Implicit Versus Explicit Motor Training for Upper Extremity Rehabilitation in Chronic Stroke Patients

Implicit Versus Explicit Motor Training for Upper Extremity Rehabilitation in Chronic Stroke Patients

Training methods that improve proprioception of the shoulder joint involve specific tasks targeting joint position sense, kinesthesia, or sense of force. These exercises can involve explicit or implicit motor learning. Explicit learning involves verbal knowledge of movement performance, while implicit learning involves minimal verbal knowledge and learning in a less conscious manner. The purpose of the study is to identify the efficacy and difference between implicit and explicit motor training in improving upper extremity functions in chronic stroke patients. The study will use laser pointer pattern tracking exercises and precise repositioning tasks for explicit motor training and a cognitive-motor dual-task training for implicit motor training. The laser-pointer assisted angle reproduction test, Wolf Motor Function Test and Arm Motor Ability Test will be used for evaluation.

Inclusion Criteria:

1. Age is ranging between 50 to 65 years
2. Diagnosis of a single stroke 6 months to 2 years prior to study entry confirmed by neuroimaging reports (to minimize the chance that improvements occur because of spontaneous recovery).
3. Sufficient cognitive and language abilities to understand and follow multiple-step instructions (a score of 24 or more on the mini mental state examination).
4. Adequate vision to track the laser beam.
5. Muscle strength of ≥ 3/5 for all upper extremity joints on manual muscle testing.
6. Subjects are able at least to partially move outside of synergies at the affected elbow (Brunnstrom recovery stage in the upper limb following stroke is 4 or greater)
7. Spasticity at the paretic elbow, wrist, or fingers, defined as a score less than 2 on the modified Ashworth scale.

Exclusion Criteria:

1. Uncontrolled seizure disorders.
2. Additional neurological impairments, for example, Parkinson disease that (severely) influence their upper limb functions.
3. Excessive spasticity at the paretic upper limb muscles defined as a score equal or more than 2 on the modified Ashworth scale.
4. Excessive pain in the affected UE, as measured by a score of 5 or higher on a 10-point visual analog scale.
5. Patients with musculoskeletal disorders of upper limb joints, such as severe arthritis, fractures, or fixed deformities.
6. Patients with cognitive, visual, or auditory impairments.