Constraint-induced Movement Therapy Versus Task-oriented Training On Upper Extremity Function Post-Botox Injection in Stroke Patients

Constraint-induced Movement Therapy Versus Task-oriented Training

This study will be conducted to determine the impact of Constraint-Induced Movement Therapy versus Task-Oriented Training on upper extremity function post-Botox injection in stroke patients.

Arm and hand movement problems are significant contributors to disability in stroke patients, with only 5% regaining full arm function and 20% regaining no functional use. Alternative strategies are needed to reduce long-term disability and upper limb impairment in hemiparesis patients. Previous studies have used various treatment methods, including botulinum toxin, but the degree of motor improvement depends on task complexity. Future research should focus on adjunct therapy, such as task-specific training and constrained induced therapy, in addition to botulinum toxin treatments, to facilitate functional improvement in spastic upper extremity.

Inclusion Criteria:

• The study focuses on patients aged 45-60 years
• Patients who have subacute spastic hemiplegia with occlusion of the middle cerebral artery
• Patients who are able to maintain balance in sitting positions.
• Patients are diagnosed with the affected upper extremity being the dominant side.
• Physiotherapy sessions are initiated 3-7 days post-injection,
• Patients have pre-injection Modified Ashworth scores equal to 2 (moderate spasticity) in wrist or elbow flexors.
• Patients can actively extend joints at least 10° at metacarpophalangeal and interphalangeal joints and 20° at the wrist of the affected upper limb.

Exclusion Criteria:

• Joint immobility in the upper limb due to contracture, bony deformity, or heterotopic ossification
• Significant cognitive deficits (Mini-Mental Status Examination score <24).