Comparison of Upper Limb Functional Outcomes in Stroke Patients Receiving Motor Relearning Programme (Mrp) vs. Proprioceptive Neuromuscular Facilitation (Pnf)
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Abstract
Background: Upper-limb impairment is a major contributor to disability after stroke. Motor Relearning Programme (MRP) emphasizes task-specific motor control and learning, whereas Proprioceptive Neuromuscular Facilitation (PNF) uses proprioceptive stimulation and diagonal movement patterns to facilitate neuromuscular responses. The present study compared changes in upper-limb functional outcomes following MRP and PNF.
Methods: Thirty patients with first-ever ischemic middle cerebral artery stroke and impaired upper-extremity motor function were randomly allocated to Group I (MRP, n=15) or Group II (PNF, n=15). Treatment was provided for three consecutive weeks, five days per week (15 sessions). Upper-limb and self-care outcomes were assessed weekly using the Motor Assessment Scale (MAS) upper-extremity sections and Functional Independence Measure (FIM) self-care sections. Between-group comparisons used the unpaired t-test; within-group repeated measurements were analyzed using repeated-measures ANOVA with Bonferroni post-hoc analysis.
Results: The groups were comparable in age, sex, and involved side. FIM total scores increased from 6.73±1.53 to 17.20±6.23 in the MRP group and from 7.66±1.75 to 21.60±6.92 in the PNF group over three weeks; the between-group difference at week 3 was not statistically significant in the thesis analysis. MAS total scores increased from 1.13±1.76 to 8.93±3.39 in the MRP group and from 1.66±1.49 to 10.40±3.37 in the PNF group, with no significant between-group difference at week 3. Within-group analyses demonstrated significant overall improvement in both groups.
Conclusion: Both MRP and PNF were associated with improvement in upper-limb functional outcomes over the three-week intervention period. The thesis conclusion reported no statistically significant superiority of either technique over the other; combining approaches may therefore be considered within individualized rehabilitation, while recognizing the study’s small sample and short intervention duration.
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References
Duncan PW. Stroke Disability. Physical Therapy. 1994;74:399-407.
Kinsella G, Ford B. Acute Recovery Patterns in Stroke Patients. Medical Journal of Australia. 1980;2:663-666.
Wade DT, Wood VA, Hewer RL. Recovery After Stroke—The First Three Months. Journal of Neurology, Neurosurgery and Psychiatry. 1985;48:7-13.
Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Recovery of the Upper Extremity Function in Stroke Patients: The Copenhagen Stroke Study. Archives of Physical Medicine and Rehabilitation. 1994;75:394-398.
Wade DT, Hewer RL. Functional Abilities After Stroke: Measurement, Natural History and Prognosis. Journal of Neurology, Neurosurgery and Psychiatry. 1987;50:177-182.
Dombovy ML, Basford JR, Whisnant JP, Bergstralh EJ. Disability and Use of Rehabilitation Services Following Stroke. Stroke. 1987;18:830-836.
Gresham GE, Phillips TF, Wolf PA, et al. Epidemiologic Profile of Long Term Stroke Disability: The Framingham Study. Archives of Physical Medicine and Rehabilitation. 1979;60:487-491.
Bonita R, Beaglehole R. Recovery of Motor Function After Stroke. Stroke. 1988;19:1497-1500.
Lehmann JF, DeLateur BJ, Fowler RS, et al. Stroke Rehabilitation: Outcome and Prediction. Archives of Physical Medicine and Rehabilitation. 1975;56:383-389.
Langhorne P. Collaborative Systematic Review of the Randomized Trials of Organized Inpatient (Stroke Unit) Care After Stroke. BMJ. 1997;314:1151-1159.
Kwakkel G, Wagenaar RC, Twisk JWR, Lankhorst GJ, Koetsier JC. Intensity of Arm and Leg Training After Primary Middle Cerebral Artery Stroke: A Randomized Trial. Lancet. 1999;354:191-196.
Sommerfeld DK, Eek EUB, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity After Stroke. Stroke. 2004;35:134-139.
Feys HM, De Weerdt WJ, Selz BE, et al. Effect of Therapeutic Intervention for the Hemiplegic Upper Limb in the Acute Phase After Stroke. Stroke. 1998;29:785-792.
Werner RA, Kessler S. Effectiveness of an Intensive Outpatient Rehabilitation Program for Postacute Stroke Patients. American Journal of Physical Medicine & Rehabilitation. 1996;75:114-120.
Kwakkel G, Wagenaar RC, Koelman TW, Lankhorst GJ, Koetsier JC. Effects of Intensity of Rehabilitation After Stroke. Stroke. 1997;28:1550-1556.
Woldag H, Waldmann G, Hummelsheim H. Is the Repetitive Training of Complex Hand and Arm Movements Beneficial for Motor Recovery in Stroke Patients? Clinical Rehabilitation. 2003;17:723-730.
Armagan O, Tascioglu F, Oner C. Electromyographic Biofeedback in the Treatment of the Hemiplegic Hand. American Journal of Physical Medicine & Rehabilitation. 2003;82:856-861.
Wang RY, Yang YR, Tsai MW, Wang WTJ, Chan RC. Effects of Functional Electrical Stimulation on Upper Limb Motor Function and Shoulder Range of Motion in Hemiplegic Patients. American Journal of Physical Medicine & Rehabilitation. 2002;81:283-290.
Langhammer B, Stanghelle JK. Bobath or Motor Relearning Programme? A Comparison of Two Different Approaches of Physiotherapy in Stroke Rehabilitation. Clinical Rehabilitation. 2000;14:361-369.
Dromerick AW, Edwards DF, Hahn M. Does the Application of Constraint-Induced Movement Therapy During Acute Rehabilitation Reduce Arm Impairment After Ischemic Stroke? Stroke. 2000;31:2984-2988.
Powell J, Pandyan D, Granat M, Cameron M, Stott DJ. Electrical Stimulation of Wrist Extensors in Post Stroke Hemiplegia. Stroke. 1999;30:1384-1389.
Blanton S, Wolf SL. An Application of Upper Extremity Constraint-Induced Movement Therapy in a Patient With Subacute Stroke. Physical Therapy. 1999;79:847-853.
Butefisch C, Hummelsheim H, Denzler P, Mauritz KH. Repetitive Training of Isolated Movements Improves the Outcome of Motor Rehabilitation of the Centrally Paretic Hand. Journal of the Neurological Sciences. 1995;130:59-68.
Kraft GH, Fitts SS, Hammond MC. Techniques to Improve Function of the Arm and Hand in Chronic Hemiplegia. Archives of Physical Medicine and Rehabilitation. 1992;73:220-227.
Carr JH, Shepherd RB. A Motor Relearning Programme for Stroke. 2nd ed. London: Heinemann; 1987.
Carr JH, Shepherd RB. Stroke Rehabilitation: Guidelines for Exercise and Training to Optimize Motor Skill. London: Butterworth; 2004.
Adler SS, Beckers D. PNF in Practice: An Illustrated Guide. Springer-Verlag; 1993.
Daving Y, Andren E, Nordholm L, Grimby G. Reliability of an Interview Approach to the Functional Independence Measure. Clinical Rehabilitation. 2001;15:301-310.
Poole JL, Whitney SL. Motor Assessment Scale for Stroke Patients: Concurrent Validity and Inter-Rater Reliability. Archives of Physical Medicine and Rehabilitation. 1988;69:195-197.
Bohannon RW, Smith MB. Inter-Rater Reliability of the Modified Ashworth Scale of Muscle Spasticity. Physical Therapy. 1987;67:206-207