Multisensory Stimulation Exercises And Task Oriented Exercises On Upper Limb Function In Post Stroke Patients.
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The objective of the study was to determine the effects of Multisensory stimulation exercises
      and Task-oriented exercises on upper limb function and to determine the effects of
      Multisensory stimulation exercises and Task-oriented exercises on Activities of daily living
      and cognition . Study Design was Randomized control trial. Sampling Technique was purposive
      sampling. Study Setting was Physiotherapy department of Railway General Hospital Rawalpindi
      and NIRM Islamabad. Inclusion criteria were patients with hemiplegia due to stroke, Both male
      & female, Sub-acute and chronic stroke patients, First-ever stroke patient, Age between 40
      -65, Modified Ashworth scale <3.

      Exclusion criteria were Un bearable upper limb pain, Recent surgery, Visual impairment and
      Non cooperative Patients.

      Total sample size calculated, by using epi tool is 12. Assessment tools used were Fugal Meyer
      motor assessment scale, Wolf motor function test, Revised Nottingham sensory, Motor activity
      log and Montreal cognitive assessment.

      Individuals who met the inclusion criteria will be included in this study. All participants
      will go through randomization and divided into two groups Experimental group 1 and
      Experimental group 2. The pre-intervention assessment was made for both groups. Then
      intervention was applied to both groups.All statistical analyses will be performed through
      SPSS 21.
    

Detailed description: 
      Stroke is defined as a neurological dysfunction due to sudden or acute injury to the central
      nervous system due to vascular causes, which includes cerebral infarction, intracranial
      hemorrhage and subarachnoid hemorrhage.Stroke is categorized as ischemic stroke (85%) and
      hemorrhage stroke (20%). Hemorrhagic stroke is further classified as interacerebral
      hemorrhage (15%) and subarachnoid hemorrhage (5%). Transient Ischemic attack (TIA) is a
      temporary blockage of blood flow to the brain and its symptoms resolves within 24 hours of
      the injury. Stroke is currently the second leading cause of death worldwide and is one of the
      leading causes of long-term disability in the United States. Almost 15 million stroke cases
      occur each year worldwide, resulting in 5 million deaths and leaving about 5 million stroke
      survivors with unchangeable abnormality and dependency.According to world health organization
      (WHO) in 2002 approximately 5.5 million people died due to stroke and 20% of these deaths
      occurred in south Asia .In Pakistan stroke cases reported are estimated to be 3,50,000
      annually.Stroke survivors experience damaged upper limb function which also affects their
      activites of daily living. A large number of them is left with impaired upper extremity
      function, even after completion of conventional rehabilitation programmes.Only 5-20 % of
      patients regain Upper extremity functional status.Along with motor impairments somatosensory
      impairments are also assosoiated with severity of stroke but is overlooked most of the times.
      Sensory impairment decreases the ability to discriminate textures, weights ,shapes and
      sizes.Proprioception and stereognosis were found to be more impaired than tatile sensation
      ,7-53 % had impaired tactile sensations ,31-89% impaied sterognosis and 34-64 % impaired
      proprioception.Mostly, the focus is on motor recovery in paretic limb but the studies showed
      that improvement in sensory functions also leads to motor recovery. By only focusing on motor
      performance without sensory dysfunction assessment, maximum outcomes cannot be achieved.Not
      only Sensory dysfunction but Cognitive issues after stroke such as ,decreased perception and
      attention ,memory deficits ,difficulty in problem solving tend to be disregarded which
      eventually effects patient performance of daily activities.Multisensory stimulation exercises
      also known as neurocognitive therapeutic exercises, cognitive exercise therapy or cognitive
      sensory motor training was proposed by Carlo Perfetti of Italy .The Hallmark of this training
      is that it focuses on sensory retraining along with emphasis on joint position perception. It
      considers recovery as a learning process, the movement as a means to know and the body as a
      surface receptor for information.Laia Salles et.al conducted a randomized controlled pilot
      study to compare the effectiveness of the cognitive exercise therapy with conventional
      treatment protocol on upper limb in sub-acute stroke patients. The result showed favourable
      clinical progression regarding upper extremity functional gain.Sunghee Lee et.al did a study
      on effect of the cognitive exercise therapy on chronic stroke patients upper limb function,
      activities of daily living and quality of life .They compared it with Task oriented exercise
      group. There was significant difference between two groups and application of cognitive
      exercise therapy was found more effective for functional recovery in stroke patients.A study
      compared the effectiveness of cognitive sensory motor training therapy with conventional
      therapy on recovery of arm function in acute stroke patients. There were no significant
      differences found between two groups in acute stroke patients. The studies based on
      Multisensory stimulation exercises of perfetti focused on evaluating motor function of upper
      limb ,activities of daily living and quality of life but cognitive elements such as attention
      and memory also activated in discriminatory tasks and were not evaluated. The past records
      shows that in randomized controlled trials Multi sensory stimulation therapy is used alone
      for the experimental group .Combination of two protocols has not been analyzed yet .So, the
      aim of the study is to observe and determine the combine effect of Task Oriented Exercises
      and Multisensory stimulation exercises on upper limb function , Activities of daily living
      and Cognition .It is expected that the combination of these two approaches will give more
      significant results in improving sub-acute and chronic stroke patients condition.
    

Intervention name(s): Multi Sensory stimulation exercises; Task Oriented Exercises; Task-oriented exercises and Multisensory stimulation Exercises
Intervention type(s): Other; Other; Other
Intervention description(s): Multi Sensory stimulation exercises:Identification tasks will be given to a blindfolded patient. Which includes recognizing shapes, sizes , textures ,Identifying heights , hardness , weight discrimination .Difficulty will be added by increasing the objects to be identified. Joint angle perception training will be started with one joint perception and will advance to multiple joints position perception. Task Oriented Exercises: Patient will perform upper limb functional activities such as Reaching for objects, putting up and down an object, hand to mouth activity, combing hair, folding piece of cloth grasp and release activity, opening a jar, putting beads in jar and writing letters or draw something will be done. Complexity is added by increasing speed of task performance. Conservative Management:Passive stretching exercises for paretic upper extremity muscles .Stretchings will be applied for 30 sec with 30 sec rest, 10 repetitions for1 set.; Task Oriented Exercises: Patient will perform upper limb functional activities such as Reaching for objects, putting up and down an object, hand to mouth activity, combing hair, folding piece of cloth grasp and release activity, opening a jar, putting beads in jar and writing letters or draw something will be done. Complexity will be added by increasing speed of task performance.
Conservative Management:Passive stretching exercises for paretic upper extremity muscles . Stretchings will be applied for 30 sec with 30 sec rest, 10 repetitions for1 set.; Multi Sensory stimulation exercises:Identification tasks will be given to a blindfolded patient. Which includes recognizing shapes, sizes , textures ,Identifying heights , hardness , weight discrimination .Difficulty will be added by increasing the objects to be identified. Joint angle perception training will be started with one joint perception and will advance to multiple joints position perception. Task Oriented Exercises: Patient will perform upper limb functional activities such as Reaching for objects, putting up and down an object, hand to mouth activity, combing hair, folding piece of cloth grasp and release activity, opening a jar, putting beads in jar and writing letters or draw something will be done. Complexity will be added by increasing speed of task performance.
Conservative Management:Passive stretching exercises for paretic upper extremity muscles . Stretchings will be applied for 30 sec with 30 sec rest, 10 repetitions for1 set.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: stroke; Multisensory stimulation exercises; Task oriented exercises