The Effectiveness of Proprioceptive Neuromuscular Facilitation Exercise With Virtual Reality Motion Capture Gaming System and Concurrent Feedback on Early Shoulder Muscle Activation in Healthy Individuals

Study Design A one-way repeated measures design was employed to investigate the potential benefits of augmenting PNF exercises with VR and concurrent feedback for enhancing early shoulder muscle activation in healthy individuals.

Participants Thirty healthy volunteers (14 males and 16 females with an average age of 26.2 ± 4 years) were recruited through convenience sampling. The inclusion criteria required being 18-45 years old and capable of performing PNF D2 shoulder flexion exercise. Exclusion criteria, designed to ensure sample homogeneity and data reliability, included any shoulder injuries in the dominant arm within the last 3 months, such as pain in the scapular region, rotator cuff tear or reconstruction, shoulder dislocation, shoulder instability, frozen shoulder, fracture, and chronic neck pain. This study received ethical approval from the Institutional Review Board (IRB) as minimal risk research (IRB # 2023-0322-01). The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki (Helsinki Declaration as revised in 2013).

Researchers screened potential participants for inclusion criteria. Eligible individuals were given a detailed explanation of the study's purpose, interventions, and their role, followed by informed consent. Participants then completed a demographic information form. To protect confidentiality, participants were assigned numerical identifiers, and all identifying information was stored separately from research data in a secure location.

Outcome measures This study utilized a combination of technologies to measure shoulder muscle activation and ROM. The NORAXON 3D Motion Capture system, equipped with Ultium EMG sensors and Ultium Motion sensors, provided precise tracking of muscle activity and movement patterns (ICC ranging from 0.87-0.98). The Ultium surface EMG Sensors were utilized to detect the Maximum Voluntary Contraction (MVC) as well as muscle activation in the form of % MVC during three different interventions. Ultium Motion ROM sensors were utilized to analyze the PNF D2 shoulder flexion exercise in three different planes of motion via flexion, abduction, and external rotation. Data collection was conducted using MyoMUSCLE and MyoMOTION software.

Participants' subjective feedback was collected using the Borg Rating of Perceived Exertion (RPE) scale and a customized questionnaire including enjoyment, confidence, frustration, boredom, and level of difficulty.