Type of Article:  Original Research

Volume 7; Issue 4 (August 2019)

Page No.: 3150-3156

DOI: https://dx.doi.org/10.16965/ijpr.2019.149


Hayy Y Patni *.

Consultant Physiotherapist, Mumbai, Maharashtra, India.

Address for correspondence: Dr. Hayy Y Patni,  5/85, Artist Village, Sector 8, Cbd Belapur, Navi Mumbai, Mumbai, Maharashtra, India. E-Mail: hayy.patni@gmail.com


Background: Most hemiplegic patients who suffer from stroke experience restrictions on mobility at home and in the community, and they especially have difficulty with independent walking. Proprioceptive Neuromuscular Facilitation (PNF) is one approach commonly used to improve the gait of patients with hemiplegia.  Various PNF procedures have been used, depending on the affected site. Among these PNF techniques is facilitation of pelvic motion to improve control of the pelvis.Hence the study was done to compare the effects of pelvic PNF exercises and Hip extensor strengthening exercises on gait parameters of chronic hemiplegic patients.

Materials and Methods: 30 subjects were conveniently divided into either of the two groups namely Pelvic PNF Group (Group A) and Hip extensor strengthening Group (Group B). Subjects in Group A received a protocol of 3 PNF techniques for 3 days a week for a total duration of 4 weeks (12 sessions). These procedures were done to facilitate anterior elevation and posterior depression of pelvis in a side lying position. Subjects in Group B received a protocol for hip extensor strengthening exercise (HESE) program. Each session consisted of 3 sets of 15 performances of the 3-step program lasting about 30 min, with 30 seconds of relaxation time between the sets. The measurements of the variables i.e. Gait speed, Cadence, Stride Length, Step Length was taken twice, one at the beginning of the study (Pre) and one at the conclusion of the 4 week duration (Post).The pre post measurements of outcome measures were analysed.

Results: Following 4 weeks of Pelvic PNF exercises and Hip extensor strengthening exercises, there was a statistically significant increase in Gait parameters in all domains. However the increase was statistically more significant in the experimental group (Pelvic PNF) as compared to the control group (HESE).

Conclusion: Pelvic Proprioceptive Neuromuscular Facilitation technique is more effective than Hip extensor strengthening exercises in improving gait parameters such as stride length, gait velocity and cadence in chronic hemiplegic patients.

KEY WORDS: Pelvic PNF, Hip Extensor Strengthening Exercises, Hemiplegia, Gait Parameters.


  1. Dally S, and Ruff RL, Electrically induced recovery of gait components for older patients with chronic stroke, Am J Phys Med Rehabil. 2000;79:349- 60.
  2. Thompson JE, The evolution of surgery for the treatment and prevention of stroke. The Willis Lecture, Stroke 1996;27(8):142734.
  3. Kopito, and Jeff, A Stroke in Time. 2001;6(9).
  4. World Health Organization, Cerebrovascular Disorders Geneva: World Health Organization. 1978.
  5. Susan B O Sullivan and Thomas J Schmitz, Physical Rehabilitation, Fifth edition. New Delhi: Jaypee Brothers Publication; 2007;706-750.
  6. Jeyaraj Durai Pandian andPaulin Sudhan, Stroke Epidemiology and Stroke Care Services in India, J Stroke. 2013;3-7.
  7. Nagaraja, G. Gururaj, N. Girish, Samhita Panda, A.K. Roy, G.R.K. Sarma, R. Srinivasa, Feasibility study of stroke surveillance: Data from Bangalore, India, Indian J Med Res 2009;130:396-403.
  8. Indian Council for Medical Research, Stroke: Assessment of the burden of Non-communicable diseases: Final project report, New Delhi. Indian Council of Medical Research 2004; 18-22.
  9. Eich HJ, Mach H, Werner C, et al.: Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial. Clin Rehabil, 2004;18:640–651.
  10. Turnbull GI, Charteris J, Wall JC: Deficiencies in standing weight shifts by ambulant hemiplegic subjects. Arch Phys Med Rehabil, 1996;77:356–362.
  11. Mumman CM: Perceived losses following stroke. Rehabil Nurs, 1986;11:19–24.
  12. Perry J: Kinesiology of lower extremity bracing. Clin Orthop Relat Res, 1974;102:18–31.
  13. Bohannon RW: Strength of lower limb related to gait speed and cadence in stroke patients. Physiother Can, 1986;38:204–206.
  14. Don S, Reiker GG, Hildebolt C, et al.: Soft-copy versus hard-copy cranial sonography: intraobserver agreement and workstation efficiency. AJR Am J Roentgenol, 1997;169:555–561.
  15. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Archives of physical medicine and rehabilitation. 2000 Apr 1;81(4):409-17.
  16. Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: effects of function and spasticity. Arch Phys Med Rehabil 1997;78:1231–1236.
  17. Bohannon R, Andrews A. Correlation of knee extension torque and spasticity with gait speed in patients with stroke. Arch Phys Med Rehabil 1990;71:330–333.
  18. Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. Reducing impairment and disability in chronic stroke survivors through muscle strengthening and physical conditioning. Arch Phys Med Rehabil 1999;8:1211–1218.
  19. Wang, Ray-Yau. Effect of proprioceptive neuromuscular facilitation on gait of patients with hemiplegia of long and short duration. J. Phys. Ther., 1994;74(12): 1108-15.
  20. Kang KY. Effects of resistance strengthening exercise for the hip flexor and extensor functional improvement in chronic stroke patients. PTK. 2006;13(3);1017.
  21. Basmajian JV, Wolf SL: Therapeutic exercise (5th ed). Baltimore: Williams and Wilikins, 1990;260–277.
  22. Roerdink, M., M., Lamoth, J.C.C., Kwakkel, G., Piet, C.W., van Wieringen, P.C.W and Beek, P.J. Gait Coordination after Stroke: Benefits of Acoustically Paced Treadmill Walking. Phys. Ther., 2007;87(8):1009-1022.
  23. Trueblood PR, Walker JM, Perry J and Gronley JK. Pelvic exercises and gait in hemiplegia. Phys Ther 1989;69:32-40.
  24. Kumar et Al. Effect of PNF Technique on Gait Parameters and Functional Mobility in Hemiparetic Patients. Journal of Exercise Science and Physiotherapy, 2012;8(2):67-73.
  25. Susan Adler, Math Buck, Dominiek Beckers, PNF in Practice, Springer, 3rd edition, Pg No. 60-68, 2008.
  26. Mehrholz, J., Wagner, K., Rutte, K., Meiβner, D., Pohl, M. Predictive validity and Responsiveness of the functional modulation category in hemiparetic patients after stroke. Archv. Phys. Med. Rehabil. 2007;88(10):13141319.
  27. Yang, Y.R., Wang, R.Y., Chen, Y.C., Kao, M.J. Dual-Task Exercise Improves Walking Ability in Chronic Stroke: A Randomized Controlled Trial. Archv. Phys. Med. Rehabil., 2007;88:1236-40.
  28. Agarwal, V., Kumar, M., Kumar, M.R., Pandey, R. Effect of number of repetitions of weight bearing exercises on time-distance parameters in stroke. Ind. J. Physioth. Occup. Therap. 2008;2(1):57-63.
  29. Hsu AL, Tang PF, Jan MH: Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil, 2003;84:1185–1193.
  30. Hesse S, Reiter F, Jahnke M, et al.: Asymmetry of gait initiation in hemiparetic stroke subjects. Arch Phys Med Rehabil, 1997;78:719–724.
  31. Bobath B: Adult hemiplegia: evaluation and treatment, 3rd ed. Oxford: William Heinemann Medical Books, 1990;20–57.
  32. Simons DG: Reply to M.I. Weintraub. Pain, 1999;80:451–452.
  33. Sanders G, Stavrakas P: A technique for measuring pelvic tilt. Phys Ther, 1981;61:49–50.
  34. Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis, 4th edition, pg 551-553.
  35. Krebs DE, Wong D, Jevsevar D, et al.: Trunk kinematics during locomotor activities. Phys Ther. 1992;72:505.
  36. Stokes VP, Andersson C, Forssberg H: Rotational and translational movement features of the pelvis and thorax during adult human locomotion. J Biomech 1989;22:43.
  37. Kawahira, K., Shimodozono, M., Ogata, A. and Tanaka, N. Addition of intensive repetition of Facilitation Exercises to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb. J. Rehabil. Med., 2004;36: 159-164.
  38. Shimura, K. & Kasai, T. 2002. Effect of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potential in upper limb muscles. Science Direct- Human Movement Science 2002;21:101–113.
  39. Thiruppathi, P.Rajitha, V.Kiran, K.Suneel kumar; Efficacy of Proprioceptive Neuromuscular Facilitation techniques to Pelvic girdle muscles in improving gait in hemiplegic patient; JMSCR 2016;4(07).