Effects of Proprioceptive Neuromuscular Facilitation and Balance Training on Activities of Daily Living (ADL) of Stroke Survivors with and without Cognitive Impairment

摘要

Background: Motor training after stroke should be targeted to goals that are relevant to the functional needs of the patient in order to facilitate functional recovery. Therefore, combining Proprioceptive Neuromuscular Facilitation (PNF) and Task-specific Balance Training to facilitate Activities of Daily Living (ADL) on stroke survivors with and without cognitive impairment was intentioned in this study. Activities of Daily Living are those activities that people must be able to do routinely to be considered fully independent. Barthel Index is one of the instruments used in measuring ADL. This study evaluated the effect of 12 months Proprioceptive Neuromuscular Facilitation (PNF) and Task Specific Balance Training on Activities of Daily Living in cognitive impaired and cognitive normal stroke survivors. Methods: One hundred of 143 available stroke survivors were recruited using convenience sampling technique in a quasi-experimental study. Those with and without cognitive deficits were assigned into a cognitive impaired group (CIG) and non-cognitive impaired group (NCIG) group, respectively. The patients were grouped into cognitive impaired mean age 55.36±10.2 and cognitive normal mean age 50.20± 13.23 after neuropsychiatric test. Ethical approval was obtained at Nnamdi Azikiwe University Ethical Committee (NAUTHEC), Nnewi. The Proprioceptive Neuromuscular Facilitation comprising rhythmic initiation, repeated contraction, slow reversal and rhythmic stabilization and Task-specific Balance Training TSBT comprising repetitive rising from a chair (10 repetitions), cycle ergometer (10 mins), stepping over obstacle (10 repetitions), backward and forward progression (10 repetitions), turning task (10 repetitions) and standing balance training (10 repetitions). TSBT was applied three times a week, 30mins per session, for 12 months. Four research assistants were trained to assist in each treatment session. The outcome measures applied were mini-mental state examination for determining the neuropsychiatric status of participants at baseline and Berthal index for activities of daily living. Result: The mean Berthel Index (BI) scores was significantly greater than the baseline values for the both CIG (F (1.729, 84.709) = 158.575, p < 0.001, with large effect size (partial eta squared) of .764), and NCIG (F(2.478, 121.409) = 5.787, p < 0.001 with large effect size (partial eta squared) of 0.549). Conclusion: There was improvement in Activities of Daily Living (ADL) of the subacute stroke survivors with and without cognitive impairments after 12 months PNF and Task Specific Balance Training protocol adapted in this study.