Can people with hemiplegic stroke benefit from the application of Neuro-Developmental Treatment (NDT) to improve their tone and postural control?

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.

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}

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.

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.

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.

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.

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.

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 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.

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.

Piloting of the study selection process is being undertaken.