Middle Cerebral Artery Infarction, Stroke
Conditions
Keywords
Stroke rehabilitation, Upper limb, PNF, Rood's technique, NMES, Acute stroke
Brief summary
Middle cerebral artery (MCA) stroke often causes weakness or stiffness in the arm and hand, making daily activities difficult. This study compares two physical therapy approaches - Rood's facilitatory techniques (using touch, quick stretch, and ice to activate muscles) and PNF sequential patterns (using diagonal movement patterns) - to improve arm function in acute stroke patients. Both groups will also receive neuromuscular electrical stimulation (NMES). A total of 28 patients will be randomly assigned to one of two groups and receive treatment three times per week for eight weeks. Arm function will be measured using the Fugl-Meyer Assessment, and muscle stiffness will be measured using the Modified Ashworth Scale before and after treatment.
Detailed description
This is a single-blind, parallel-group randomized controlled trial. The study will be conducted at three settings in Faisalabad, Pakistan: Allied Hospital, Madinah Teaching Hospital, and Shahid Heera's Health Clinic. Adult patients (≥18 years) with CT or MRI-confirmed MCA stroke (ischemic or hemorrhagic), mild to moderate upper limb motor dysfunction (MRC ≥2), and cognitive competence (MoCA ≥19) will be included. Exclusion criteria include severe comorbidities, fixed contractures, severe cognitive impairment, skin contraindications to sensory stimulation, and inability to provide consent. A sample size of 28 participants (14 per group) was calculated using Rao soft app based on previous literature. Participants will be randomly assigned using a computer-generated sequence. The single-blind design keeps participants unaware of group allocation. Group A receives NMES followed by Rood's facilitatory techniques: quick stretch before or during movement to activate muscle spindles, tactile stimulation (light stroking) over the muscle belly for 10-20 seconds, and icing for 5-7 seconds on the tendon or muscle surface immediately preceding activation. Group B receives NMES followed by PNF sequential training using conventional upper limb diagonal functional patterns (D1 and D2). PNF techniques include rhythmic initiation, dynamic reversals, repetitive contractions, and combination of isotonic contractions with moderate resistance, performing 8-12 repetitions per pattern over 20-30 minutes per session. NMES parameters: biphasic waveform at 30-40Hz frequency with pulse duration of 200-300μs, producing comfortable visible contraction, administered for 30 minutes per session. Both groups receive interventions three times per week for eight weeks. Outcome measures: Fugl-Meyer Assessment for Upper Extremity (FMA-UE, score range 0-66) measures motor function; Modified Ashworth Scale (MAS, score range 0-4) measures muscle tone. Assessments are conducted at baseline and post-intervention by a qualified physiotherapist. Data will be analyzed using SPSS version 22.
Interventions
DEVICENeuromuscular Electrical Stimulation
Biphasic waveform NMES at 30-40Hz frequency with pulse duration of 200-300μs, producing comfortable but visible muscle contraction. Applied to affected upper limb for 30 minutes per session, three times per week for eight weeks.
PROCEDURERood's Facilitatory Techniques
Quick stretch applied before or during movement to activate muscle spindles; tactile stimulation (light stroking) over muscle belly for 10-20 seconds; icing for 5-7 seconds on tendon or muscle surface immediately preceding activation. Applied three times per week for eight weeks following NMES.
PROCEDUREProprioceptive Neuromuscular Facilitation
PNF sequential training with upper limb diagonal functional patterns (D1 and D2). Techniques include rhythmic initiation, dynamic reversals, repetitive contractions, and combination of isotonic contractions with moderate resistance according to patient's capabilities. Each session includes 8-12 repetitions per pattern over 20-30 minutes, three times per week for eight weeks.
Sponsors
University of Faisalabad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Only participants are unaware of group allocation
Eligibility
Sex/Gender
ALL
Age
40 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Adults (40-60 years) with confirmed MCA stroke (ischemic or hemorrhagic) on neuroimaging (CT or MRI) * Mild to moderate upper limb motor dysfunction with MRC ≥2 for proximal limb motor strength * Cognitive competence to understand instructions (MoCA ≥19 or equivalent) * First stroke, acute or subacute phase * Willingness to provide written informed consent * Both male and female genders
Exclusion criteria
* Severe coexisting medical disorders (heart, liver, kidney failure; malignant tumors) * Fixed musculoskeletal abnormalities or contracture in affected upper limb * Severe cognitive impairment or aphasia preventing adherence or consent (MMSE below threshold) * Skin sores, ulcers, or hypersensitivity (e.g., to cold) contraindicated for sensory stimulation * Refusal or inability to give informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Upper Limb Motor Function | Baseline and 8 weeks (post-intervention) | Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A standardized 66-point scale assessing motor recovery after stroke based on Brunnstrom stages. Evaluates shoulder, elbow, wrist, hand, and coordination functions. Higher scores indicate better motor function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Muscle Tone | Baseline and 8 weeks (post-intervention) | Modified Ashworth Scale (MAS). A 5-point scale (0-4) measuring resistance during passive stretching of the affected upper limb muscles. 0 = normal tone; 4 = rigidity. Assesses spasticity reduction. |
Countries
Pakistan
Outcome results
None listed