Comparative efficacy between Scapular Proprioceptive Neuromuscular Facilitation and Scapular Stabilization exercises on scapular dyskinesia of hemiplegic shoulder: a randomized clinical trial

PURPOSE OF THE STUDY:

Scapular dyskinesia is a major obstacle in improvement of shoulder function in hemiplegic shoulder. Studies have shown that proprioceptive neuromuscular facilitation techniques can improve scapular orientation and upper extremity function. Scapular stabilization exercises have also been shown to significantly improve scapular orientation and upper extremity functions after stroke. However, to the best of our knowledge, there is paucity of studies investigating the comparative efficacy between scapular proprioceptive neuromuscular facilitation and scapular stabilization exercises on scapular dyskinesia of hemiplegic shoulder.

Therefore, the purpose of the study is to compare the efficacy between scapular proprioceptive neuromuscular facilitation and scapular stabilization exercises on scapular dyskinesia of hemiplegic shoulder after stroke.

AIM:

To find out the comparative efficacy between scapular proprioceptive neuromuscular facilitation and scapular stabilization exercises on scapular dyskinesia of hemiplegic shoulder.

OBJECTIVES:

1. To find out the efficacy of scapular proprioceptive neuromuscular facilitation on scapular dyskinesia of hemiplegic shoulder. 2. To find out the efficacy of scapular stabilization exercises on scapular dyskinesia of hemiplegic shoulder.

2. To compare the efficacy between scapular proprioceptive neuromuscular facilitation and scapular stabilization exercises on scapular dyskinesia of hemiplegic shoulder.

HYPOTHESES:

NULL HYPOTHESIS:

There is no statistically significant difference between the efficacy of scapular proprioceptive neuromuscular facilitation and scapular stabilization exercises on scapular dyskinesia of hemiplegic shoulder.

ALTERNATIVE HYPOTHESIS:

There is statistically significant difference between the efficacy of scapular proprioceptive neuromuscular facilitation and scapular stabilization exercises on scapular dyskinesia of hemiplegic shoulder.

PROCEDURE:

Institutional Ethical Committee (IEC) approval will be obtained before commencement of the study. Hemiplegic stroke patients referred from the NILD Assessment Clinic to the Department of Physiotherapy will be approached with the study proposal. Patients meeting the exclusion criteria will not be included. 32 hemiplegic stroke patients will be included after evaluation and screening according to the inclusion and exclusion criteria. The purpose of study will be explained to the patients in the language they can communicate easily. Written informed consent in their preferred language will be obtained from patients who will agree to participate. Patients will be divided into two groups using block randomization method by computer-generated random blocks. Demographic data and outcome measures including Kibler’s Lateral Scapular Slide Test for scapular orientation and Fugl-Meyer Upper Extremity Assessment for upper extremity function will be collected from all patients prior to intervention and post intervention. All patients in Group A  will receive scapular proprioceptive neuromuscular facilitation (PNF) along with supervised exercise program and home exercise program. Scapular PNF will be applied in two diagonal patterns that are Anterior Elevation and Posterior Depression and Posterior Elevation and Anterior Depression. The therapist will apply Rhythmic Initiation and Repeated Contraction Facilitation technique on the hemiplegic shoulder for all movement patterns to facilitate. Diagonal patterns will be applied for 20 repetitions, 10 repetitions of Rhythmic Initiation and 10 repetitions of Repeated Contraction Facilitation techniques will be applied with 2 minutes break in between the two techniques. All patients in Group B  will receive scapular stabilization exercises along with supervised exercise program and home exercise program. Scapular Stabilization Exercises in form of Dynamic Closed-Chain (Weight-Bearing) stabilization exercises along with Open chain strengthening exercises of the scapula stabilizer will be applied on the hemiplegic shoulder of the patient either in standing/ sitting, prone lying or in quadruped position. All patients, in both Group A and Group B will receive 16 sessions (4 sessions per week for 4 weeks). The patients in both the groups will be suggested to follow the home exercise program. Both groups will continue to use prescribed medication along with physiotherapy.