Effects of Proprioceptive Neuromuscular Facilitation-Based Lower Extremity Training on Balance, Gait, and Functional Independence in Individuals With Stroke

This study aims to investigate the effects of a proprioceptive neuromuscular facilitation (PNF)-based lower extremity rehabilitation program on balance, gait performance, functional independence, and quality of life in individuals with stroke. Stroke is a leading cause of long-term disability and is commonly associated with impairments in motor control, balance, and walking ability, which negatively affect independence and daily functioning. In this randomized controlled trial, participants with stroke will be randomly assigned to either a PNF-based rehabilitation group or a control group receiving conventional physiotherapy. The intervention will focus on lower extremity PNF techniques to improve motor control, balance, and gait performance. Assessments will be conducted at baseline and at the end of the intervention period. The findings are expected to contribute to the development of evidence-based rehabilitation strategies for individuals with stroke.

This study is designed as a prospective, randomized, parallel-group controlled trial to evaluate a PNF-based lower extremity rehabilitation program in individuals with stroke. A total of 40 participants will be randomly allocated in a 1:1 ratio to either an intervention group or a control group using a computer-generated randomization sequence. The intervention group will receive a structured rehabilitation program based on proprioceptive neuromuscular facilitation principles. The program will incorporate techniques such as rhythmic initiation, dynamic reversals, stabilizing reversals, and rhythmic stabilization. These techniques will be applied through lower extremity diagonal movement patterns (D1 and D2) in functional positions including supine, sitting, and standing. The intervention will be individualized and progressively adjusted according to participant performance and tolerance. The control group will receive a conventional physiotherapy program consisting of range of motion exercises, muscle strengthening, balance training, and gait-related activities consistent with standard rehabilitation practice. Both groups will receive interventions with equivalent duration and frequency. Outcome assessments will be performed by an independent assessor who is blinded to group allocation. Statistical analyses will be conducted to evaluate changes over time and differences between groups.

Inclusion Criteria: * Diagnosis of stroke confirmed by a neurologist * Age between 40 and 80 years * Ability to walk with or without an assistive device * Medically stable condition * Ability to understand and follow verbal instructions * Willingness to participate and provide informed consent Exclusion Criteria: * Severe cognitive impairment preventing participation * Other neurological disorders affecting mobility * Severe musculoskeletal disorders affecting lower extremity function * Severe cardiovascular conditions contraindicating exercise * Participation in another rehabilitation study