Roods vs PNF for Upper Limb Function in Acute MCA Stroke

Official title

Comparison Between Roods Facilitatory Techniques and Sequential PNF Pattern on Upper Limb Function in Acute Phase of Middle Cerebral Artery Stroke Patients

Overview

Middle cerebral artery (MCA) stroke often causes weakness or stiffness in the arm and hand, making daily activities difficult. This study compares two physical therapy approaches - Rood's facilitatory techniques (using touch, quick stretch, and ice to activate muscles) and PNF sequential patterns (using diagonal movement patterns) - to improve arm function in acute stroke patients. Both groups will also receive neuromuscular electrical stimulation (NMES). A total of 28 patients will be randomly assigned to one of two groups and receive treatment three times per week for eight weeks. Arm function will be measured using the Fugl-Meyer Assessment, and muscle stiffness will be measured using the Modified Ashworth Scale before and after treatment.

Detailed description

This is a single-blind, parallel-group randomized controlled trial. The study will be conducted at three settings in Faisalabad, Pakistan: Allied Hospital, Madinah Teaching Hospital, and Shahid Heera's Health Clinic. Adult patients (≥18 years) with CT or MRI-confirmed MCA stroke (ischemic or hemorrhagic), mild to moderate upper limb motor dysfunction (MRC ≥2), and cognitive competence (MoCA ≥19) will be included. Exclusion criteria include severe comorbidities, fixed contractures, severe cognitive impairment, skin contraindications to sensory stimulation, and inability to provide consent. A sample size of 28 participants (14 per group) was calculated using Rao soft app based on previous literature. Participants will be randomly assigned using a computer-generated sequence. The single-blind design keeps participants unaware of group allocation. Group A receives NMES followed by Rood's facilitatory techniques: quick stretch before or during movement to activate muscle spindles, tactile stimulation (light stroking) over the muscle belly for 10-20 seconds, and icing for 5-7 seconds on the tendon or muscle surface immediately preceding activation. Group B receives NMES followed by PNF sequential training using conventional upper limb diagonal functional patterns (D1 and D2). PNF techniques include rhythmic initiation, dynamic reversals, repetitive contractions, and combination of isotonic contractions with moderate resistance, performing 8-12 repetitions per pattern over 20-30 minutes per session. NMES parameters: biphasic waveform at 30-40Hz frequency with pulse duration of 200-300μs, producing comfortable visible contraction, administered for 30 minutes per session. Both groups receive interventions three times per week for eight weeks. Outcome measures: Fugl-Meyer Assessment for Upper Extremity (FMA-UE, score range 0-66) measures motor function; Modified Ashworth Scale (MAS, score range 0-4) measures muscle tone. Assessments are conducted at baseline and post-intervention by a qualified physiotherapist. Data will be analyzed using SPSS version 22.

Interventions

• Device Neuromuscular Electrical Stimulation
  Biphasic waveform NMES at 30-40Hz frequency with pulse duration of 200-300μs, producing comfortable but visible muscle contraction. Applied to affected upper limb for 30 minutes per session, three times per week for eight weeks.
• Procedure Rood's Facilitatory Techniques
  Quick stretch applied before or during movement to activate muscle spindles; tactile stimulation (light stroking) over muscle belly for 10-20 seconds; icing for 5-7 seconds on tendon or muscle surface immediately preceding activation. Applied three times per week for eight weeks following NMES.
• Procedure Proprioceptive Neuromuscular Facilitation
  PNF sequential training with upper limb diagonal functional patterns (D1 and D2). Techniques include rhythmic initiation, dynamic reversals, repetitive contractions, and combination of isotonic contractions with moderate resistance according to patient's capabilities. Each session includes 8-12 repetitions per pattern over 20-30 minutes, three times per week for eight weeks.

Primary outcome measures

• Upper Limb Motor Function [Time frame: Baseline and 8 weeks (post-intervention)]

Secondary outcome measures (1)

• Muscle Tone [Time frame: Baseline and 8 weeks (post-intervention)]

Eligibility criteria

Inclusion criteria

• Adults (40-60 years) with confirmed MCA stroke (ischemic or hemorrhagic) on neuroimaging (CT or MRI)
• Mild to moderate upper limb motor dysfunction with MRC ≥2 for proximal limb motor strength
• Cognitive competence to understand instructions (MoCA ≥19 or equivalent)
• First stroke, acute or subacute phase
• Willingness to provide written informed consent
• Both male and female genders

Exclusion criteria

• Severe coexisting medical disorders (heart, liver, kidney failure; malignant tumors)
• Fixed musculoskeletal abnormalities or contracture in affected upper limb
• Severe cognitive impairment or aphasia preventing adherence or consent (MMSE below threshold)
• Skin sores, ulcers, or hypersensitivity (e.g., to cold) contraindicated for sensory stimulation
• Refusal or inability to give informed consent

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• The University of Faisalabad — Faisalābad

Identifiers

NCT: NCT07616622 · TUF/EIRB/ 220 /26

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗