Effect of PNF + Core Strengthening Exercise in Sub-acute Guillain Barre Syndrome ( PNF-CORE-GBS )

Guillain-Barré Syndrome (GBS) is an acute immune-mediated inflammatory polyneuropathy characterized by rapidly progressive muscle weakness, diminished or absent deep tendon reflexes, sensory disturbances, impaired balance, and functional limitations in activities of daily living (ADLs). Although most patients recover gradually following the acute phase, many continue to experience persistent muscle weakness, impaired postural control, reduced trunk stability, and decreased functional independence during the subacute stage. Early rehabilitation plays a vital role in maximizing neurological recovery and improving functional outcomes. Conventional physiotherapy is considered a standard rehabilitation approach for patients with subacute GBS and typically includes range of motion exercises, muscle strengthening, balance training, gait training, and functional mobility exercises. However, there is limited evidence regarding the additional benefits of combining Proprioceptive Neuromuscular Facilitation (PNF) with core strengthening exercises in this population. Proprioceptive Neuromuscular Facilitation (PNF) is a therapeutic approach that uses proprioceptive stimulation, resistance, stretching, and coordinated movement patterns to facilitate neuromuscular activation and functional movement. Core strengthening exercises focus on improving trunk stability, pelvic control, postural alignment, and balance.

Although both interventions are used in neurological rehabilitation, evidence regarding the combined application of PNF and core strengthening exercises in patients with sub-acute GBS remains limited. Therefore, this study is designed to evaluate the effectiveness of combining these interventions compared with conventional physiotherapy.

This study is a randomized controlled trial involving 32 participants with clinically diagnosed sub-acute Guillain-Barré Syndrome. Participants will be recruited through non-probability purposive sampling from the Neuro-Medicine Ward and Physiotherapy Outpatient Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.

Eligible participants will be adults aged 18-45 years, of either gender, diagnosed with GBS and clinically stable for participation in physiotherapy rehabilitation. Participants will be randomly allocated into two groups using the sealed-envelope method. The outcome assessor will be blinded to group allocation.

Participants assigned to Group A will receive Proprioceptive Neuromuscular Facilitation (PNF) combined with core strengthening exercises.

The PNF intervention will include Contract-Relax (CR) and Contract-Relax-Antagonist-Contract (CRAC) techniques applied to the upper and lower extremities. The techniques will involve an initial stretch of approximately 10-20 seconds, followed by resisted muscle contraction lasting 3-6 seconds, with a relaxation period of approximately 2-3 seconds before further stretching.

Core strengthening exercises will include:

• Pelvic control exercises.
• Bridging exercises.
• Curl-up exercises.
• Curl-ups with diagonal reaching.
• Bridging with crossed legs.
• Single-leg bridging.
• Side-bridging exercises. These exercises will target trunk and pelvic stability, neuromuscular control, and postural function.

*Control Group (Group B)*

Participants assigned to Group B will receive conventional physiotherapy, including:

• Upper and lower extremity stretching and strengthening exercises.
• Techniques for normalization of muscle tone.
• Weight-bearing exercises.
• Active functional training.
• Postural control exercises.
• Conventional balance training. Both groups will receive physiotherapy rehabilitation four times per week over eight weeks.

The study will evaluate the following outcome measures:

1. Balance: Assessed using the Berg Balance Scale (BBS), which evaluates static and dynamic balance through 14 functional tasks. The total score ranges from 0 to 56.
2. Muscle Strength: Assessed using Manual Muscle Testing (MMT), which evaluates muscle strength on a grading scale from 0 to 5.
3. Functional Independence: Assessed using the Barthel Index (BI), which evaluates independence in activities of daily living, including feeding, bathing, dressing, transfers, mobility, and stair climbing. The total score ranges from 0 to 100.

Assessments will be performed at baseline, the fourth week, and the eighth week of the intervention.

The primary objective is to determine whether PNF combined with core strengthening exercises is more effective than conventional physiotherapy in improving balance, muscle strength, and functional independence among patients with sub-acute Guillain-Barré Syndrome.