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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Constraint Induced Movement Therapy Group | Experimental | Participants in this arm will receive Constraint Induced Movement Therapy for 3 weeks. The unaffected arm will be constrained with a mitt for 90% of waking hours, and the affected arm will receive intensive task-oriented training for 2 hours per day, 5 days per week. Training tasks will include reaching, grasping, manipulating, dressing, and eating activities. Participants will also receive standard physiotherapy for mobility and postural control. |
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| Hand-Arm Bimanual Intensive Training Group | Active Comparator | Participants in this arm will receive Hand-Arm Bimanual Intensive Training for 3 weeks. Training will be provided for 2 hours per day, 5 days per week, using symmetrical and asymmetrical bimanual activities such as folding clothes and pouring water. Participants will also receive standard physiotherapy for mobility and postural control. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Constraint Induced Movement Therapy | Behavioral | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Fugl-Meyer Assessment - Upper Extremity (FMA-UE) | Measures motor recovery and voluntary movement of the affected upper limb after stroke. | Baseline and Week 3 (Post-intervention) |
| Action Research Arm Test (ARAT) | Assesses upper extremity functional ability including grasp, grip, pinch, and gross movement. | Baseline and Week 3 (Post-intervention) |
| Measure | Description | Time Frame |
|---|---|---|
| Motor Activity Log (MAL) | Evaluates real-world use of the affected arm including Amount of Use and Quality of Movement. | Baseline and Week 3 |
| Box and Block Test (BBT) | Assesses gross manual dexterity by counting blocks transferred within 60 seconds. |
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Inclusion Criteria:
Adults aged 40 years and above.
Exclusion Criteria:
Severe pain in the more affected upper limb on verbal rating scale.
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| Name | Affiliation | Role |
|---|---|---|
| Ambreen I IQBAL | Riphah International University Role | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Riphah College of Rehabilitation Sciences | Lahore | Punjab Province | 55100 | Pakistan |
Individual participant data will not be shared because no formal data-sharing mechanism or repository has been established for this academic study. Participant confidentiality and privacy will be maintained.
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D000098483 | Constraint Induced Movement Therapy |
| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| D026741 | Physical Therapy Modalities |
| D013812 | Therapeutics |
| D012046 | Rehabilitation |
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participants will be randomly allocated into two groups: Constraint Induced Movement Therapy group and Hand-Arm Bimanual Intensive Training group.
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The outcome assessor will remain blinded to group allocation during baseline and post-intervention assessments.
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| Hand-Arm Bimanual Intensive Training | Behavioral | 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. |
|
| Baseline and Week 3 |
| Jebsen-Taylor Hand Function Test (JTHFT) | Measures functional hand performance during simulated daily activities. | Baseline and Week 3 |
| Adult Assisting Hand Assessment (Ad-AHA) | Measures effectiveness of affected hand use during bimanual task performance. | Baseline and Week 3 |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |