effectiveness of proprioceptive neuromuscular facilitation neck pattern exercise versus weight shift training on trunk control to improve balance in acute and subacute stroke patients-a randomized clinical trial.

Stroke is second leading cause of death and the third leading cause of disability. Due to the sudden death of brain cells by lacking of oxygen, when blood flow to the brain is lost by blockage or rupture of an artery. 85.5% of stroke patients are living with disabilities. The definition for stroke by world health organization (WHO) is “Rapidly developed clinical signs of focal disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular originâ€. • Trunk performance has been identified as an important independent predictor of ADL after stroke.The trunk muscle weakness and the loss of proprioception concerning the affected side can interfere with balance, stability, and functional disability. Trunk control is the ability to maintain the upright posture, to adjust weight shifting, and to perform selective movements in the trunk to maintain the center of mass within the base of support. Trunk movements are necessary to maintain postural control, and the function of trunk muscles is an essential factor for balance, transfers, gait, and the range of activities in daily living.• Proprioceptive Neuromuscular Facilitation (PNF) is a rehabilitation technique, which is widely used by physiotherapists and forms part of physiotherapy.  PNF uses the body’s proprioceptive system to facilitate or inhibit muscle contraction. Proprioceptive neuromuscular facilitation is a dynamic approach to the evaluation and treatment of neuromuscular dysfunction on the trunk. The resistance against the neck exercise causes irradiation in the body-trunk muscle exercise. However, few studies have investigated the improvement in trunk control in chronic stroke patients as a result of using the PNF neck pattern. • Weight shifting and balance are fundamental functional activities. Weight shifting training perform on unstable surface in sitting that may improve trunk control and dynamic balance in chronic stroke patients. • The Trunk Impairment Scale(TIS) consists of three subscales: static sitting balance, dynamic sitting balance and co-ordination. Each subscale contains between three and ten items. The TIS score ranges from a minimum of 0 to a maximum of 23. A study demonstrate that the dynamic sitting balance and coordination subscale are valid measures of selective trunk performance in people after stroke and can be utilized with confidence in clinical practice and stroke rehabilitation research. The Berg Balance Scale(BBS) measures multi-tasking ability and includes 14 items that require participants to maintain their balance in different tasks and positions with various levels of difficulty. Each item is scored from 0 to 4 points, total score is 56.The strong psychometric properties of the BBS demonstrated by this systematic review suggest that it is an effective and appropriate assessment of balance in patients with stroke.

Impaired trunk stability and imbalance has been proved to be the cause of limitation in daily living activities in patients suffering from stroke. There are many studies available on the fact that trunk specific exercises and the proprioceptive neuromuscular facilitation trunk pattern would improve in patients with stroke. However, no available study for comparison of the proprioceptive neuromuscular facilitation neck pattern and weight shift training for improvement of trunk control. Thus, focus of the present study is to prove the effectiveness of both proprioceptive neuromuscular facilitation neck pattern and weight shift training program individually as well as in comparison on trunk improvement in acute and subacute stroke patients.