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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
34
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.
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.
Riphah College of Rehabilitation Sciences
Lahore, Punjab Province, Pakistan
Fugl-Meyer Assessment - Upper Extremity (FMA-UE)
Measures motor recovery and voluntary movement of the affected upper limb after stroke.
Time frame: Baseline and Week 3 (Post-intervention)
Action Research Arm Test (ARAT)
Assesses upper extremity functional ability including grasp, grip, pinch, and gross movement.
Time frame: Baseline and Week 3 (Post-intervention)
Motor Activity Log (MAL)
Evaluates real-world use of the affected arm including Amount of Use and Quality of Movement.
Time frame: Baseline and Week 3
Box and Block Test (BBT)
Assesses gross manual dexterity by counting blocks transferred within 60 seconds.
Time frame: Baseline and Week 3
Jebsen-Taylor Hand Function Test (JTHFT)
Measures functional hand performance during simulated daily activities.
Time frame: Baseline and Week 3
Adult Assisting Hand Assessment (Ad-AHA)
Measures effectiveness of affected hand use during bimanual task performance.
Time frame: Baseline and Week 3
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