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