Effect of Proprioceptive Neuromuscular Facilitation Techniques on Elderly People With Scapular Disposition

Study Overview
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Brief Summary
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Proprioceptive neuromuscular facilitation (PNF) has been defined as a comprehensive rehabilitation approach focusing on a motor learning effect, especially in the elderly. Therefore, PNF can be an effective treatment method for our purpose which is to analyze if PNF techniques improve balance and gait characteristics in elderly with scapular disposition and to determine the difference when used with the gait education

Detailed Description
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Participants will be randomly divided into 2 groups. Scapular PNF techniques in addition to gait training will be applied to the 1st group for 8 weeks, and only gait training exercises will be applied to the 2nd group for 8 weeks. Individuals will be evaluated in detail at the beginning, and end of the study, and after 3 months as a follow-up evaluation. For the assessment of scapular disposition, the Visual Scapular Disposition Test and Lateral Scapular Slide Test will be applied. Walking Speed will be evaluated with a dedicated area by measuring the distance. The Modified Dynamic Gait Index will be used for measuring the ability of the participant to maintain walking balance while responding to different task demands. For fall risks and functional mobility Timed Up and Go Test and Falls Efficacy Scale will be used. For balance assessment Berg Balance Scale and Functional Reach Test. For assessment of the quality of life, SF-36 will be used. Posture will be assessed with a dedicated application called PostureCo

Official Title
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Effect of Proprioceptive Neuromuscular Facilitation (PNF) Techniques on Balance and Gait Characteristics of Elderly People With Scapular Disposition: A Randomized Controlled Trial

Conditions
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Geriatric Rehabilitation, Scapular Dyskinesis

Intervention / Treatment
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* Other: 1st Group
* Other: 2nd Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Having scapular disposition (Patients will be determined after the visual scapular disposition test and lateral scapular slide test) With no injuries Able to walk without any assistive devices To be able to read and write in Turkish Exclusion Criteria: Having a musculoskeletal or neurological problem that causes issues with applying the intervention. Any orthopedic, neurological, cardiac, vestibular, visual, or psychiatric impairment which would not allow them to perform Had physiotherapy during the past 3 months

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 74 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PNF Technique Group<br>Participants in this group will receive PNF techniques and gait training 3 times per week for 8 weeks | Other: 1st Group<br>* 1st group is going to undergo scapula-oriented PNF techniques (diagonal) which are anterior elevation and posterior depression - posterior elevation and anterior depression with 20 repetitions with rhythmic initiation and repeated contractions facilitation techniques during all patterns. In addition to PNF techniques, gait training is going to be applied as standing with balance exercises (15 repetitions) as well as specific exercises for the stance and swing phases of the gait which are; stepping forward and sideways (15 repetitions), and gait education (walking 3 lapses within 2 meters parallel bar)<br>|
| Active Comparator: Gait Training Group<br>Participants in this group will receive only gait training 3 times per week for 8 weeks | Other: 2nd Group<br>* 2nd group is going to undergo only gait training and balance exercises (15 repetitions) as well as specific exercises for the stance and swing phases of the gait which are; stepping forward and sideways (15 repetitions), and gait education (walking 3 lapses within 2 meters parallel bar)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Scapular Disposition Test | During the visual scapular disposition test, patients will be asked to perform bilateral shoulder elevation movements and scapular movements will be observed in order to determine scapular dyskinesia | 5 minutes | 
| Lateral Scapular Slide Test | During the lateral scapular slide test, patients will be evaluated in 3 different arm positions while standing. at each position, special measurements of the scapula will be taken with measurement tape. If the difference between measurements in the same position is more than 1.5 centimeters (cm), the patient will be recorded as having scapular dyskinesia | 5 minutes | 
| Walking Speed | Participants normal walking speed measurement will be taken by asking patient to walk a dedicated 15m line and normal walking speed will be measured after 3 repetitions average time calculated | 5 minutes | 
| Modified Dynamic Gait Index (mDGI) | The DGI tests the ability of the participant to maintain walking balance while responding to different task demands, through various dynamic conditions. | 10 minutes | 
| Timed Up and Go Test | The timed get up and walk test is the basic functional mobility test for the elderly which they will be asked to stand up from a regular chair, walk 3 meters, turn and walk back to the chair and sit. | 5 minutes | 
| Berg Balance Scale | Berg Balance Scale (BDI) is generally used to measure balance performance in elderly patients. It is effective in assessing postural control and predicting fall risk. | 5 minutes | 
| Functional Reach Test | Functional Reach Test (FRT) is a clinical outcome measure and assessment tool for assessing dynamic balance in one simple task. It will be done in the standing position, by measuring the distance between the length of an outstretched arm in a maximal forward reach, while maintaining a fixed base of support, and this information is correlated with the risk of falling | 5 minutes | 
| Falls Efficacy Scale | The Falls Efficacy Scale is a short, easy to administer tool that measures the level of concern about falling during social and physical activities inside and outside the home whether or not the person actually does the activity. | 5 minutes | 
| PostureCO | PostureCo, Inc. is a technology company focusing on posture and movement analysis, it takes the data for the posture and movements. A special posture application for mobile phones will be used to determine postural sway. Data will be collected by scanning each patient and analyzing the posture. | 5 minutes | 
| SF-36 | The 36-item Short Form (SF-36) is a commonly used questionnaire for measuring health-related quality of life. Each patient will be asked to answer the questions in order to get the results for the quality of life | 5 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Balance, Geriatric Rehabilitation, Scapular Disposition, Posture, Gait