Combining proprioceptive neuromuscular facilitation and virtual reality for improving sensorimotor function in stroke survivors: a randomized clinical trial
Aim of the study: To assess a program combining virtual reality (VR) games and proprioceptive neuromuscular facilitation (PNF), and to compare it to the standalone techniques in stroke survivors.
Methods: A randomized controlled clinical trial. Forty-eight participants were recruited in the outpatient clinic of a University Hospital in Salvador, Brazil. They were randomly assigned to three groups (n=16 each): PNF, VR, and PNF/VR. Participants attended twice-weekly fifty-minute sessions over a two-month period. The PNF/VR group performed both PNF and virtual reality exercises employing Nintendo Wii electronic games. Motor performance was assessed before and immediately after the treatment using the Fugl-Meyer Assessment scale.
Results: Improvement in the mean scores was observed after treatment independent of the allocation group with significant intra-group changes: 14.5, 10.5, and 10.4 for PNF, VR and PNF/VR, respectively. Score changes were also observed in the analyses of specific sections as follows: (1) A significant improvement in the passive movement and pain score was observed in the PNF and PNF/VR groups. (2) The same was observed for the motor function of the upper limb in all groups, for the motor function of the lower limb in the VR group and for balance in the PNF and PNF/VR groups.
Conclusion: The use of a program combining virtual rehabilitation and PNF presented results that were comparable to those obtained with the isolated techniques