Additional Effects of Motor Imaginary Technique Along With Task Oriented Trunk Control Training

The aim of this randomized controlled trial is determine additional effects of motor imagery technique along with task oriented training on trunk control, posture, balance and mobility.

Stroke has been classified as leading cause of death and disability. Mild to severe disruption on physical and cognitive functions may occur in stroke patients. Lack of motor control, muscle control, sensations, balance commonly develop after stroke. Motor dysfunctions result in body paralysis, paresis,stifness, decrease range of motion, thereby limiting mobility, body movements hence increasing dependance in performing activities of daily living. Majority of patients of stroke face trunk and pelvis instability and asymmetry resulting in swaying posture, decreased stability, difficulty in weight shifting on affected side therefore resulting in impaired balance. One of advanced technique used in stroke patients is an active cognitive approach known as motor imagery technique (MIT). It involves mental rehearsal of simple and complex movements as per required internally in working memory of a person followed by asking patient to try practical implementation of imagined movement or task at end of each session. Thus this technique is constant reprocessing of interpretation that arise from perception of movement created in mind of a patient enhancing neural connections. In today's world intervention has been goal oriented involving task specific training i.e, repetitive practice of functional task incorporating desired movement and action during activity there by regulating nervous system re-building neural pathways through repeated practice (18). Task specific training enhance performance of trunk muscles by focusing on concept of function, participation and quality of life. To gain gaintful effects among stroke patients, combining cognitive developmental strategy with physical goal oriented activity can be fruitful as it nourishes the concept of neuronal recruitment alongwith motor control development by improving trunk control, posture and balance among stroke patients. The rationale for the use of these techniques is to identify additional effects of MIT alongwith task oriented training on trunk control and mobility as studies conducted on trunk control using MI in past were devoid of activitiy based training, where as those conducted using task-oriented training lack advancement in technology. Therefore, due to dearth of empirical data on symbiotic benefits of motor imagery technique along with task oriented training leads to foundation of this study.

Eligibility Criteria:
Inclusion Criteria:

* Patients with sub-acute stroke (\> 3 months stroke till 6 months after stroke)
* Both male and female are included.
* Patient with stage 2 of postural control on Chedoke McMaster Stroke Assessment Score.
* Patient who are able to sit without holding on to objects/people
* Patient who are able to stand for 30seconds
* Patient able to flex non-paretic shoulder upto 90 degree, without holding on to any object
* Patients with no cognitive deficits ( score \> 25 on Montreal Cognitive Assessment Tool)
* Patients with moderate spasticity of upper/lower extremity (Modified Ashworth Scale Grade = 1, +1)

Exclusion Criteria

* Patients with visuo-spatial neglect.
* Patients with hearing impairment
* Hip pathologieOlder adults 60 years \& aboves or any condition other than stroke interfering with trunk movements will be excluded