci. IJHRS. 2015 Jan 1; 4: 95. Publisher Full Text

[36] 36. Price CI, Rodgers H, Franklin P, et al.: Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: a noninvasive evaluation. Arch. Phys. Med. Rehabil. 2001 Jul; 82(7): 955–960. PubMed Abstract | Publisher Full Text

[37] 37. Dell’Uomo D, Morone G, Centrella A, et al.: Effects of scapulohumeral rehabilitation protocol on trunk control recovery in patients with subacute stroke: A pilot randomized controlled trial. NeuroRehabilitation. 2017 Jan 1; 40(3): 337–343. PubMed Abstract | Publisher Full Text

[38] 38. Jo K, Bh L, J L.: Effect of Scapular Stabilization Exercise during Standing on Upper Limb Function and Gait Ability of Stroke Patients. J. Neurosci. Rural. Pract. 2017 Oct; 08(4): 540–544. Publisher Full Text

[39] 39. Nascimento LR, Polese JC, Faria CDCM, et al.: Isometric hand grip strength correlated with isokinetic data of the shoulder stabilizers in individuals with chronic stroke. J. Bodyw. Mov. Ther. 2012 Jul; 16(3): 275–280. PubMed Abstract | Publisher Full Text

[40] 40. (PDF) Scapular Malalignment in Patients with Stroke: A Narrative Review.[cited 2023 Jan 14].

[41] 41. Effect of shoulder girdle strengthening on trunk alignment in patients with stroke.[cited 2023 Jun 27].

[42] 42. Jaraczewska E, Long C: Kinesio® Taping in Stroke: Improving Functional Use of the Upper Extremity in Hemiplegia. Top. Stroke Rehabil. 2006 Jul 1; 13(3): 31–42. Publisher Full Text

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

Abstract

Keywords

Introduction

Aims

Primary objectives

Secondary objectives

Trial design

Protocol

Figure 1. Summary of study process.

Figure 2. Schedule of enrolment, interventions, and assessments.

Inclusion criteria

Exclusion criteria

Interventions

Table 1. Showing the PNF pattern of each segment of upper limb.

Outcomes

Sample size calculation

Data collection and management

Data analysis

Monitoring

Ethics and dissemination

Consent

Confidentiality

Ancillary and post-trial care

Access to the trial set

Discussion

Data availability

Underlying data

Extended data

Reporting guidelines

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Comments on this article

Browse by related subjects

Competing Interests Policy

Stay Updated