#010- Articles on PNF and Bobath Therapy after Stroke

Covered Topics

1. Two Weeks of PNF Improve Brain-Derived Neurotrophic Factor (BDNF) Levels Post-Stroke.

2. Bobath Therapy with Another Evidence of Inferiority.

Estimated reading time: 3 minutes, 37 seconds.


Two Weeks of PNF Improve Brain-Derived Neurotrophic Factor (BDNF) Levels Post-Stroke.

  • Brain-Derived Neurotrophic Factor (BDNF) is one of four neurotrophins that are important regulators of neural survival, development, function and plasticity.
  • BDNF also regulates both excitatory and inhibitory synaptic transmission and activity-dependent plasticity, BDNF has been directly lined with learning and memory by promoting synaptic consolidation, therefore, improving BDNF levels can promote recovery after neurological pathology. (Reference)

This prospective cohort study investigated the influence of Proprioceptive neuromuscular facilitation on BDNF levels.

208 Stroke patient, each stroke patient was given a PNF protocol that consisted of 30 minute twice/ day, 5 days/week for 2 weeks and involved PNF for neck, scapula, pelvis, trunk, upper extremity and lower extremity. (Full Description of PNF techniques)

Results: 6 months after enrollment.

  • BDNF: a significant increase in the level of BDNF after stroke.
    • The increase was found irrespective of the severity of the stroke, although, the more sever the stroke was, the more decline in BDNF was observed.
    • The increase in BDNF was higher in patients with sever hemorrhagic than with sever ischemic stroke.
  • The risk factors that significantly affected the stroke outcome were diabetes, both hypertension and diabetes, alcohol consumption and smoking.
  • Significant improvement in Functional Independence measure (FIM)
    • Patients with mild stroke became almost independent after 6 months.
    • Patients with hemorrhagic stroke had better improvement than those with ischemic stroke.
    • The improvement in the FIM score was less in patients with moderate stroke and severe stroke compared to mild stroke.
  • Modified Rankin Scale score improved in all cases but in the severe stroke, better improvement in hemorrhagic stroke than in ischemic stroke.
  • No significant difference was found for Barthel’s index score.

In summery, PNF can improve BDNF levels after stroke, which leads to better neuroplasticity.

Note that PNF is not the only intervention that can improve BDNF levels after stroke, moderate to high intensity aerobic exercise was also shown to improve BDNF levels.

Bobath therapy with another evidence of inferiority.

This systematic review and meta-analysis compared Bobath therapy to other interventions on an lower limb activity, performance, strength or coordination after stroke.

22 trials in the systematic review and 17 trials in the meta-analysis.


  • Bobath therapy was less effective than Task-specific training in general and walking specific outcomes. (9 Trials, 487 Participant).
  • Bobath was more effective than PNF for standing balance. (1 Trial 72 Participant)
  • No significant difference between Bobath therapy and PNF in function, strength, range of motion or walking.

This review aggressively opposes Bobath therapy, arguing that Bobath therapy was developed based on scientific knowledge from the 1950s.

Overall, Bobath therapy is not superior to most interventions, except for standing balance compared to PNF.


  • Task-specific training for improving walking and lower activity outcomes after stroke.
  • Do not use Bobath therapy.

Good Note

  • PNF can improve BDNF levels.
  • We can move on from Bobath therapy.

Bad Note:

  • PNF was found to improve BDNF levels, while in the other article, it was no different or less effective than Bobath therapy, which was shown to be not effective. That speaks volume to how much evidence can be confusing.


  • PNF was searched for more than Bobath therapy, during the last year, only people in the UK searched for Bobath, where PNF was searched by people in Philippines, Australia, Untied states, Canada and UK.


  1. Post-stroke BDNF concentration changes following proprioceptive neuromuscular facilitation (PNF) exercises. (Open Access)
  2. Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review. (Open Access)

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