Comparison of Proprioceptive Neuromuscular Facilitation and Neurodevelopmental Treatment on Trunk Control, Balance and Gait in Children with Spastic Diplegic Cerebral Palsy: A Randomized Controlled Trial
DOI:
https://doi.org/10.61581/mjsp.v7i03.400Keywords:
Balance, cerebral palsy, Gait, Neurodevelopmental treatment, Proprioceptive neuromuscular facilitationAbstract
Objective: To evaluate the effects of Proprioceptive Neuromuscular Facilitation (PNF) and Neurodevelopmental Treatment (NDT) on trunk control, balance and gait in children with spastic diplegic cerebral palsy (CDCP).
Methods: This randomized controlled trial was conducted at Irus Clinic, Multan, Pakistan. The children aged between 4-12 years with spastic diplegic cerebral palsy (GMFCS I to III) were randomly divided into two groups, Group A of PNF techniques and conventional therapy (n=33) and Group B of NDT facilitation and conventional therapy (n=33). 45 minute sessions were held 3 to 4 times per week for 4 months for both groups. Trunk Control Measurement Scale (TCMS), Pediatric Balance Scale (PBS), Timed Up and Go test (TUG), and 10-Meter Walk Test (10MWT) were assessed before and after intervention. For within group comparisons paired t test and Wilcoxon signed rank test were used and for between group comparisons independent samples t test and Mann Whitney-U test were used.
Results: There were significant within-group improvements in all outcome measures for both groups (p<0.001). Between-group analysis revealed that the PNF group demonstrated significantly greater improvements in TCMS change scores (10.545±2.181 vs 4.970±1.334, p<0.001), PBS (U=26.500, p<0.001), TUG (U=27.500, p<0.001), and 10MWT (U=1.500, p<0.001) compared to the NDT group.
Conclusion: PNF was more effective in improving children with spastic diplegic cerebral palsy's trunk control, balance and gait speed when compared with NT.
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References
1. Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171(9):897-907. doi:10.1001/jamapediatrics.2017.1689
2. Shinde S, Qureshi MDI, R R, HV S. Physiotherapy interventions to improve mobility in children with spastic diplegic cerebral palsy: a systematic review. J Clin Diagn Res. 2026;20(2). doi:10.7860/JCDR/2026/81012.22445
3. Tiwari S, Rao PT, Karthikbabu S. Correlations between trunk control and balance in children with bilateral spastic cerebral palsy. Percept Mot Skills. 2024;131(2):432-45. doi:10.1177/00315125231226297
4. Balzer J, Marsico P, Mitteregger E, van der Linden ML, Mercer TH, van Hedel HJ. Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy. DisabilRehabil. 2018;40(26):3164-70. doi:10.1080/09638288.2017.1380719
5. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23. doi:10.1111/j.1469-8749.1997.tb07414.x
6. Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, et al. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Front Neurol. 2023;14:1171224. doi:10.3389/fneur.2023.1171224
7. Talgeri AJ, Nayak A, Karnad SD, Jain P, Tedla JS, Reddy RS, et al. Effect of trunk targeted interventions on functional outcomes in children with cerebral palsy: a systematic review. Dev Neurorehabil. 2023;26(3):193-205. doi:10.1080/17518423.2023.2193265
8. Shanmugam S. Effectiveness of pelvic proprioceptive neuromuscular facilitation on trunk control in children with spastic diplegia: a randomized controlled trial. Indian J Public Health Res Dev. 2020;11(2). doi:10.37506/v11/i2/2020/ijphrd/194867
9. Pachkhede PM, Salphale VG, Dhage P, Deshmukh NS. Effectiveness of a blend of pelvic proprioceptive neuromuscular facilitation, task-oriented approach, and Rood’s approach in a three-year-old child with spastic diplegia: a case report. Cureus. 2022;14(11):e31063. doi:10.7759/cureus.31063
10. Adiguzel H, Kirmaci ZIK, Gogremis M, Kirmaci YS, Dilber C, Berktas DT. The effect of proprioceptive neuromuscular facilitation on functional skills, muscle strength, and trunk control in children with cerebral palsy: a randomized controlled trial. Early Hum Dev. 2024;192:106010. doi:10.1016/j.earlhumdev.2024.106010
11. Salphale VG, Kovela RK, Harjpal P, Kovela RK Sr. Effectiveness of pelvic proprioceptive neuromuscular facilitation on balance and gait parameters in children with spastic diplegia. Cureus. 2022;14(10):e30571. doi:10.7759/cureus.30571
12. Khanna S, Arunmozhi R, Goyal C. Neurodevelopmental treatment in children with cerebral palsy: a review of the literature. Cureus. 2023;15(12):e50389. doi:10.7759/cureus.50389
13. Park M, Kim J, Yu C, Lim H. The effects of neurodevelopmental treatment-based trunk control exercise on gross motor function and trunk control in children with developmental disabilities. Healthcare (Basel). 2023;11(10):1446. doi:10.3390/healthcare11101446
14. Te Velde A, Morgan C, Finch-Edmondson M, McNamara L, McNamara M, Paton MCB, et al. Neurodevelopmental therapy for cerebral palsy: a meta-analysis. Pediatrics. 2022;149(6):e2021055061. doi:10.1542/peds.2021-055061
15. Zanon MA, Porfírio GJ, Riera R, Martimbianco ALC. Neurodevelopmental treatment approaches for children with cerebral palsy. Cochrane Database Syst Rev. 2015;2015(11):CD011937. doi:10.1002/14651858.CD011937
16. Raipure A, Kovela RK, Harjpal P, Kovela RK Sr. Effectiveness of neurodevelopmental treatment and sensory integration therapy on gross motor function, balance and gait parameters in children with spastic diplegia. Cureus. 2023;15(8):e43876. doi:10.7759/cureus.43876
17. Adler SS, Beckers D, Buck M. PNF in practice: an illustrated guide. 4th ed. Berlin: Springer; 2014.
18. Sah AK, Balaji GK, Agrahara S. Effects of task-oriented activities based on neurodevelopmental therapy principles on trunk control, balance, and gross motor function in children with spastic diplegic cerebral palsy: a single-blinded randomized clinical trial. J PediatrNeurosci. 2019;14(3):120-6. doi:10.4103/jpn.JPN_35_19
19. Khan AK, Arslan SA, Tanveer F, Jabbar S, Ashraf I, Anwar A, et al. Effects of neurodevelopmental therapy on gross motor function and postural control in children with spastic cerebral palsy: a randomized controlled trial. Pak BioMed J. 2022;5(5):298-304. doi:10.54393/pbmj.v5i5.418
20. Kofotolis N, Kellis E. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Phys Ther. 2006;86(7):1001-12. doi:10.1093/ptj/86.7.1001
21. Moreau NG, Bodkin AW, Bjornson K, Hobbs A, Soileau M, Lahasky K. Effectiveness of rehabilitation interventions to improve gait speed in children with cerebral palsy: systematic review and meta-analysis. Phys Ther. 2016;96(12):1938-54. doi:10.2522/ptj.20150401
22. Ha SY, Kim YH, Sung YH. Effects of abdominal muscle strengthening and pelvic control exercises on trunk control and pelvic movement in children with unilateral cerebral palsy. J ExercRehabil. 2024;20(6):250-5. doi:10.12965/jer.2448570.285
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