Investigation of the effects of upper extremity and trunk proprioceptive neuromuscular facilitation techniques combined with breathing on respiratory capacity and swallowing in individuals with multiple sclerosis

Even in the early stages of the MS patients may suffer from respiratory muscle weakness, impaired lung functions and swallowing disorders. Although PNF is used to improve neuromotor outcomes in MS, its effects on respiratory functions and swallowing has not been investigated yet. This study aimed to examine the effects of combined practice of PNF breathing patterns with upper extremity and trunk patterns on respiratory functions, swallowing, functional capacity, fatigue and quality of life in MS. Thirty-four MS patients randomized in the study. Breathing exercise group (Age:38,47±8,18/years, 12 women, 5 men; EDSS:1,20±0,46, time on MS:8,05±6,39/years) or PNF group (Age:43,23±10,55/years, 10 women, 7 men; EDSS:2,08±1,18, time on MS:6,58±2,91/years). In the PNF group, PNF techniques combined with respiration were applied, 3 days/week for 6 weeks. Breathing exercise group maintained breathing exercise at home for 20 minutes/ day for 6 weeks and followed-up with mobile messages. Pulmonary functions (%FEV1, %FVC, %FEV1%/FVC, %PEF, %FEF25-75%,PCF%)pred and inspiratory (MIP) and expiratory muscle strength (MEP) were evaluated. Swallowing function was assessed using "DYMUS" and "EAT-10". Functional capacity evaluated with "2 MWT'' while fatigue and Qol questioned using "MUSIQoL" and "FSS". After treatment, MIP (p=0.038), MEP (p=0.033), DYMUS (p=0.010), EAT-10 (p=0.001), 2MWT (p=0,001) and MUSIQoL (p=0.007) improved in breathing group. In the PNF group, MIP (p=0.005), MEP (p=0.001), %FEV1/FVCpred(p=0.003),%PEFpred(p=0.010),%FEF2575pred(p=0.023),%PCFpred(p=0.017), DYMUS(p=0.001), EAT-10 (p=0.001), FSS (p=0.017) and MUSIQoL (p=0.002) improved. In the comparison of the groups, change in MIP was significantly higher in breathing group (p=0.013) and FEV1% was significantly improved in the PNF group (p=0.011). Our results indicated that PNF has a potential to improve respiratory muscle strength, pulmonary functions, swallowing, fatigue and QoL in MS. However, the only parameter in which PNF had a greater effect than breathing exercises was FEV1%, and even breathing exercises were found to be more effective in increasing MIP. Keywords: Multiple Sclerosis, PNF, Respiratory, Swallowing