Keywords
Neurodevelopmental Treatment (NDT), Explicit Training, Stroke, Hemiplegia, Tone and Postural Control, Bobath Approach.
-
Views
-
Downloads
How to cite this article
Raghuveer R, Hullumani V S, Bansal K and Agarwal PR. Explicit training through neurodevelopmental therapy improves tone and postural control in hemiplegic stroke-A Systematic review protocol [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:615 (https://doi.org/10.12688/f1000research.145248.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
Export Citation
Sciwheel
EndNote
Ref. Manager
Bibtex
ProCite
Sente
▬
✚
Study Protocol
Explicit training through neurodevelopmental therapy improves tone and postural control in hemiplegic stroke-A Systematic review protocol
[version 1; peer review: awaiting peer review]
PUBLISHED 11 Jun 2024
OPEN PEER REVIEW
REVIEWER STATUS
Abstract
Corresponding author:
Sharath Hullumani V
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2024 Raghuveer R et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Raghuveer R, Hullumani V S, Bansal K and Agarwal PR. Explicit training through neurodevelopmental therapy improves tone and postural control in hemiplegic stroke-A Systematic review protocol [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:615 (https://doi.org/10.12688/f1000research.145248.1)
First published: 11 Jun 2024, 13:615 (https://doi.org/10.12688/f1000research.145248.1)
Latest published: 11 Jun 2024, 13:615 (https://doi.org/10.12688/f1000research.145248.1)
Introduction
A stroke or Cerebrovascular Accident (CVA) is the sudden onset of deterioration of the neurological function of a person due to disruption of blood supply or rupture of a blood vessel of the brain. The clinical signs of neurological impairment must be present for at least a day to be defined as a Stroke. Motor impairments are characteristically present in the contralateral side of the body as either Hemiplegia (Paralysis) or Hemiparesis (weakness). Hemiplegia is the common term used to define a multitude of clinical problems associated with a stroke. The location of the lesion, the total area of the brain involved, the amount of collateral blood flow, and early acute care management determine the severity of neurological deficits in an individual patient.1 Stroke is a major cause of disability in adults, with 70–85% of first strokes causing hemiplegia and 60% of stroke patients were able to acquire independence in functional activities like walking and toileting by six months.2,3
The trunk is described as the part of the body between the neck and the pelvis.4 Effective trunk control maintains the stability of the spine for the limbs to perform their mobility tasks.5 A stable trunk maintains the COG within the BOS while providing for controlled mobility and skillful walking. There is symmetrical loading and transfer of weight of the head, arms, and trunk towards the lower limbs in both static as well as dynamic activities.6 Trunk muscles also contribute to the maintenance of balance while performing functional tasks.7 During dynamic activity like walking, there is a minimal shift of the trunk in multiplanar directions.8 Hemiplegic subjects have abnormal trunk stability due to weakness of one-half of the trunk, which further leads to gait impairment.9 Stroke patients then compensate by increasing lateral trunk sway and by elevating the affected side hip to clear the ground during the swing phase of gait. Impairment is also seen in reciprocal arm movement in relation to the trunk and pelvis owing to spasticity of the affected upper limb and loss of recoil of the trunk in relation to the pelvis, further increasing the energy expenditure during walking. This causes early fatigue in hemiplegic subjects.10 Following a stroke, trunk impairment leads to loss of balance reactions. This can range from the decreased capacity to correct perturbations to complete loss of balance, depending on the extent and severity of neurological impairment. The normal side cannot compensate enough for the affected side as loading is impaired due to spasticity or weakness.11,12
Neuro-developmental therapy, or the Bobath approach, is one of the most used rehabilitation concepts for the treatment of cerebral palsy children and a regularly used model for adults with hemiplegia following stroke.13 The approach was developed on the concept that any pathology of the Central Nervous System will lead to impaired movement and posture due to abnormal muscle tone causing impairment in functions. The approach is based on the dynamic systems theory of Bernstein (1967), who proposed that multiple systems of the CNS and Musculoskeletal systems work dynamically in regulating motor control. He proposed that in biological organisms’ multiple systems work together in a complex fashion where all subsystems have equal roles in managing motor output. The approach utilizes the facilitation of movements by guiding them by providing various cues using somatosensory, touch, and vestibular receptors to perform purposive actions of useful movement synergies in a task context. It also incorporates self-generated movements for solving motor problems to enhance motor learning and produce permanent changes in motor skills.14
This systematic review aims to investigate the availability of research on the benefits of Neurodevelopmental Treatment (NDT) which utilizes an explicit training feedback approach for enhancing tone and postural control in people with hemiplegic stroke. This review attempts to integrate evidence addressing the effects of specific NDT therapies on tone and postural control outcomes through a thorough analysis of pertinent studies. The study will address any gaps in the literature, find patterns or trends in the literature, and critically evaluate the methodology used in the chosen research. This work aims to provide important insights into the effectiveness of NDT for patients with hemiplegia which could potentially guide future research, clinical practice, and rehabilitation protocols in this population.
Review question(s)
Can people with hemiplegic stroke benefit from the application of Neuro-Developmental Treatment (NDT) to improve their tone and postural control?
Inclusion criteria
Population
The systematic review will include all Randomized Control Trials published on adults with first-ever hemiplegic stroke diagnosed clinically and/or radiologically, aged ≥ 18 years, of any gender, geographical location, and duration of stroke. Further, the studies that specifically employed Neuro-developmental Therapy as a treatment approach in at least one study group and tone and postural control as the primary or secondary outcomes will be included. The studies will be limited to those published in the English language between 2000 – 2023. All the studies on the subject that have used other outcomes without including those for tone and postural control will be excluded, along with studies utilizing qualitative research methods, published reviews, Case reports/series, and editorials.
Intervention
Neuro-Developmental Treatment (NDT) approach is developed to rehabilitate people with neurological disorders, like stroke. It emphasizes enhancing function, posture, and movement through guided movement sequences by an NDT-trained therapist. To support motor recovery and re-education, NDT places a strong emphasis on the examination of movement impairments and makes use of practical approaches through key point facilitation, inhibition, and functional training.14,15
Comparator
Conventional Physiotherapy Rehabilitation: This is a typical strategy for treating hemiplegic stroke patients. Conventional Physiotherapy utilizes a variety of modalities, exercises, activities, and strategies to enhance functional capacities and encourage motor recovery. They include stretching techniques for tight muscle groups, strengthening exercises for weaker muscle groups, and the application of electrotherapeutic modalities for facilitation and improving the tone of the muscles.
Outcomes
The International Classification of Functioning, Disability, and Health (ICF) framework will be used to categorize the systematic review’s outcomes, with an emphasis on body structures and functions, activity constraints, and participation limitations. The main outcome measures for bodily structures and functions will be the Modified Ashworth Scale and Tardieu Scale. Tardieu scale measures the muscle’s response to passive stretch at various velocities, and the Modified Ashworth Scale, measures muscle spasticity. The trunk Impairment Scale measures the static and dynamic sitting balance, and coordination of the trunk in sitting. These assessments will offer a thorough knowledge of how explicit training via Neurodevelopmental Treatment (NDT) affects the neuromuscular characteristics of hemiplegic stroke patients.
Activity limitations will be used to evaluate the postural control. Tools like the Postural Assessment Scale for Stroke Patients, which focuses on several aspects of postural control, and the Berg Balance Scale, which assesses both static and dynamic balance, will be used. These metrics are in line with the ICF framework’s focus on the person’s capacity to carry out duties and activities. Studies that employ these standardized measurement instruments to evaluate outcomes at short-term (immediately post-intervention) and long-term (follow-up assessments) time points will be included in the systematic review’s inclusion criteria. This methodology guarantees a thorough assessment of the impact of NDT on enhancing postural control throughout different timeframes, accounting for the dynamic nature of recovery in hemiplegic stroke patients.
The baseline (pre-intervention) and post-intervention phases are included in the assessment points. The review guarantees a thorough and uniform assessment of the effect of NDT training on tone and postural control in hemiplegic stroke patients by outlining the primary outcomes and their measurement techniques. The thorough methodology employed enhances the dependability and precision of the results obtained from the systematic review.
Type of studies
Randomized Controlled trials, will be included. Non-randomized, cross-sectional studies, observational, descriptive studies, observational analytical research designs, such as case-control & and cohort studies, and qualitative study designs, such as qualitative case studies, narrative studies, etc., will be excluded. Since there are no resources available for translating research written in languages other than English, only published and unpublished English-language studies will be included. Targeted research that has been published between 2000-2023 will be included.
Methods
This protocol describes how a systematic review should be carried out in compliance with the PRISMA recommendations for systematic reviews that have been referred to. The F1000 journal methodology for the systematic review of effectiveness will be followed in all steps involved in carrying out this systematic review. This systematic review protocol has been registered in PROSPERO (CRD42023476137).
Search strategy
Selection criteria: Studies that meet the inclusion requirements for both conventional rehabilitation therapies and NDT will be chosen. A thorough exploration of several electronic databases, such as PubMed/Medline, Scopus, and Cochrane Library, will be carried out to locate pertinent research articles published in peer-reviewed publications.
Screening procedure: The titles and abstracts of the discovered papers will be first screened by two independent reviewers to determine their applicability to the research issue. Full-text screening will then be carried out to ascertain the ultimate eligibility for the study. If disagreements arise throughout the screening process, they will be settled by discussion or if required, consultation with a third reviewer. The search terms will be selected with care to include interventions pertaining to postural control, tone, hemiplegic stroke, and explicit training through Neurodevelopmental Treatment (NDT) and will include all kinds of studies aimed at patients with hemiplegic stroke, reporting tone and postural control results will be the inclusion criteria. Two teams of impartial reviewers will filter the publications, gather information, and evaluate the caliber of the chosen research based on predetermined standards. A third reviewer will be consulted to address any inconsistencies. The retrieved data will be combined narratively.
Study selection
The research findings will be organized using citation management software. Following the elimination of duplicates, two independent reviewers from each team will use the Rayyan QCRI to screen and evaluate the titles and abstracts in three domains in relation to the inclusion and exclusion criteria. Using Rayyan QCRI software (RRID:SCR_017584),16 https://new.rayyan.ai three independent reviewers will then examine titles and abstracts and evaluate them in relation to the review’s inclusion and exclusion criteria. Following the initial screening, all relevant studies will be fully retrieved and thoroughly evaluated by three independent reviewers in relation to the inclusion criteria. The final analysis will include a record of the reasons, the full-text papers that did not match the inclusion criteria were excluded.
Assessment of methodological quality and risk of bias
In addition, a concurrent risk of bias assessment will be performed on the publications using the Standards for Reporting Implementation Studies (StaRI)16 checklist and, PEDRO Scale for rating the methodological quality of RCTs selected.17,18 It is also determined in advance to use the SWiM (Synthesis without Meta-analysis)19 guidelines to create a narrative overview of the chosen papers from the standpoint of implementation research.
Data extraction
Data items: The following information will be taken out of the chosen studies: participant demographics, intervention specifics, outcome measures, study characteristics (e.g., author, publication year, study design), and results regarding tone and postural control.
Extraction method: To methodically record pertinent data from each included study, a uniform data extraction form will be designed in Microsoft Excel sheet. The data will be extracted by two impartial reviewers, and any disagreements will be settled by discussion or, if required, consultation with a third reviewer.
Data synthesis
Narrative synthesis: A detailed summary of the primary findings drawn from the included studies will be given, detailing the features of the subjects, the interventions, and the results. The narrative synthesis will entail a qualitative examination of the parallels and discrepancies among the study findings, with an emphasis on how well NDT and traditional rehabilitation work to improve tone and posture.
Discussion
The expected results and their possible bearing on future research and clinical practice will be thoroughly examined in this review. The analysis will take into account the methodological rigor of the included research, highlighting the significance of conducting a comprehensive risk of bias assessment using the Cochrane Risk of Bias Tool for randomized controlled trials. The discussion will emphasize the benefits and drawbacks of the current literature by critically evaluating the quality of the evidence and identifying any potential sources of bias that might affect the overall results obtained from the systematic review.
Additionally, the discussion will delve to the possible therapeutic ramifications of the expected discoveries. Rehabilitation procedures for stroke victims may be informed and guided if the systematic review finds consistent evidence of the beneficial effects of explicit training through Neurodevelopmental Therapy in enhancing tone and postural control in hemiplegic stroke patients. On the other hand, if restrictions or fallacies in the data are found, the conversation will highlight the necessity of more investigation and possible improvements to intervention tactics. In general, the discussion part will add to the body of knowledge on hemiplegic stroke rehabilitation by pointing out areas that require further research and clinical application, providing an assessment of the available data, and suggesting directions for further investigation.
Download
Export To
metrics
| Views | Downloads | |
|---|---|---|
| F1000Research | - | - |
|
PubMed Central
Data from PMC are received and updated monthly.
|
- | - |
Citations
CITE
how to cite this article
Raghuveer R, Hullumani V S, Bansal K and Agarwal PR. Explicit training through neurodevelopmental therapy improves tone and postural control in hemiplegic stroke-A Systematic review protocol [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:615 (https://doi.org/10.12688/f1000research.145248.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.
Open Peer Review
Current Reviewer Status:
AWAITING PEER REVIEW
AWAITING PEER REVIEW
Key to Reviewer Statuses
VIEW
HIDE
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Comments on this article Comments (0)