Effects of Proprioceptive Neuromuscular Facilitation And Balance Training on Functional Recovery of People With Cerebrovascular Accident And its Association With Cognitive Impairment

Abstract

Cerebrovascular accident (CVA) is an important cause of morbidity in the elderly; resulting not only in physical disability, but also significant cognitive impairment. There was dearth of studies on cognitive impairment on functional recovery on stroke survivors in Nigeria. However, previous studies elsewhere on effects of impaired cognition on functional recovery amongst stroke survivors centered on short term outcomes of exercises on Activities of Daily Living and balance, while this study evaluated the long term outcomes. This study sought to ascertain the changes in functional recovery of people with cerebrovascular accident and its associated cognitive impairment after 12 months proprioceptive neuromuscular facilitation (PNF) and Task specific Balance Training. The research design was quasi experimental involving hundred ischemic stroke survivors who were recruited through purposive sampling technique from four Specialist centers. Subjects were grouped into cognitive and noncognitive impaired after assessment for cognitive impairment by the researcher using Minimental Stroke Examination. Other outcome measures used included: National Institute of Health Stroke Scale for severity of impairment, Barthel Index scale for ADL, and Bergs Balance Scale for balance. The participants in both groups were trained three times per week, one hour per session of PNF and balance exercises for 12 months at the various intervention sites: Physiotherapy Department Nnamdi Azikiwe University Teaching Hospital, Nnewi, and Landmark Physiotherapy Services, Nnewi. The results showed there were significant improvement (p < .05) in the ADL (42.481±7.415 to 76.240±12.504) with mean value of 33.759representing 79.468% increase and (59.900 ± 15.693 to 79.260±14.504) with mean value of 19.360 representing 32.559 % increase for cognitive group and non-cognitive group respectively; however, between groups revealed no significant difference (p> 0.056). Also there was significant improvement in balance (26.500 ± 5.177 to 45.04o±6.013) with mean value of 10.640 representing 69.962% increase and (35.200 ± 6.931 to45.18± 6.931) with mean value of 7.120 representing 30.227% increase for cognitive group and non-cognitive group respectively, however; between groups revealed no significant difference (p >.539). There was significant improvement in cognition (19.62 ± 3.469 to 24.160 ± 3.151) with mean value of 4.700 representing 23.955% increase and (25.040 ± 1.195 to 27.700 ± 1.249) with mean value of 2.660representing 10.85% increase for cognitive group and non-cognitive group respectively; however, between groups comparison showed significant difference (p<.032). There was significant improvement (p<0.05) in stroke severity (17.700 ± 6.025 to 6.260± 3.343) with mean value of 11.440 representing 64.633% increase and (8.080 ± 3.212 to 3.380 ± 1.596) with a mean value of 4.400representing 54.455% increase for cognitive group and non-cognitive group respectively; however, between groups comparison revealed significant difference p<.012. There were significant differences (p < 0.05) in within groups’ analysis for all variables studied, but between groups analysis revealed no significant difference (p > 0.05) for ADL and balance, and significant difference for cognition and stroke severity respectively after 12 months exercises respectively. The outcome of this study revealed that 12 months PNF and Balance training had significant improvement in the ADL and Balance status of cognitive impaired and non-cognitive impaired stroke survivors. This implies that cognitive impairment in post stroke survivors did not block the efficacy of rehabilitation in the long term.