Comparison of Motor Relearning and Neurodevelopmental Therapy in Stroke Patients
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The purpose of the study is to find out the comparison of motor relearning and
      neurodevelopmental therapy on motor performance and quality of life in stroke patients.As
      motor relearning program and neurodevelopmental therapy have different effects on lower limb
      motor functions and quality of life. Therefore, there is need to find out the best treatment
      approach either MRP, neurodevelopmental therapy or both to improve motor function of lower
      limb and quality of life as it will help the patient to gain functional independency. This
      study will provide the health professionals the evidence to use these techniques according to
      patient interest in the clinical setup.
    

Detailed description: 
      Stroke is one of the leading causes of death and the commonest cause of long-term disability
      in adults. In Pakistan it is also prevalent with prevalence of 1.24%, having common risk
      factor hypertension, diabetes, dyslipidemia and smoking. The focus of stroke rehabilitation
      is largely on the recovery of impaired movements and functions as it often leads to balance
      impairment and impaired postural control and mobility. The diagnosis and management of acute
      ischemic stroke are limited by the lack of rapid diagnostic assays for use in an emergency
      setting. Computed tomography (CT) scanning is used to diagnose hemorrhagic stroke but quite
      ineffective (<33% sensitive) to diagnose ischemic stroke. Among patients with acute ischemic
      stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good
      collateral circulation, rapid endovascular treatment improved functional outcomes and reduced
      mortality.

      Stroke is a common, serious, and disabling worldwide health-care problem and rehabilitation
      is a major part of patient care. Many evidences support the concept of rehabilitation of
      stroke which involve multidisciplinary team.Stroke have adverse effect on mobility and
      activity of daily livings depending upon which vessel is being effected. If ACA is involved
      then there will be contralateral hemiparesis and hemisensory loss more effecting the lower
      limb with mobility issues and dependency of stroke patients on their relatives in ADLs and if
      MCA involve then upper extremities will be affected with speech related impairments. Stroke
      patients must get rehabilitation despite of which vessel is being involved in the
      cerebrovascular accident CVS. Stroke patients get benefit from the physical therapy
      rehabilitation. A well planned rehabilitation program can reduce the catastrophic events

      from stroke. Motor relearning is a specialized program rehabilitation focused on motor
      function recovery. Many studies have been conducted to check the effectiveness of MRP on
      physical performance of stroke patients. The motor relearning program has found to be useful
      to increase functional recovery of patients with strok. Peroneal nerve stimulation (PNS) for
      motor relearning have significant role in improving functional mobility and quality of life.
      Berta Bobath gave the concept of Bobath or neurodevelopmental therapy (NDT). Bobath therapy
      or neurodevelopmental therapy NDT is use as an adjunct in stroke rehabilitation which is
      based on the principal of encouragement of normal movement pattern and discouragement of
      compensatory movements (11). Bobath therapy is based on inhibition of spasticity and
      facilitation of normal movement. Bobath therapy has become the heart of neurorehabilitation
      approach.

      Different strategies had been used for this purpose, which includes motor relearning program
      (MRP) and neurodevelopmental therapy. MRP involves active participation from patients because
      MRP involve relearning of functional activities that are very beneficial for patients
      whereas, neurodevelopmental therapy include performance that facilitated by the therapist;
      spasticity that was inhibited, thus permitting more normal movement.

      This randomized clinical trial will recruit patients through consecutive sampling. Diagnosed
      patients of stroke will be included. The patients will be divided into 2 groups, 1 and 2 and
      MRP therapy will be given to group 1 and neurodevelopmental therapy will be given to group 2.
      Session of 1 hour per day for 5 days a week will be given to both groups. The study will be
      based on pre-test post-test assessment of patients through Fugl Meyer assessment scale,
      Modified Barthel Index and Time Up and Go test. The data will be analyzed using SPSS 25
      version software
    

Intervention name(s): Motor relearning program; Neurodevelopmental therapy
Intervention type(s): Other; Other
Intervention description(s): Treatment session of one hour per day for five days a week, for four weeks for each participant until 20 sessions; Treatment session of one hour per day for five days a week, for four weeks for each participant until 20 sessions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stroke