Standard vs Dual-Task Hand-Arm Bimanual Training in Post-Stroke Patients

Comparative Effects of Standard and Dual Task Oriented Hand Arm Bimanual Intensive Training on Cognitive Performance, Upper Limb Functions and Coordination Among Post-Stroke Patients

This study aims to compare the effects of standard and dual-task-oriented hand-arm bimanual intensive training on cognitive performance, upper limb function, and coordination in post-stroke patients. Stroke often leads to impairments in motor and cognitive functions, limiting independence in daily activities. This randomized controlled trial will include adult stroke patients who will be assigned to two groups: one receiving standard training and the other receiving dual-task-oriented training. The interventions will be provided over eight weeks. Outcomes will be assessed using standardized tools for motor function, coordination, and cognition. The study seeks to determine whether combining cognitive and motor tasks leads to better rehabilitation outcomes compared to standard therapy alone.

Stroke is a leading cause of long-term disability, commonly resulting in deficits in upper limb function, coordination, and cognitive performance. These impairments significantly affect the ability to perform daily activities and reduce overall quality of life. Rehabilitation strategies that integrate both motor and cognitive components may enhance functional recovery and promote neuroplasticity.

Hand-Arm Bimanual Intensive Training (HABIT) is a task-specific, repetitive, and goal-oriented intervention designed to improve bilateral upper limb function through coordinated use of both hands. While standard HABIT has demonstrated effectiveness in improving motor outcomes, dual-task-oriented HABIT incorporates simultaneous cognitive demands, such as attention and problem-solving, to better simulate real-life functional activities.

This study is a randomized controlled trial designed to compare the effects of standard HABIT and dual-task-oriented HABIT on cognitive performance, upper limb motor function, and coordination among post-stroke patients. A total of 20 participants aged 40-70 years with mild to moderate upper limb impairment will be recruited. Participants will be randomly assigned to either the intervention group receiving a combination of standard and dual-task-oriented HABIT or the control group receiving standard HABIT only. The intervention will be delivered over eight weeks, with three sessions per week.

Outcome measures will include the Fugl-Meyer Assessment for upper limb function, Action Research Arm Test for functional performance, Finger-to-Nose test for coordination, and Montreal Cognitive Assessment for cognitive evaluation. Assessments will be conducted at baseline, mid-intervention (4 weeks), and post-intervention (8 weeks).

The findings of this study will provide evidence on whether integrating cognitive challenges into bimanual training leads to superior rehabilitation outcomes, supporting more comprehensive and functionally relevant stroke rehabilitation strategies.

Inclusion Criteria:

• Both male and female' genders.

  • Adults aged between 40 and 70 years.
  • Clinically diagnosed ischemic or hemorrhagic stroke confirmed by neuroimaging (CT or MRI).
  • Modified Ashworth Scale 1, 1+ and 2 will be included.
  • Presence of mild to moderate upper limb motor impairment (as defined by Fugl Meyer Assessment score range 23-55 or clinical evaluation).
  • Ability to comprehend and follow simple verbal instructions.

Exclusion Criteria:

• Severe cognitive impairment or expressive/receptive aphasia limiting effective communication. (10)

  • Other neurological disorders (e.g., Parkinson's disease) or psychiatric illnesses that could confound results.(11)
  • Exclusion of patients with prior upper limb impairments (e.g., arthritis) unrelated to the recent stroke event.(10)