Proprioceptive Neuromuscular Facilitation in Multiple Sclerosis
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      Multiple Sclerosis (MS) is an autoimmune central nervous system disease characterized by
      inflammation, demyelination, and axonal degeneration. Clinical symptoms of the disease
      include fatigue, speech, breathing, and swallowing problems. Although respiratory issues are
      less common in patients with MS, pulmonary complications are among the most common causes of
      mortality and morbidity in the terminal period. Although it is known that expiratory and
      inspiratory respiratory muscle training is beneficial in MS disease, the protocols used are
      variable and there is no standard exercise protocol. Respiratory muscle training is one of
      the instrument-oriented techniques, and the issue of delivering these devices to each patient
      creates a cost disadvantage. It is foreseen that the preference for the PNF technique to be
      applied in combination with respiration in the project will enable the development of
      alternative treatment approaches in order to solve the researched problems in MS disease,
      which is a critical health problem. Proprioceptive Neuromuscular Facilitation (PNF) is
      defined as facilitating the responses of the neuromuscular mechanism by stimulating the
      proprioceptors. In the literature, there is no study examining the effectiveness of PNF on
      respiratory and swallowing functions in individuals with MS. The aim of the study is to
      investigate the effects of PNF application in combination with upper extremity and trunk
      patterns on respiratory and swallowing functions in patients with MS.
    

Detailed description: 
      Among the physiotherapy and rehabilitation approaches applied for the problems affecting the
      quality of life in Multiple Sclerosis; Exercises for muscle strength loss, balance
      coordination exercises, electrical stimulation, orthotic approaches, breathing and swallowing
      exercises, and Proprioceptive Neuromuscular Facilitation (PNF) techniques are included. Among
      the respiratory dysfunctions are seen in MS patients: abnormal respiratory control,
      respiratory muscle weakness, bulbar dysfunction/respiratory failure, and sleep breathing
      disorders can be cited as examples. Significant expiratory weakness develops in MS patients
      with the progression of the disease, and the accompanying upper extremity involvement
      exacerbates this problem. It should not be ignored that swallowing-respiratory coordination
      and ultimately swallowing can be affected by the deterioration of respiration in MS patients.
      Among the neurophysiological approaches, the PNF technique; is known to have positive effects
      on tidal volume, respiratory rate, and minute ventilation parameters in neurological
      patients. Respiratory patterns of PNF can be applied alone or in combination with other
      extremity patterns. This study aims to examine the effect of using PNF breathing techniques
      in combination with upper extremity and trunk on MS patients on respiratory and swallowing
      functions.
    

Intervention name(s): PNF; Breathing exercises
Intervention type(s): Other; Other
Intervention description(s): PNF will be applied to the trunk and upper extremities combined with breathing, 3 times a week, 1 hour a day for 6 weeks. Breathing PNF patterns, pressure, and stretches will be applied inward and upwards into the rib cage so that they do not cause pain. Diaphragmatic stimulation will be performed on both sides with repeated contractions, hand contacts, and stabilization techniques. Facilitation techniques will be used to stimulate the intrinsic respiratory muscles. Again, with respect to inspiration, the patterns will be studied in neck extension, upper and lower trunk extension, and upper extremities flexion patterns. Neck flexion, upper and lower trunk flexion, and extension patterns of the upper extremities will be applied in relation to expiration. The physiotherapist will apply pressure and stretches to the chest wall and diaphragm for 20 seconds by giving verbal commands to the patient for the inspiration/expiratory phases.; Breathing exercises: diaphragmatic breathing, thoracic expansion, pursed-lip breathing and respiratory control for 15 minutes a day, every day of the week.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: respiratory function; swallowing; proprioceptive neuromuscular facilitation