Stroke
Conditions
Brief summary
This study will compare the effects of Constraint Induced Movement Therapy and Hand-Arm Bimanual Intensive Training on upper extremity function in late sub-acute post-stroke patients. It will be a randomized controlled trial. Eligible participants will be randomly allocated into two groups. One group will receive Constraint Induced Movement Therapy, while the other group will receive Hand-Arm Bimanual Intensive Training. Both groups will also receive standard physiotherapy for mobility and postural control. The intervention will continue for 3 weeks. Outcomes will be assessed at baseline and after the intervention using upper limb function and motor control assessment tools.
Detailed description
Stroke commonly affects upper extremity function and may reduce a patient's ability to perform daily activities independently. In the late sub-acute phase after stroke, structured rehabilitation may help improve arm and hand function, motor control, and real-world use of the affected upper limb. Constraint Induced Movement Therapy encourages use of the affected upper limb by restricting the unaffected arm and providing intensive task-oriented training. Hand-Arm Bimanual Intensive Training focuses on coordinated use of both hands through functional bimanual tasks. This study will compare these two rehabilitation approaches in late sub-acute post-stroke patients. Findings may help guide evidence-based selection of upper limb rehabilitation strategies for improving functional recovery after stroke.
Interventions
BEHAVIORALConstraint Induced Movement Therapy
Constraint Induced Movement Therapy will be provided for 3 weeks. The unaffected upper limb will be constrained with a mitt for 90% of waking hours. Participants will receive intensive task-oriented training of the affected upper limb for 2 hours per day, 5 days per week. Activities will include reaching, grasping, manipulating objects, dressing, and eating tasks. Standard physiotherapy for mobility and postural control will also be provided.
BEHAVIORALHand-Arm Bimanual Intensive Training
Hand-Arm Bimanual Intensive Training will be provided for 3 weeks. Participants will receive supervised bimanual upper limb training for 2 hours per day, 5 days per week. Activities will include symmetrical and asymmetrical bilateral tasks such as folding clothes, pouring water, object transfer, and coordinated hand use. Standard physiotherapy for mobility and postural control will also be provided.
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The outcome assessor will remain blinded to group allocation during baseline and post-intervention assessments.
Intervention model description
participants will be randomly allocated into two groups: Constraint Induced Movement Therapy group and Hand-Arm Bimanual Intensive Training group.
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults aged 40 years and above. * Diagnosed with unilateral ischemic or hemorrhagic stroke. * Stroke duration between 3 to 6 months. * Mini-Mental State Examination score of 24 or above. * Able and willing to provide informed consent.
Exclusion criteria
Severe pain in the more affected upper limb on verbal rating scale. * Spasticity greater than 3 on the Modified Ashworth Scale in the affected upper limb. * Unstable cardiovascular conditions. * Any traumatic musculoskeletal injury of the upper limb.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fugl-Meyer Assessment - Upper Extremity (FMA-UE) | Baseline and Week 3 (Post-intervention) | Measures motor recovery and voluntary movement of the affected upper limb after stroke. |
| Action Research Arm Test (ARAT) | Baseline and Week 3 (Post-intervention) | Assesses upper extremity functional ability including grasp, grip, pinch, and gross movement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Motor Activity Log (MAL) | Baseline and Week 3 | Evaluates real-world use of the affected arm including Amount of Use and Quality of Movement. |
| Box and Block Test (BBT) | Baseline and Week 3 | Assesses gross manual dexterity by counting blocks transferred within 60 seconds. |
| Jebsen-Taylor Hand Function Test (JTHFT) | Baseline and Week 3 | Measures functional hand performance during simulated daily activities. |
| Adult Assisting Hand Assessment (Ad-AHA) | Baseline and Week 3 | Measures effectiveness of affected hand use during bimanual task performance. |
Countries
Pakistan
Contacts
STUDY_CHAIRAmbreen I IQBAL
Riphah International University Role
Outcome results
None listed