Although there are studies examining the effect of actively performed PNF exercises on haemodynamic responses in intensive care patients and healthy individuals, there are no studies investigating their effect on circulation and haemodynamic responses in unconscious patients. Therefore, this study was designed to investigate the acute effects of proprioceptive neuromuscular facilitation (PNF) exercises on peripheral circulation and haemodynamic responses in patients admitted to a neurological intensive care unit.
Hypotheses:
H1-1: Passively administered PNF exercises have beneficial effects on peripheral circulation.
H2-1: Passively administered PNF exercises have beneficial effects on haemodynamic responses.
Patients being monitored in the neurology intensive care unit
Aged 18 years or over
Haemodynamically stable
No orthopaedic condition preventing the performance of passive joint movements in the upper and lower limbs
Presence of haemodynamic instability
Fractures, contractures or serious orthopaedic conditions in the upper or lower limbs that restrict movement
Diagnosis or suspicion of deep vein thrombosis
Severe peripheral arterial disease
Parallel
Proprioceptive Neuromuscular Facilitation Exercises
Other interventionThe following PNF patterns will be applied to the upper extremity: * flexion - abduction - external rotation → extension - adduction - internal rotation * extension - abduction - internal rotation → flexion - adduction - external rotation The following PNF patterns will be applied to the lower extremities: * flexion - adduction - external rotation (with the knee extended) → extension - abduction - internal rotation * extension - adduction - external rotation (with the knee extended) → flexion - abduction - internal rotation All exercises will be performed passively by the physiotherapist. Each movement will be performed in sets of 10-12 repetitions, with a 30-second rest period between sets.
Passive Range of Motion Exercises
Other interventionExercises for the upper extremities: * shoulder flexion - extension * shoulder abduction - adduction * shoulder internal - external rotation * elbow flexion - extension * wrist flexion - extension * finger flexion - extension Exercises for the lower extremities: * hip flexion - extension * hip abduction - adduction * hip internal - external rotation * knee flexion - extension * ankle dorsiflexion - plantar flexion All exercises will be performed passively by the physiotherapist. Each movement will be performed in sets of 10-12 repetitions, with a 30-second rest period between sets.
Ankle-Brachial İndex
Systolic blood pressure will be measured at the brachial artery (upper limb) and the posterior tibial or dorsalis pedis artery (lower limb) using a Hadesco ES-101EX Doppler device, with patients in a supine resting position. The cuff will be placed at mid-arm and above the malleolus. It will be inflated until the pulse disappears and deflated slowly; the first reappearance of the pulse will be recorded as systolic pressure. Measurements will be taken in order: same-side arm, same-side leg, opposite leg, and opposite arm. The ankle-brachial index will be calculated as the ratio of the highest lower limb systolic pressure to the highest upper limb systolic pressure.
Heart Rate
Heart rate will be recorded as beats per minute and breaths per minute, respectively, based on data obtained from the patient monitor. Measurement will be taken whilst patients are in the supine position and at rest.
Systolic blood pressure and diastolic blood pressure
Systolic and diastolic blood pressure measurements will be taken from the patient's upper extremity using an appropriately sized cuff and recorded in millimetres of mercury (mmHg). Measurement will be taken whilst patients are in the supine position and at rest.
Respiratory rate
respiratory rate will be recorded as beats per minute and breaths per minute, respectively, based on data obtained from the patient monitor. Measurement will be taken whilst patients are in the supine position and at rest.
Rate Pressure Product
Rate Pressure Product is calculated by dividing the product of heart rate and systolic blood pressure by 1,000
Quadriceps circumference measurement
Measurements will be taken whilst patients are in the supine position or, where appropriate, in a seated position. During the measurement, a non-elastic tape measure will be used to measure the circumference at the widest part of the thigh. The tape measure will be placed parallel to the thigh circumference, and the measurement result will be recorded in centimetres (cm). To enhance the reliability of the measurement, two separate measurements will be taken for each patient, and the average of the obtained values will be used in the analyses.
Oxford Acute Severity of Illness Score
Oxford Acute Severity of Illness Score comprises a total of 10 parameters: age, heart rate, mean arterial pressure, respiratory rate, body temperature, Glasgow Coma Scale, urine output, mechanical ventilation status, length of stay in intensive care, and the presence of elective surgery. Each parameter is assessed according to specific score ranges, and the total score indicates the severity of the illness. Higher scores indicate a higher risk of mortality.
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