Proprioceptive neuromuscular facilitation compared to conventional physiotherapy for adults with traumatic upper brachial plexus injury: A protocol for a randomized clinical trial.

BACKGROUND: Traumatic upper plexus injury affects daily living activities performance and participation of individuals. Physical therapy treatment has a fundamental role on functional recovery, but it is still an unexplored and challenging field. AIM: To develop a protocol to evaluate the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) compared to conventional physiotherapy (CPT group) on functionality and quality of life. METHODS: A committee was formed by four physical therapists to develop the treatment protocol. A Delphi study was carried out in order to quantify the level of agreement. A protocol for a randomized controlled trial was proposed to evaluate the effectiveness of the protocol in improving functionality and quality of life, according Consolidated Standards of Reporting Trials. Participants will be randomly assigned (1:1) to PNF or CPT group and two weekly sessions will be carried out for 12 months postsurgery, with a three-month follow-up. The main outcome measurements are: upper limb functionality, quality of life, range of motion, muscle strength, tactile sensitivity, and pain, which will be assessed at baseline, on the 6th, 9th, and 12th months postsurgery. RESULT: A PNF protocol was developed for traumatic upper brachial plexus injury, consisting of 11 illustrated exercises, three for immediate postoperative and eight for postoperative. Biomechanical objectives, observations, positions of patients and therapists and PNF principles, procedures and techniques have been described. An 80% agreement on all items in the first round of the Delphi study was achieved. CONCLUSION: A protocol based on the PNF-concept was developed with the aim of improving the functionality and quality of life of individuals undergoing nerve transfer after traumatic injury to the upper plexus. The detailed description of a physical therapy treatment protocol through an appropriate method will allow its use in clinical practice and in future studies with this population.

Efeitos da irradiação de força contralateral na extensão de punho de pacientes após acidente vascular cerebral / Efects of contralateral force irradiation in the wrist extention, in patients after stroke

FUNDAMENTO: Um dos princípios de irradiação de força da facilitação neuromuscular proprioceptiva (FNP) é estimular a musculatura fraca, a partir da resistência da musculatura forte, contribuindo para o aprendizado motor. Por esta razão, este procedimento básico tem sido utilizado em pacientes após acidente vascular cerebral (AVC), no tratamento da hemiparesia contralateral à lesão. OBJETIVO: Avaliar os efeitos da técnica de irradiação de força contralateral no controle motor para ativação dos músculos extensores de punho em pacientes após AVC. MÉTODOS: Foram incluídos 10 participantes de ambos os sexos (62±6,4 anos), divididos em grupo hemiparético (n=5) e controle saudável (n+5). Foi realizado o padrão da FNP: flexão, abdução e rotação externa no membro não afetado do grupo hemiparético e no braço direito do controle. O sinal eletromiográfico dos músculos extensores radial longo e curto do carpo foi registrado em duas etapas (FNP1 e FNP2). Foram realizadas quatro repetições do padrão, mantidas por 6 segundos. A ativação muscular foi analisada pela root mean square (RMS). RESULTADOS: Houve aumento na ativação da musculatura extensora do punho por irradiação entre as etapas FNP1 e FNP2 de 7,32% no grupo hemiparético e de 18,62% no grupo saudável, porém sem diferença estatística (p>0,05). A resposta motora foi maior na etapa FNP2, após a repetição das diagonais. CONCLUSÃO: Não houve ativação significativa dos extensores de punho em pacientes hemiparéticos com o procedimento de irradiação de força da FNP. Todavia, a repetição parece aumentar a resposta de irradiação de força em pacientes após AVC.

BACKGROUND: A principle of force irradiation of proprioceptive neu-romuscular facilitation (PNF) is to stimulate the weak muscles by applying resistance in strong muscles, contributing to motor learning. Therefore, this technique is used in patients after stroke, to treat the hemiplegia contralateral to the lesion. OBJECTIVE: To evaluate controlateral force irradiation effects in motor control for activation of the wrist extensors in patients after ischemic stroke. METHODS: The study included 10 subjects of both sexes (62±6.4 years) divided into hemiparetic group (n=5) and healthy controls (n=5). We performed the PNF pattern: flexion, abduction and external rotation in the unaffected member of the hemiparetic group and in the right arm of the control. The electromyography signal of the long and short radial extensor carpi was recorded in the first stage (FNP1) , in which the diagonal was repeated 4 times, and in the standard learning stage (FNP2), with 4 times. The contractions were maintained for 6 seconds. Muscle activation was analyzed by the root mean square (RMS). RESULTS: The-re was an increase in the extensor muscles of the wrist activation by irradiation between FNP1 and FNP2 stages, of 7.32% in hemiparetic group and 18.62% in healthy group, without statiscal difference (p>0.05). Motor response was higher in FNP2 stage, after the repetition of the diagonals. CONCLUSION: There was no significant activation of the wrist extensors in hemiparetic patients with the technique of force irradiation of PNF. However, the repetition seems to increase the force irradiation response in patients after stroke.