Motor learning with the PNF-concept, an alternative to constrained induced movement therapy in a patient after a stroke; a case report

Abstract

Introduction: Over sixteen million people suffer a stroke each year. Stroke is characterized by a one-sided paresis. Upper extremity and hand function are most limited. The current view on "neuro rehabilitation" advocates a constrained induced movement therapy (CIMT) setting. This case report seeks to illustrate the clinical reasoning and the feasibility of applying an alternative approach in patients who are not accepted or not suitable for the constrained induced movement therapy.

Case description: A male patient, 68 years of age, developed impairments in his right arm and hand, such as loss of range of motion and strength besides spasticity after a stroke. This resulted in a loss of dexterity in his affected right side and in "disuse" of that arm and hand.

Patient management: A therapy was designed based upon the Proprioceptive Neuromuscular Facilitation-concept (PNF-concept) and consisting of PNF pattern exercises in a functional task setting with specified PNF-principles of facilitations and PNF-techniques for motor re-learning activities, over a period of six weeks. This resulted in clinical important improvements of wrist extension, grip strength, spasticity, dexterity and patient satisfaction with specific tasks.

Discussion and conclusion: The provided comprehensive therapy mimics CIMT and robotics. The approach addresses possibly motor learning effects, cortical reorganization and structural impairments. Proprioceptive Neuromuscular Facilitation (PNF) - diagonal movement patterns have been described as: "having beneficial effects in cortical adaptations and cortical organization resulting in motor learning effects". In cases where CIMT is difficult to apply, a specified PNF-based therapy has shown to be a feasible alternative.

Keywords: CIMT; Hemiplegic hand; PNF; Rehabilitation; Stroke.