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International Journal of Science and Healthcare Research Vol.6; Issue: 1; Jan.-March 2021 Website: ijshr.com Case Study ISSN: 2455-7587 PNF Training for Improving Lower Limb Coordination in Cerebral Palsy: A Case Study in a Child with Spastic Diplegia Preksha Sharma Assistant Professor, Department of Physiotherapy, Sanskriti University, Mathura, U.P., 281401, India ABSTRACT childhood[1]. Cerebral palsy is considered The research focused on assessing the as severe mental, physical dysfunction along effectiveness of PNF training on lower limb with disturbances in growth, gait, cognition coordination on a Male child with spastic and sensation[2]. Commonest childhood diplegia Cerebral Palsy. Mental and physical disability hampering physical growth the dysfunctioning along with the growth, sensation most, worldwide affecting 2 to 2.5 children and gait disturbances is termed as Cerebral per 1,000 live born [3]. Spastic Diplegia Palsy. This is unconditional neurological (both legs are affected) is predominant type problem that has severe effect on the control and of CP preterm infants specially born with coordination of muscles. This generally occurs birth weights below 1000gm [4]. at early childhood age or infancy. This research Velocity dependant increased in is a case study in which subject was a child with resistance to passive muscle stretch is dysfunctioning arms and legs. The branch of considered as Spasticity [5] .The onset of Cerebral Palsy that deals with dysfunctioning of spasticity in the legs is during the first year. arms and legs is termed as Spastic Diplegia. The During first 4 months of life most of spastic patient underwent PNF on both lower limbs diplegic children have normal tone, or (hip, knee, foot), followed by hot fermentation. hypotonia. In first year onset of spasticity is After the intervention, significant improvement insidious and slowly progressive [6]. is seen in all the outcome measures (gait Lesion in sensorimotor cortex and parameter, BBS score, GFMC score) .As the extra pyramidal system (corticospinal tract) result affected lower limb improved in terms of results in lower limb dysfunction. The lower coordination, execution and accurateness of the movement, number of jerks, and duration of limb is usually more severely involved than clonus. Improvement was seen in preciseness upper limb. This restricts walking, and accurateness of coordinated movement at ascending and descending stairs, the different ranges of motion for lower limbs. exploration, play and other ADL activities PNF seems to be a promising intervention for [7]. improving lower limb movement coordination Common management effective in in Cerebral palsy children. Further spastic diplegia includes pharmacological investigations are certainly needed to assess. (botulinum toxin, intrathecal pump and Keywords: Cerebral palsy, Proprioceptive surgical management (orthopaedic surgery), Neuromuscular Facilitation, Gait Training, constraint induced movement therapy, Balance, Incoordination. occupational therapy, Neuro-Developmental Therapy, Sensorimotor training program, 1. INTRODUCTION balance training, Proprioceptive Cerebral Palsy is considered to be Neuromuscular Facilitation and other the mundane disability that is chronic. This traditional physiotherapy techniques to is the disability most common in today’s International Journal of Science and Healthcare Research (www.ijshr.com) 35 Vol.6; Issue: 1; January-March 2021 Preksha Sharma. PNF training for improving lower limb coordination in Cerebral Palsy: a case study in a child with spastic diplegia improve gait, balance and coordination of The important clinical findings were lower limb function [1],[8]. showed in Table no 1. Limited dorsiflexion PNF is considered as very effective was seen in bilateral feet. In postural therapeutic exercise for the betterment of examination bilateral flat foot, exaggerated gait and dynamic balance [9]. PNF is used lumbar lordosis, bilateral adductor tightness, widely in clinics to treat post stroke physical valgum deformity is seen at knee. It was dysfunctions[10]. Studies done states that seen in the assessment that patient was able PNF techniques mainly focus on muscle to perform with bilateral upper limb without activity. Evidences also suggest change in much difficulty. stiffness and increased tone due to spasticity after stroke [12]. Table 1: Patients parameters diagnosed during assessment Left Right Most of the literature work done MUSCLE TONE Hip Adductors 1+ 1+ earlier focussed on using of PNF for the Hamstrings 2+ 1+ management of Stroke patient to reduce Calf Muscles 1+ 1+ REFLEXES Knee Reflex +++ ++ spasticity and improve tone. This case study Ankle Reflex +++ +++ aim to use PNF as an potential approach to show improvement in gait parameter, 5. Therapeutic Intervention walking status, balance and functional In starting of the treatment session to independence. normalize increased tone inhibitory techniques were given. It took 3 months to 2. Patient Information normalize tone. Session was started with Patient was 7 year old Spastic rhythmic stabilization exercises of entire diplegic male child who was under lower limb focusing on proximal joint physiotherapy treatment since past 2 years primarily to gain stability of lower limb. which includes PROM of all the joints, Mat After that sets of hold relax and dynamic and gym ball exercises. Child was having reversals in both the diagonal pattern good communication skills, but not going to performed, initially with assistance later on school. Able to perform his ADLs activities without assistance. Exercises were with difficulty, highest functional ability performed in both supine and standing was independent sitting, donning on & off positions. Treatment was given 40 minutes a clothes with assistance. His primary concern day, for 6 days a week for 16 weeks. Follow was his difficulty of independent standing, up was taken after each 15 days to see the walking and inability to go up and down long term effect of treatment. stairs. He was taking muscle relaxants earlier on regular basis, but currently not Table 2: Pre and post scores of outcome measures Pre Scores Post Scores taking any medication and no psychological Berg Balance Scale Score 18 30 illness found. Patient was already diagnosed Stride length (in cm ) 60 75 by paediatrician as Spastic cerebral palsy. Step length (in cm ) 35 48 Cadence (in cm ) 38 48 GMFCS score Level V Level IV 3. Diagnostic Assessment Balance was assessed by Berg Outcome measures were recorded balance scale; different parameters like before and after completing treatment that is (Stride length (cm), Cadence (steps/min) 1 day of the treatment and after 16 weeks. and Gait velocity (m/ min)) were used to Treatment protocol was not changed and evaluate gait characteristics. Gross Motor only dosage was progressed. Treatment was Function Scale is used to check not even missed for a single day. After 4 independence level of the child. Pre and months during follow up it was found that post scores of all the variables are shown in treatment was effective. Activity specific Table no 2. lower limb training, Sit to Stand, Single leg standing like activities , muscle stretching 4. Clinical Findings exercises was given to the patient to International Journal of Science and Healthcare Research (www.ijshr.com) 36 Vol.6; Issue: 1; January-March 2021 Preksha Sharma. PNF training for improving lower limb coordination in Cerebral Palsy: a case study in a child with spastic diplegia perform at home as the part of Home this child motivated us to follow the similar Exercise Program. protocol in other children too. 6. DISCUSSION ACKNOWLEDGEMENT Present study aimed to evaluate the We would like to thank patient and efficiency of PNF training in improving his attendants for their enormous lower limb coordination in a child with cooperation during this duration of 1 year. I Spastic diplegic Cerebral palsy. Evidences would also like to thank Management of are present in previously done studies of School of Medical and Allied Sciences, PNF in stroke populations were proved to Department of Physiotherapy for providing be highly beneficial. Sang Wang et al in required infrastructure. Ethical clearance their study applied PNF to chronic stroke was obtained from Institutional ethical patients and concluded that it decreases committee and Informed consent was filled muscle stiffness and abnormally increased by patient after explaining all the procedure. muscle tone. FCR muscle of affected side with MAS grade 2 in stroke patients with 7. REFERENCES Brunnstrom stage III showed significantly 1. A.N. 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