Acute Effects of Physiotherapy Interventions on Biceps Brachii Muscle Tissue Perfusion After Stroke

NCT07853859 | Completed

• 2 other identifiers: 1019BBAP.2023.10
• Study Type: interventional
• Target: 26
• Locations: 1 country
• Sites: 1

Brief Summary

This study aimed to investigate the acute effects of proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and virtual reality (VR)-based interventions on biceps brachii tissue perfusion in individuals with chronic stroke. In this randomized crossover study, participants received all three physiotherapy interventions in a randomized order. Each intervention lasted 10 minutes. Biceps brachii muscle oxygenation and local blood volume responses were assessed using near-infrared spectroscopy (NIRS) before, during, and after each intervention.

Conditions

Stroke

Keywords

Chronic Stroke; Spasticity; Biceps Brachii; Near-Infrared Spectroscopy; Muscle Oxygenation; Tissue Perfusion; Proprioceptive Neuromuscular Facilitation; Bobath Concept; Virtual Reality

Outcome Measures

Primary Outcomes (4)

• Change in Biceps Brachii Skeletal Muscle Oxygen Saturation (ΔSmO₂)

  Change in SmO₂ was calculated as the post-intervention value minus the pre-intervention value for the affected biceps brachii.

  From the 2-minute period immediately before to the 2-minute period immediately after each 10-minute intervention.

• Mean Biceps Brachii Skeletal Muscle Oxygen Saturation (SmO₂) During Intervention

  Skeletal muscle oxygen saturation (SmO₂) of the affected biceps brachii was continuously measured using wearable near-infrared spectroscopy (NIRS). The mean SmO₂ value during each intervention was calculated.

  During each 10-minute intervention.

• Mean Biceps Brachii Total Hemoglobin (tHb) During Intervention

  Total hemoglobin (tHb) of the affected biceps brachii was continuously measured using wearable NIRS as an indicator of local blood-volume response. The mean tHb value during each intervention was calculated.

  During each 10-minute intervention.

• Change in Biceps Brachii Total Hemoglobin (ΔtHb)

  Change in tHb was calculated as the post-intervention value minus the pre-intervention value for the affected biceps brachii.

  From the 2-minute period immediately before to the 2-minute period immediately after each 10-minute intervention.

Study Arms (6)

A. PNF - Bobath - VR

EXPERIMENTAL

Participants received PNF first, followed by the Bobath concept, and then the VR-based intervention, with 10-minute rest intervals between the interventions.

Behavioral: Proprioceptive Neuromuscular Facilitation (PNF); Behavioral: Bobath Concept; Behavioral: Virtual Reality (VR)-Based Intervention

B. PNF - VR - Bobath

EXPERIMENTAL

Participants received PNF first, followed by the VR-based intervention, and then the Bobath concept, with 10-minute rest intervals between the interventions.

Behavioral: Proprioceptive Neuromuscular Facilitation (PNF); Behavioral: Bobath Concept; Behavioral: Virtual Reality (VR)-Based Intervention

C. Bobath - PNF - VR

EXPERIMENTAL

Participants received the Bobath concept first, followed by the PNF, and then the VR-based intervention, with 10-minute rest intervals between the interventions.

Behavioral: Proprioceptive Neuromuscular Facilitation (PNF); Behavioral: Bobath Concept; Behavioral: Virtual Reality (VR)-Based Intervention

D. Bobath - VR - PNF

EXPERIMENTAL

Participants received the Bobath concept first, followed by the VR-based intervention, and then the PNF, with 10-minute rest intervals between the interventions.

Behavioral: Proprioceptive Neuromuscular Facilitation (PNF); Behavioral: Bobath Concept; Behavioral: Virtual Reality (VR)-Based Intervention

E. VR - PNF - Bobath

EXPERIMENTAL

Participants received the VR-based intervention first, followed by the PNF, and then the Bobath concept, with 10-minute rest intervals between the interventions.

Behavioral: Proprioceptive Neuromuscular Facilitation (PNF); Behavioral: Bobath Concept; Behavioral: Virtual Reality (VR)-Based Intervention

F. VR - Bobath - PNF

EXPERIMENTAL

Participants received the VR-based intervention first, followed by the Bobath concept, and then the PNF, with 10-minute rest intervals between the interventions.

Behavioral: Proprioceptive Neuromuscular Facilitation (PNF); Behavioral: Bobath Concept; Behavioral: Virtual Reality (VR)-Based Intervention

Interventions

Proprioceptive Neuromuscular Facilitation (PNF) BEHAVIORAL

A 10-minute PNF intervention was applied to the affected upper extremity in the supine position. Rhythmic initiation was followed by half- and full-pattern techniques. Biceps brachii inhibition and triceps brachii facilitation were performed mainly using an extension-abduction-internal rotation pattern with elbow extension. Repeated stretch and slow opposing movements were used for triceps facilitation. Pectoral inhibition in a flexion-abduction-external rotation pattern was added when required.

A. PNF - Bobath - VR; B. PNF - VR - Bobath; C. Bobath - PNF - VR; D. Bobath - VR - PNF; E. VR - PNF - Bobath; F. VR - Bobath - PNF

Bobath Concept BEHAVIORAL

A 10-minute Bobath concept intervention was applied primarily in the supine and hook-lying positions. The intervention included latissimus dorsi elongation, scapular depression, supine arm elevation, elbow control, functional elbow control, midline approximation when tolerated, and bilateral elbow flexion-extension with the hands clasped. Light resistance, repeated contractions, or active-assistive movements were used according to muscle strength and active range of motion.

A. PNF - Bobath - VR; B. PNF - VR - Bobath; C. Bobath - PNF - VR; D. Bobath - VR - PNF; E. VR - PNF - Bobath; F. VR - Bobath - PNF

Virtual Reality (VR)-Based Intervention BEHAVIORAL

A 10-minute VR-based upper-extremity intervention was performed in a seated position with back support. Following orientation and device-use training, participants played a beginner-level Fruit Ninja game continuously for 10 minutes. The game was selected because its movements resembled PNF diagonals and were compatible with Bobath concept upper-extremity facilitation.

A. PNF - Bobath - VR; B. PNF - VR - Bobath; C. Bobath - PNF - VR; D. Bobath - VR - PNF; E. VR - PNF - Bobath; F. VR - Bobath - PNF

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥18 years
• Chronic phase of stroke
• Mini-Mental State Examination score ≥ 24
• Modified Ashworth Scale score ≥1
• Brunnstrom stage ≥3

You may not qualify if:

• Presence of another neurological disorder
• Cardiovascular, vestibular, metabolic, or orthopedic conditions severe enough to limit participation
• Inability to sit in a chair with back support
• Use of eyeglasses for visual correction without the option of wearing contact lenses
• Onset of symptoms of cybersickness or any discomfort preventing participation in the exercise during the procedure.

Sponsors & Collaborators

• Izmir Bakircay University: lead

Study Sites (1)

Izmir Bakircay University Physiotherapy and Rehabilitation Application and Research Center

Çiğli, İzmir, 35620, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Stroke; Muscle Spasticity

Interventions

Muscle Stretching Exercises

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Muscular Diseases; Musculoskeletal Diseases; Muscle Hypertonia; Neuromuscular Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: Proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and virtual reality (VR)-based interventions were administered to all participants, with rest intervals between them. The order of administration for these three interventions was randomized to allow for a within-subject comparison of acute muscle oxygenation and local blood volume responses.

Study Record Dates

• First Submitted: September 26, 2026
• First Posted: October 2, 2026
• Study Start: September 19, 2024
• Primary Completion: April 8, 2026
• Study Completion: April 8, 2026
• Last Updated: October 2, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)