Immediate Effects of PNF With Lower Leg Kinesio Taping in Chronic Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The aim of this research is to find the immediate effects of propriocepticve neuromuscular
      facilitation with lower leg kinesiotaping on ankle dorsiflexion, gait and functional mobility
      in patients with chronic stroke. It will be a randomized clinical trial in which participants
      will be selected through non probability convenience sampling. Patients aged range from 40 to
      70 years, both gender, diagnosed with hemiplegia due to hemorrhagic or ischemic stroke for
      more than 6 months, with insufficient ankle dorsi flexion less than 8 degree will be included
      in this study whereas patients with neurological problems other than stroke that would
      interfere with gait and balance control and with limbs affected bilaterally will be excluded
      from study. Participant will be randomly allocated into three groups (A,B and C). Group A
      will receive only ankle kinesiotaping that will be applied for 30 minutes for one session.
      Group B will receive proprioceptive neuromuscular facilitation hold-relax technique in
      flexion-adduction-external rotation pattern, 15-20 repetitions that will be applied in lying
      position for 10-15 minutes for one session.

      Group C will receive both proprioceptive neuromuscular facilitation hold-relax technique with
      ankle kinesiotaping. Posttest measurement will be taken after 30 minutes of one session of
      treatment using Time up and GO (TUG) test, dynamic gait index, barthel index and Motor
      Assessment Scale . Data will be analyzed by SPSS version 21
    

Detailed description: 
      Detailed Description: Stroke has been described clinically through the abrupt onset of signs
      of focal neurological disorder that remain more than 24 hours( or lead to earlier brain
      damage) and are due to acute vascular damage to part of the brain.The general prevalence
      charge of stroke is round 2-25 according to thousand population. The chance of recurrance
      over five years is 15-40%. Ischemic stroke is a type of stroke that occurs when a blood
      vessel in the neck or brain becomes blocked.Blockage can be due to thrombosis, embolism and
      narrowing of artery (stenosis).Hemorrhagic stroke is because of bleeding into the brain
      through the rupture of a blood vessel. Hemorrhagic stroke can be in addition subdivided into
      intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).

      The concord symptom is abrupt numbness or weakness in the face, arms, or legs, especially on
      one side of the body. Sudden disorientation or difficulty speaking or understanding language.
      sudden loss of vision in one or both eyes; sudden difficulty walking, lightheadedness, or
      loss of balance or coordination; sudden severe headache of unknown cause.The most common risk
      factor for stroke is hypertension.Upper motor neuron lesion due to stroke outcomes in a
      constellation of sensorimotor impairments which includes muscle weakness, impaired selective
      motor control, spasticity, and proprioceptive deficits that intervene with normal gait.Gait
      is one of the most important aspects of a stroke rehabilitation program. Patients with stroke
      are characterized by decreased ankle dorsiflexion during the swing, which leads to a decrease
      in gait ability.

      Hemiparetic gait is characterised by using particular spatiotemporal styles, along with
      decreased cadence, prolonged swing period on the paretic aspect, prolonged stance duration on
      the nonparetic side, and step length asymmetry.Post-stroke hemiplegic gait is a combination
      of deviations and compensatory movement dictated by way of residual functions.Decreased
      functional mobility is a well-known residual disability after stroke and is associated with
      the ability to move (e.g., get in and out of a bed or chair), walk a certain distance, and
      turn. , is related.

      while remaining independent.

      Proprioceptive neuromuscular facilitation (PNF) is a stretching technique used to improve
      muscle flexibility and has been exhibited to have a positive effect on active and passive
      range of motion. Proprioceptive neuromuscular facilitation (PNF) is a very powerful healing
      exercise for the improvement of muscle thickness, dynamic stability and gait and broadly used
      in medical settings to improve the bodily functioning of stroke patients.Some of the
      techniques of Proprioceptive neuromuscular facilitation are contarct-relax, hold-relax,
      rhythmic initiation etc.PNF techniques are done in diagnol pattern involving flexion and
      extension, abduction and adduction, internal and external rotation. Kinesiotape is an elastic
      therapeutic tape used for the treatment of various disorders.Kinesiotapingis theorize to have
      numerous features (1) restoring muscle characteristic by assisting weakened muscles,(2)
      reducing c ongestion through improving the flow of blood and lymphatic fluid, (3) decreasing
      ache by way of stimulating neurological system, and (4) correcting misaligned joints by
      retrieving muscle spasm. Depending on the direction of application and tape tension
      increasing proprioception and increasing or inhibiting muscle recruitment can be obtained.
      The effect and positive result of Kinesio Tape greatly centers on increase in neuromuscular
      recruitment.RCT was conducted by S.Choi et.al in 2020 on immediate effects of ankle
      nonelastic taping on balance and gait ability in patients with chronic stroke. 30 patients
      with stroke more than the duration of 6 months, both genders were included in this study.
      Non-elastic ankle taping is applied first, start at the bottom of the first metatarsal head
      and wrap the tape diagonally toward the fifth metatarsal head. Primary Outcome measure tools
      for static and dynamic balance measured by balance system SD and changes in gait parameters
      measured by GATErite system. Their study demonstrate that non-elastic ankle taping has a
      beneficial effect on static and dynamic balance ability scores, gait velocity, step length,
      and stride length in patients with chronic stroke. Another RCT study was carried by Youngsook
      Bae et.al in 2022 on immediate effects of lower leg kinesiotaping on ankle dorsiflexion and
      gait parameters in chronic stroke with foot drop.The aim of the study was to estimate the
      immediate effects kinesiotaping of lower leg on ankle dorsiflexion . Overall, 18 stroke
      patients aged 30-80 years were enrolled in this study .There were three conditions no taping,
      ankle taping and PNF with ankle taping with the time interval of 10 minutes between each
      condition. GATErite system was used to measure spatial and temporal aspects of gait.. They
      concluded that ankle taping and PNF with ankle taping significantly improves the dorsiflexion
      as compared to no taping.
    

Intervention name(s): : lower leg kinesiotaping; propriocepticve neuromuscular facilitation; propriocepticve neuromuscular facilitation with lower leg kinesiotaping
Intervention type(s): Other; Other; Other
Intervention description(s): Kinesiotaping will be applied on tibialis anterior for 30 minutes for one session; :Proprioceptive neuromuscular facilitation hold relax technique will be applied to ankle with 15-30 repititions on affected side for one session; Kinesiotaping will be applied on tibialis anterior for 30 minutes with proprioceptive neuromuscular facilitation hold relax technique will be applied to ankle with 15-30 repititions on affected side for one session
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stroke, ankle dorsiflexion, PNF