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Hussein Z A, Khazraji R T T, Gazi H K. The Efficacy of Strengthening and Stretching by PNF for Foot Drop in Hemiplegia. Iranian Rehabilitation Journal 2025; 23 (3) :331-338
URL: http://irj.uswr.ac.ir/article-1-2489-en.html

Objectives: To test the effectiveness of proprioceptive neuromuscular facilitation (PNF) on muscle strength, spasticity, functional mobility, and range of motion (ROM) in hemiplegic patients with foot drop.
Methods: This was a single-arm, pre-post study of 30 adults (21–60 years) with hemiplegic foot drop receiving a 14-week PNF. The interventions included contract-relax stretching, resistance training (D1/D2 diagonal patterns), and functional exercises. The assessed outcomes were muscle strength, spasticity, ankle dorsiflexion ROM, and functional mobility.
Results: Following the intervention, all outcomes significantly improved. Tibialis anterior (TA) strengthened grade 2 to 3 (P<0.001, r=0.62), and 42% achieved grades 4–5. There were large effect sizes for the quadriceps, hamstrings, and calf muscles (r=0.51–0.62). TA spasticity dropped from grade 3 to 2 (P<0.001, r=0.75), and 68% reached grade ≤2. Functional mobility improved by 5.21 cm (P<0.001, r=0.83), and ankle dorsiflexion ROM increased by 8.5° (P<0.001, r=0.52).
Discussion: Diagonal patterns and resistance training decrease the degree of spasticity and increase strength and mobility, making it possible to use this PNF type even in comparison to shorter-term protocols. These findings support the use of PNF to address foot drop in stroke rehabilitation.