Transcranial direct current stimulation combined with trunk-targeted, proprioceptive neuromuscular facilitation in subacute stroke: a randomized controlled trial

Abstract

Background Stroke is the foremost cause of death and disability worldwide. Improving upper extremity function and quality of life are two paramount therapeutic targets during rehabilitation. Aim of the study To investigate the effects of transcranial direct current stimulation (tDCS) combined with trunk-targeted proprioceptive neuromuscular facilitation (PNF) on impairments, activity limitations, and participation restrictions of subjects with subacute stroke. Methodology Fifty-four subjects with subacute stroke were divided into three groups using block randomization. All three groups received rehabilitation sessions lasting 90 min in duration, four times per week, for 6 weeks. Group 1 (n = 18) received conventional physical therapy (CPT); group 2 (n = 18) received CPT, trunk-targeted PNF, and sham tDCS; and group 3 (n = 18) received CPT, trunk-targeted PNF, and bihemispheric motor cortex stimulation with tDCS. Changes in motor impairment, motor activity, and health-related quality of life assessments were outcome measures. Results A two-way linear mixed model analysis revealed interaction effects (group × time) for all outcome measurements (Trunk Impairment Scale, Fugl-Meyer Assessment of Motor Recovery after stroke upper extremity subsection, Wolf Motor Function Test, 10-Meter Walk Test, and the Stroke-Specific Quality of Life scale; all p < 0.01 or lower). Overall, post–pre mean differences demonstrate more substantial improvement in the active tDCS group, followed by sham stimulation associated with the PNF group and the group that received CPT alone. Conclusion Trunk-targeted PNF combined with bihemispheric tDCS along with CPT engender larger improvements in upper extremity and trunk impairment, upper limb function, gait speed, and quality of life in the subacute stroke population.

Transcranial direct current stimulation for upper extremity motor dysfunction in poststroke patients: A systematic review and meta-analysis

“…The included studies 18–61 involved 1555 patients (experimental group: 820, control group: 715) and were published between 2010 and 2024 in 20 countries. The top three countries based on the number of research studies were Italy ( n = 10), China ( n = 9), and the United States ( n = 5).…”

The Effect of Scapular Proprioceptive Neuromuscular Facilitation Techniques on Pain and Functionality in Patients with Subacromial Impingement Syndrome: A Randomized Controlled Trial

“…Also, the ESs of PPTs of all muscles were higher in the PNF group. It has been previously stated that the afferent inputs from muscle spindles, joints, tendons and joint capsule can inhibit pain transmission in the gray horn lamina of spinal cord, as defined by the gate control theory 11 . This mechanism may have been effective in increasing PPT.…”

“…Neuromuscular control of the scapula can be increased by improving the strength and endurance of the scapular muscles with repeated stretch technique applied in scapular diagonals 11 . It is possible that the reorganization of trapezius and serratus anterior activity, which is an important part of the force couple, and the static and dynamic stabilization of the scapula contributed to the increase in IR ROM in the shoulder.…”

“…This can be achieved by rotational diagonal patterns of movement through several stimuli and guidance provided by the therapist. PNF is used for increase strength, flexibility and ROM 11 . Stabilization and mobility of the scapula are necessary for smooth and proper function of the upper extremity.…”

“…There are some studies that have investigated the effects of various PNF techniques in the treatment of RC lesion and adhesive capsulitis (AC) 13 14 15 . A recent meta-analysis showed that PNF was superior to conventional treatment (CT) in reducing pain and increasing abduction and external rotation range of motion in patients with AC 11 . However, we could not find any study specifically investigating the effects of scapular PNF techniques in SIS patients.…”