Effects of Proprioceptive Neuromuscular Facilitation with and without Electrical Muscle Stimulation on spasticity, gait and lower limb function in chronic stroke patients

Background: Stroke, a leading cause of death and disability, is characterized by a sudden disruption of blood flow to the brain, resulting in motor weakness and hemiparesis. Rehabilitation aims to improve functional outcomes, with Proprioceptive Neuromuscular Facilitation (PNF) and Electrical Muscle Stimulation (EMS) being promising interventions. Objective: This study aimed to determine the effects of PNF with and without EMS on spasticity, gait, and lower limb function in chronic stroke patients. Methods: A randomized controlled trial was conducted with 22 participants recruited from the physiotherapy department of District Headquarters Sheikhupura from October 2022 to May 2023. Participants were randomly divided into a control group, receiving PNF techniques alone, and an experimental group, receiving PNF combined with EMS. The PNF techniques included rhythmic initiation, stabilizing reversals, and dynamic reversals, while EMS was applied at a frequency of 25 to 50 Hz for 10 seconds, three times a week for six weeks. Outcome measures included the Modified Ashworth Scale, Modified Barthel Index, Dynamic Gait Index, and Tinetti Performance Oriented Mobility Assessment. Data were analyzed using SPSS version 25. Results: Post-intervention, the experimental group showed significant improvements over the control group in the Modified Ashworth Scale (p=0.022), Modified Barthel Index (p=0.028), Dynamic Gait Index (p=0.042), and Tinetti Assessment (p=0.004). Conclusion: The study concluded that combining PNF with EMS yields better outcomes in managing spasticity, gait, and lower limb functions in chronic stroke patients than PNF alone.