RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. Name o !"e Ca#$%$a!e A#$
A$$&e''
(%# )*o+, *e!!e&'-.
TUSHAR KURADE
L/011, NE2 AIR INDIA COLONY, KALINA,
SANTACRU3(EAST-,MUMBAI,MAHARASTRA.
4. Name o !"e I#'!%!5!e . LAXMI MEMORIAL COLLEGE OF
PHYSIOTHERAPY, MANGALORE.
0. Co5&'e o '!5$6 a#$ '5)7e+! . MASTERS OF PHYSIOTHERAPY (MPT-
4 YEARS DEGREE COURSE
PHYSIOTHERAPY IN NEUROLOGICAL AND
PSYCHOSOMATIC DISORDERS
8. Da!e o A$m%''%o# !o Co5&'e. 1 APRIL 4919
:. T%!*e o !"e !o;%+.
<TO COMPARE THE EFFICACY OF BOBATH
AND PROPRIOCEPTIVE
NEUROMUSCULAR FACILITATION (PNF-
TECHNI=UE TO NORMALISE TONE IN
SPASTIC HEMIPLEGIC UPPER LIMB.>
?. B&%e Re'5me o !"e I#!e#$e$ 2o&, .
?.1 NEED FOR THE STUDY
Stroke also known as cerebrovascular accident, is define as rapidly developing clinical sign of
focal disturbance of cerebral function, lasting more than 24hrs. Or leading to death with no apparent
cause other than that of vascular origin.
C! can be divided into ischemic and hemorrhagic. "schemic stroke make up appro#imately $%&
of all stroke. 'van peppen et al 2%%4(. )he sign and symptoms of the stroke depends on location of
obstruction, the si*e of artery involved. Over half of the patients with upper limb paresis resulting from
stroke will suffer from long term impaired arm function and an enduring disability in daily life.
' kawakkel et al 2%%+(
,
-obath concept which was last published by -ertha and .arl bobath ',//%(. )he effect of bobath
approach on the e#citability of the spinal alpha motor neuron in stroke patient with muscle spasticity.
2
)he 012 approach was developed by 3erman kabat, 45 and 4argaret .nott ',/4%6,/7%(.
012 is motor learning approach used in neuromotor development training to improve motor
function and facilitate ma#imal muscular contraction.
012 is dynamic approach to the evaluation and treatment of neuro6musculoskeletal dysfunction.
)he goal of the 012 approach is to facilited an optimal structural and neuro6muscular state. )his helps
to reduce the symptom to improve the distribution of forces through the symptomatic region and to
reduce the inherent functional stress cause by poor neuro6muscular control.
012 is effective to reduce tone in spasticity after stroke. )he techni8ues to reduce spasticity are
9hythmic movement initiation, movement reproduction, combination of isotonic contraction.
+
!bnormal tone which may be low or high than normal influences the patient:s movement pattern
adversely. 1ormali*ation of tone is seen as necessary for functional activities.
)his study will highlight the importance of bobath concept and its comparison with 012 in
concern with the abnormal tone.
)hus study can help us identify on which techni8ue is more effective in normali*ing tone.
HYPOTHESIS
NULL HYPOTHESIS (H
O
-@
)here will not be significant difference between -obath and 012 techni8ue to normali*e tone in
spastic hemiplegic upper limb
ALTERNATE HYPOTHESIS(H
1
- .
)here will be significant difference between -obath and 012 techni8ue to normali*e tone in
spastic hemiplegic upper limb.
?.4 REVIE2 OF LITERATURE
!nsari 1 1, 1aghdi S did a study to evaluate the efficacy of bobath approach on the e#citability
of the spinal alpha motor neuron in post stroke spasticity. )hey concluded that -obath therapy had
statistically significant effect of the e#citability of the alpha motor neuron in the affected side in the
stroke patient with muscle spasticity.
4
5isa .. Sommerfeld, !nna6.arin Svenson, did a study on spasticity after stroke. )he use of
-obath approach focusing on normali*ing tone and movement patterns, is widespread and claims that
inhibition of spasticity should result in an improve motor function.
7
Shelia ;enon, !) <ordanstown did a study on gait re6education on the bobath concept in two
patients with hemiplegia following stroke. )hey concluded that improvement in hip and knee
movement, reduce tone and improve mobility.
=
S*ymonpasiut, 4arta -anach , did a study on stroke rehabilitation by 012 method with and
without botulium to#in. )hey concluded that 012 is very effective to reduce spasticity but if it gives
with botulium to#in then spasticity will recover 8uickly.
,%
>) Southwestern medical center, 2an ?ao , studied on effect of 012 in spastic ankle after
stroke. !ccording to them 012 is effective to reduce spasticity around ankle @oint which helps to
improve tone and range of motion.
A

Bang 9C did study on effect of 012 on gait of patient with hemiplegia of short and long
duration.,//4. they concluded that 012 helps to improve tone of muscle along with sub@ect with
hemiplegia of short duration demonstrated immediate improvement in gait speed and cadence. !nd
long duration had no improvement after one treatment but did improve with repeated treatment.
/
.raft et al. did study on compared treatment to improve function of the arm and hand in
chronic hemiplegia. Conclusion was fugl6 4eyer score improved 42& for D4?6Stimulator, 27& for low
intensity stimulator, ,$& for 012 and negligible for no treatment.
,2
?regson <.4, 4oore !.0., Sharma ! ., did study to establish reliability of the modified
!shworth scale in stroke patients. )he reliability of modified !shworth scale was very good. )he
reliability of tone assessment scale was not strong as the modified !shworth scale. )hey concluded that
the modified !shworth scale is reliable.
,4
1 1akhostin6 !nsari , S 1aghdi did study on comparative study on the inter6 rather
reliability of !shworth scales in spasticity. )hey concluded that modified !shworth scale was slightly
more reliable than the original scale.
,7
?.0 OBJECTIVES OF STUDY
,.Dfficacy of -obath techni8ue to normali*e tone in spastic hemiplegic upper limb
2.Dfficacy of 012 techni8ue to normali*e tone in spastic hemiplegic upper limb
+.Compare -obath and 012 techni8ue to normali*e tone in spastic hemiplegic upper limb
A MATERIALS AND METHODS:
A.1 STUDY DESIGN. Comparative study
SOURCE OF DATA. 4% sub@ects from la#mi memorial collage of physiotherapy O05 and ! <
39C !nd "4S.
A.4 METHOD OF COLLECTION OF DATA
SAMPLING TECHNI=UE
9andom sampling techni8ue
INCLUSION CRITERIA
E !ge F 4% to =% years.
E 0atients of both gender.
E -runstorm stage +
E Subacute stroke
E 0atient who are medically stable.
EXCLUSION CRITERIA
E 0atients with cognition and perceptional disorder
E 1on co6operative patients
E 0atients with cardio6 respiratory disease.
MATERIALS
,. 0illow
2. 0linth
+. Stool
TECHNI=UE OF APPLICATION
METHOD. )wo groups G ?roup ! F 2% sub@ects
?roup - F 2% sub@ects
E ?roup ! G -obath techni8ue
4obili*ation
Beight transfer
Selective upper limb movement
9eaching with affected arm
9eaching with unaffected arm
9efle# inhibiting movement pattern'9"40(
9"40G )he palm acts as a peripheral refle#ogenic area. -y firmly grasping the area input is
provided to the nervous system. )he movement are done in the anatomical plane from distal to pro#imal
and in short leaver for upper limb.
E ?roup - G 012 techni8ue '0roproiceptive 1euromuscular 2acilitation(.
,( 9hythmic movement initiation
2( 4ovement reproduction
+( Combination of isotonic contraction
5 , 2le#ion patternG fle#ion, adduction, e#t. rotation
5 , D#tension patternG D#tension, abduction, "nternal rotation.
5 2 2le#ion patternG 2le#ion, abduction, intrnal rotation.
5 2 D#tension patternG D#tension, adduction, D#t, rotation.
E )reatment will be given for 47 min, = times per week for = week.
E 0re and 0ost evaluation of tone by using 4odified !shworth scale. )one assessment will do at
the end of each week
STUDY DURATION. = 4onth.
OUTCOME MEASUREH 4odified !shworth ?rading Scale.
STATISTICAL ANALYSIS. )o describe data various tables, diagram and graphs will be
represented. !ppropriate statistical test will be used.
Bilco#ons Signed )est for 0re and 0ost test within the group
4enn Bhiteny )est for comparing between the groups.
A.0 Doe' !"e '!5$6 &eB5%&e a#6 %#Ce'!%Da!%o#' o& %#!e&Ce#!%o#' !o )e +o#$5+!e$ o#
Pa!%e#!' o& o!"e& "5ma#' o& a#%ma*'E I 'o, ;*ea'e $e'+&%)e )&%e*6.
CDS. 4odified !shworth ?rading Scale will be used as an outcome measure. -obath techni8ue !nd
012 techni8ue will be used for the treatment.
Ha' e!"%+a* +*ea&a#+e )ee# o)!a%#e$ &om 6o5& %#'!%!5!%o#'
Dthical clearance obtained.
F
L%'! o Ree&e#+e'.
,. <ec8ueline -irchmerer.0rofessional !ssignment 0ro@ect."n a 3eschel and Christiane,!msterdam
school of health proffesions, Duropean school of physiotherapy, )afelbergweg 7,, ,,%7
-5,!msterdam 2%%/.
2. 4!))DO 0!C", 0hysiotherapy based on the bobath concept for adults with post stroke
hemiplegia, from department of 9ehabilitation 4edical,prato,italaly,< 9ehabil med 2%%+G+7G26A.
+. S>S!1 S.!5;D9, 5O4"1"D. -DC.D9S, 4!)3 ->C. 012 in practice. !ll illustrated
guide.)hird edition,with 2,7 figures in 7=4 separate illustrations.
4. !1S!9" 1 1, 1!?3!5" S ,)he effect of bobath approach on e#citability of the spinal alfa
motor neurons in stroke patients with muscle spasticity, Dlectromyogr clin 1europhysiol
2%%AG4A',(2/G+=.
7. 5"S! .. SO44D92D;5, D;SC >, !11! .!9"1 SD1 SO1, ;O))! B"5D1
3O;4IB"S) !15 4!?1>S,Spasticity after stroke its occurrence and association with motor
impairment and activity limitation , stroke @ournal of the !merican association sept , 2%%/.
=. S3D;"! ;D11O1, ?ait re education based on the bobath concept in two patients with
hemiplegia following stroke. , physical therapy vol. ,$ no.+ march 2%%,.
A. 2!1 ?!O,Dffect of 012 in spastic ankle after stroke, > ) Southwestern medical center )J
>S!.
$. .>1"COS3" S3"4>9! !15 )!)S>C!, Dffect of 012 on the initiation of voluntary
movement and motor evoked potential in upper limb muscles, dpt of physical education and
health sciences unit, kitasalo university ,6,76,, sagamihrar 22$ @apan / oct 2%%,.
/. B!1? 96C, Dffect of 012 on gait patient with hemiplegia. 0hy )her ,//4,A4G,,%$6,,,7.
,%. SKC4O1 0!S">), 4!9)! -!1!C3, .9CS)C1! ;O1?!B!,Stroke rehabilitation
conducted by 012 method with and without botulinium to#in, faculty of rehabilitation,institute
of neurology, @eigiellonian university medical college, cracow, 0oland 2%%7.
,,. 3 .abat , 4.knott physical therapy ,/7+.
,2. .9!2) et.al, Compare treatment to improve function of arm and hand on chronic hemiplegia.
,//2..
,+. S>S!1 - O S>;;"!1, )3O4!S < Schmit* physical rehabilitation and treatment, fifth
edition.pg 7,267,=.
,4. ?9D?SO1 <. 4G ;D!)3;DC 4.G 4OO9D !. 0 G S3!94! !. . G S4")3 ). ;G B!)."1S C.
;G 9eliability of the tone !ssessment scale and the modified ashworth scale as clinical toolfor
assessing post stroke spasticity. "SS1 %%%+6///+.
,7. 1. 1!.3OS)"16!1S!9", S. 1!?3!5", 3. 4O!44D9" !15 S. <!;!"D, ! Comparative
study on the inter6rater reliability of !shworth scale in assessment of spasticity. !cta medica
iramica 44'4(G 24=627%,2%%=.