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

Abstract

Background: Cerebral Palsy is a spacious term which highlights an extensive gamut of motor affliction which has a stagnant tendency. The estimated Cerebral Palsy is indeed very prevalent in developed nations 2 out of the next 1000 live births and neonatal survivors. Among several Cerebral Palsy comes in a variety of manifestations. Spastic Diplegia is common in a majority of Preterm babies. Several treatment strategies of Physical therapy are utilized for Spastic Diplegia. This research focusses on assessing the Efficiency of Pelvic Proprioceptive Neuromuscular Facilitation (PNF) techniques over the Dimensions of Balance and Gait in children with Spastic Diplegia.
 Objective: To evaluate the Effectiveness and impact of the techniques of Pelvic Proprioceptive Neuromuscular Facilitation (PNF) on Balance, Gait Parameters and Pelvic Asymmetry in children having Spastic Diplegia.
 Methods: In this Randomized Clinical Trial, subjects (n= 40) having Spastic Diplegia will be selected and segregated in two groups using simple random sampling method with 1:1 allocation ratio. The allocation will be done through sequentially numbered opaque sealed envelope (SNOSE). Subjects in the experimental group will receive Pelvic PNF techniques like Rhythmic initiation and Slow reversal with Task- Oriented training which will contain sit to stand exercises, walking on the ground and reaching tasks for improving the balance and those in the other group will be given only Task- Oriented training for 4 weeks following baseline assessments. Throughout the treatment session and following 4 weeks follow up will be taken by assessing the Balance and Gait parameters of the subjects. The study duration will. be of 1 year. Subjects with Spastic Diplegia with an age group of 8 to 12 years who are able to do independent sitting, who are coming under GMFCS level I to III and those who are having pelvic asymmetry will be included in the study while subjects who had any surgery of spine or lower limb in past 6 months, who are having fixed deformities of spine or lower limb or any fracture or dislocation of spine or lower limb will be excluded from the study. 
 Results: Results will be recorded by using the outcome measures and instruments such as Pediatric Balance Scale, Gait Parameters and Palpation meter device at the end of the intervention and the effects of Pelvic PNF techniques will be compared with the other group which will receive Task oriented training. The statistical analysis will be done by using paired t test but if the data does not follow a normal distribution then Wilcoxon sign rank test will be used. 
 Discussion: The intention and motive of the study is to check the Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation techniques on Balance and Gait Parameters in children with Spastic Diplegia.
 Conclusion: The conclusion of this research is to acquire the fruitfulness of Approaches of Pelvic PNF on Balance and Gait Parameters in children having Spastic Diplegia.

Case Report on Unilateral Right Acoustic Schwannoma operated for open decompression craniotomy

“…Hearing preservation and treatment-related morbidity, such as facial paralysis, are examples of secondary outcome indicators. (29)(30)(31) Acoustic Schwannoma patients can currently be managed using 3 different methods including radiotherapy/radiosurgery, resection, and conservative treatment. If a patient has a small tumor, few or no symptoms, a poor general health state, or if they are elderly, many doctors will opt for a conservative approach, although this can still cause hearing loss over time.…”

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

“…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.…”

“…14 Wang reported that studies on the effectiveness of PNFbased 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][17][18][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.…”